作者：张莉莉，戴霞，黄媞，徐丹青

单位：

530021广西壮族自治区南宁市，广西医科大学第一附属医院护理部

Units：

Department of Nursing, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China

关键词：

糖尿病，2型；原发性高血压；颈动脉粥样硬化性疾病；三酯甘油葡萄糖指数；颈动脉-股动脉脉搏波传导速度；踝肱指数

Keywords：

Diabetes mellitus, type 2; Essential hypertension; Carotid atherosclerotic diseases; Triglyceride glucoseindex; Carotid-femoral pulse wave velocity; Ankle brachial index

CLC：

R 587.1 R 544.1

DOI：

10.12114/j.issn.1008-5971.2023.00.204

Funds：

国家自然科学基金资助项目（82160440）

摘要：

目的　分析2型糖尿病（T2DM）合并原发性高血压（EH）患者颈动脉粥样硬化与三酰甘油葡萄糖（TyG）指数、颈股脉搏波传导速度（cfPWV）、踝肱指数（ABI）的关系。方法　回顾性选取2019年1月至2020年3月广西医科大学第一附属医院收治的T2DM合并EH患者240例为研究对象。根据颈动脉超声检查结果，将患者分为颈动脉粥样硬化组〔颈动脉内膜中层厚度（CIMT）≥1.0 mm，159例〕和非颈动脉粥样硬化组（CIMT≤0.9 mm，81例）；根据颈动脉粥样硬化程度，将颈动脉粥样硬化组患者进一步分为轻度亚组（1.0 mm≤CIMT＜1.5 mm，68例）和重度亚组（CIMT≥1.5 mm或CIMT≥1.0 mm且局部内膜隆起、增厚，高于周边内膜中层厚度的50%，91例）。收集患者临床资料。T2DM合并EH患者发生颈动脉粥样硬化的影响因素分析采用多因素Logistic回归分析。结果　颈动脉粥样硬化组年龄大于非颈动脉粥样硬化组，糖尿病病程、高血压病程长于非颈动脉粥样硬化组，糖化血红蛋白、餐后2 h血糖、cfPWV异常者占比、动态动脉硬化指数（AASI）异常者占比高于非颈动脉粥样硬化组，夜间收缩压下降率低于非颈动脉粥样硬化组（P＜0.05）；颈动脉粥样硬化组和非颈动脉粥样硬化组性别、BMI、有吸烟史者占比、有饮酒史者占比、高血压分级、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、TyG指数、ABI异常者占比、夜间舒张压下降率比较，差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，年龄、cfPWV异常是T2DM合并EH患者发生颈动脉粥样硬化的影响因素（P＜0.05）。轻度亚组与重度亚组TyG指数、cfPWV异常者占比、ABI异常者占比比较，差异无统计学意义（P＞0.05）。结论 T2DM合并EH患者发生颈动脉粥样硬化可能与TyG指数、ABI无关，而cfPWV异常是T2DM合并EH患者发生颈动脉粥样硬化的危险因素；且T2DM合并EH患者颈动脉粥样硬化程度可能与TyG指数、cfPWV、ABI均无关。

Abstract：

Objective To analyze the relationship between carotid atherosclerosis and triglyceride glucose (TyG)index, carotid-femoral pulse wave velocity (cfPWV) , ankle brachial index (ABI) in patients with type 2 diabetes mellitus (T2DM)and essential hypertension (EH) . Methods A total of 240 T2DM patients with EH admitted to the First Affiliated Hospital ofGuangxi Medical University from January 2019 to March 2020 were retrospectively selected as the research objects. According tothe results of carotid ultrasonography, the patients were divided into carotid atherosclerosis group [carotid intima-media thickness(CIMT) ≥ 1.0 mm, 159 cases] and non-carotid atherosclerosis group (CIMT ≤ 0.9 mm, 81 cases) . According to the degree ofcarotid atherosclerosis, the patients in the carotid atherosclerosis group were further divided into mild subgroup (1.0 mm ≤ CIMT< 1.5 mm, 68 cases) and severe subgroup (CIMT ≥ 1.5 mm or CIMT ≥ 1.0 mm with local intimal swelling and thickening, higherthan 50% of the peripheral intima-media thickness, 91 cases) . Clinical data of the patients were collected. Multivariate Logisticregression analysis was used to analyze the influencing factors of carotid atherosclerosis in T2DM patients with EH. Results The age of the carotid atherosclerosis group was longer than that of the non-carotid atherosclerosis group, the course of diabetes andhypertension was longer than that of the non-carotid atherosclerosis group, glycosylated hemoglobin, 2-hour postprandial bloodglucose, and the proportion of patients with abnormal cfPWV and ambulatory arterial stiffness index (AASI) were higher than thoseof the non-carotid atherosclerosis group, and the decrease rate of nocturnal systolic blood pressure was lower than that of the noncarotid atherosclerosis group (P < 0.05) . There were no significant differences in gender, BMI, the proportion of smoking history,the proportion of drinking history, hypertension classification, total cholesterol, high density lipoprotein cholesterol (HDL-C) ,low density lipoprotein cholesterol (LDL-C) , TyG index, the proportion of abnormal ABI, and the decrease rate of diastolic bloodpressure at night between the carotid atherosclerosis group and the non-carotid atherosclerosis group (P > 0.05) . MultivariateLogistic regression analysis showed that age and abnormal cfPWV were the influencing factors of carotid atherosclerosis in T2DMpatients with EH (P < 0.05) . There was no significant difference in TyG index, proportion of abnormal cfPWV, and proportion ofabnormal ABI between the mild subgroup and the severe subgroup (P > 0.05) . Conclusion Carotid atherosclerosis in patientswith T2DM and EH may not be related to TyG index and ABI, while abnormal cfPWV is a risk factor for carotid atherosclerosisin patients with T2DM and EH. The degree of carotid atherosclerosis in T2DM patients with EH may not be related to TyG index,cfPWV and ABI.

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