張蕊 趙曉冉 郭宏英 房亮 劉曉燕

[摘要] 目的 探討2型糖尿病患者頸動(dòng)脈斑塊的危險(xiǎn)因素。 方法 選取2016年1月～2018年1月于承德醫(yī)學(xué)院附屬醫(yī)院就診住院的2型糖尿病患者192例為研究對(duì)象，根據(jù)內(nèi)膜中層厚度（IMT）將其分為斑塊組（n = 101）和無(wú)斑塊組（n = 91）;收集患者臨床資料及實(shí)驗(yàn)室指標(biāo);比較兩組臨床資料及實(shí)驗(yàn)室指標(biāo);采用二元多因素Logistic分析對(duì)頸動(dòng)脈斑塊的危險(xiǎn)因素進(jìn)行分析。 結(jié)果 斑塊組年齡、腰圍、糖尿病病程、有吸煙史患者數(shù)、糖化血紅蛋白（HbA1c）、三酰甘油（TG）、低密度脂蛋白膽固醇（LDL-C）水平顯著高于無(wú)斑塊組（P < 0.05），而25羥維生素D3 [25（OH）D3]水平、服用他汀類患者數(shù)顯著低于無(wú)斑塊組，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）。多因素Logistic分析結(jié)果顯示，糖尿病病程（OR：1.06，95%CI：1.03～1.08，P = 0.021）、吸煙（OR：1.13，95%CI：1.10～1.16，P = 0.005）、HbA1c（OR：1.46，95%CI：1.24～1.54，P = 0.010）及LDL-C（OR：1.28，95%CI：1.16～1.42，P = 0.014）為頸動(dòng)脈斑塊發(fā)生的危險(xiǎn)因素，而25（OH）D3（OR：0.84，95%CI：0.82～0.87，P = 0.000）、服用他汀類（OR：0.78，95%CI：0.72～0.82，P = 0.039）則為其保護(hù)因素。 結(jié)論 隨著病程的延長(zhǎng)，2型糖尿病患者頸動(dòng)脈斑塊發(fā)生風(fēng)險(xiǎn)上升，吸煙、HbA1c及LDL-C水平升高均使頸動(dòng)脈斑塊發(fā)生風(fēng)險(xiǎn)增加，而高25（OH）D3水平、服用他汀類則可能延緩其發(fā)生發(fā)展。

[關(guān)鍵詞] 25-羥維生素D3;2型糖尿病;內(nèi)膜中層厚度;頸動(dòng)脈斑塊

[中圖分類號(hào)] R587.1;R543.4? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-7210（2019）07（b）-0072-04

Analysis of influencing factors of carotid plaque in patients with type 2 diabetes mellitus

ZHANG Rui1? ?ZHAO Xiaoran1? ?GUO Hongying2? ?FANG Liang1? ?LIU Xiaoyan1

1.Department of Endocrine， Affiliated Hospital of Chengde Medical University， Hebei Province， Chengde? ?067000， China; 2.Department of Medical， Tianjin Medical University General Hospital Airport Hospital， Tianjin? ?300308， China

[Abstract] Objective To investigate the risk factors of carotid plaque in patients with type 2 diabetes mellitus. Methods A total of 192 patients with type 2 diabetes mellitus who were admitted and hospitalized in Affiliated Hospital of Chengde Medical University from January 2016 to January 2018 were selected for the study. They were divided into plaque group （n = 101） and non-plaque group （n = 91） according to intima-media thickness （IMT）. Clinical data and laboratory indicators were collected and compared between the two groups. Risk factors of carotid plaque were analyzed by binary multivariate Logistic analysis. Results The age， waist circumference， duration of diabetes mellitus， number of smokers， glycosylated hemoglobin （HbA1c）， triglyceride （TG）， low density lipoprotein cholesterol （LDL-C） levels in plaque group were significantly higher than those in non-plaque group （P < 0.05）， while 25-hydroxyvitamin D3 [25 （OH） D3] levels and the number of patients taking statins were significantly lower than those in non-plaque group （P < 0.05）， the differences were statistically significant （P < 0.05）. Multivariate Logistic analysis showed that the duration of diabetes mellitus （OR： 1.06， 95%CI： 1.03-1.08， P = 0.021）， smoking （OR： 1.13， 95%CI： 1.10-1.16， P = 0.005）， HbA1c （OR： 1.46， 95%CI： 1.24-1.54， P = 0.010） and LDL-C （OR： 1.28， 95%CI： 1.16-1.42， P = 0.014） were the risk factors for carotid artery plaque， and elevated level of 25（OH）D3（OR： 0.84，95%CI： 0.82-0.87， P = 0.000） and taking statins（OR： 0.78，95%CI： 0.72-0.82， P = 0.039）were the protective factors. Conclusion With the prolongation of the course of disease， the risk of carotid plaque in type 2 diabetes mellitus increased. Smoking， elevated levels of HBA1c and LDL-C all can increase the risk of carotid plaque， while high level of 25 （OH） D3 and taking statins may delay the development of carotid plaque.