CAJ | 학술논문

　　目的观察2型糖尿病患者颈动脉粥样硬化斑块的超声特点并分析其临床相关危险因素。方法回顾性分析2009年1月至2011年12月在北京军区总医院住院的665例2型糖尿病患者的颈动脉超声检查结果，观察颈动脉粥样硬化斑块部位、数量并分析斑块发生与高血压、糖尿病家族史、年龄等糖尿病危险因素的关系，对相关危险因素进行单因素和多因素分析。结果665例患者超声检查结果表明，405例斑块阳性，260例斑块阴性。颈动脉斑块大部分位于颈总动脉窦部，且以后壁多见，斑块呈强回声、低回声或等回声。单因素分析示高血压、糖尿病家族史及年龄均为2型糖尿病患者颈动脉粥样硬化发生的危险因素（χ2＝42．322、9．682、140．658，P均＜0．01）。多因素logistic回归分析结果示，年龄可能是2型糖尿病患者颈动脉粥样硬化的独立危险因素。＜45岁、45～65岁和＞65岁的患者发生颈动脉粥样硬化的危险因素积分分别为（3．50±1．16）分、（3．46±0．92）分、（3．21±0．88）分，差异有统计学意义（F＝5．781，P＜0．001），且不同年龄段的患者危险因素积分间差异亦有统计学意义（t＝2．084、2．002、3．786、3．474、2．877、2．504，P均＜0．05）。＞65岁的2型糖尿病患者发生斑块的风险是＜45岁患者的28．732倍，控制了年龄因素之后，积分每增加1分，患颈动脉粥样硬化斑块的可能性增加1．201倍。结论2型糖尿病患者颈动脉粥样硬化斑块大部分位于颈总动脉窦部后壁，呈强回声、低回声或等回声。年龄是颈动脉斑块形成的独立危险因素，临床应对年龄＞45岁的患者进行重点早期干预，避免大血管并发症的发生。
　　목적관찰2형당뇨병환자경동맥죽양경화반괴적초성특점병분석기림상상관위험인소。방법회고성분석2009년1월지2011년12월재북경군구총의원주원적665례2형당뇨병환자적경동맥초성검사결과，관찰경동맥죽양경화반괴부위、수량병분석반괴발생여고혈압、당뇨병가족사、년령등당뇨병위험인소적관계，대상관위험인소진행단인소화다인소분석。결과665례환자초성검사결과표명，405례반괴양성，260례반괴음성。경동맥반괴대부분위우경총동맥두부，차이후벽다견，반괴정강회성、저회성혹등회성。단인소분석시고혈압、당뇨병가족사급년령균위2형당뇨병환자경동맥죽양경화발생적위험인소（χ2＝42．322、9．682、140．658，P균＜0．01）。다인소logistic회귀분석결과시，년령가능시2형당뇨병환자경동맥죽양경화적독립위험인소。＜45세、45～65세화＞65세적환자발생경동맥죽양경화적위험인소적분분별위（3．50±1．16）분、（3．46±0．92）분、（3．21±0．88）분，차이유통계학의의（F＝5．781，P＜0．001），차불동년령단적환자위험인소적분간차이역유통계학의의（t＝2．084、2．002、3．786、3．474、2．877、2．504，P균＜0．05）。＞65세적2형당뇨병환자발생반괴적풍험시＜45세환자적28．732배，공제료년령인소지후，적분매증가1분，환경동맥죽양경화반괴적가능성증가1．201배。결론2형당뇨병환자경동맥죽양경화반괴대부분위우경총동맥두부후벽，정강회성、저회성혹등회성。년령시경동맥반괴형성적독립위험인소，림상응대년령＞45세적환자진행중점조기간예，피면대혈관병발증적발생。
Objective To evaluate the relationship between carotid artery plagues and the clinical risk factors in patients with diabetes mellitus type 2 by observing the ultrasonic characteristics of carotid atherosclerosis plagues.Methods The ultrasound results of carotid arteries in 665 patients with diabetes mellitus type 2 from January 2009 to December 2011 in Beijing Amery General Hospital were retrospectively analyzed.The location and quantity of carotid atherosclerotic plaques were observed .The relationship between the occurrence and risk factors of diabetes such as hypertension ,family history of diabetes and age were analyzed.Single factor and multi-factor analysis were applied for the related risk factors .Results The ultrasonography showed 405 cases of carotid artery plaques.Most carotid artery plaques were located in the posterior wall of carotid sinus and were hyperechoic ,hypoechoic or isoechoic.The single factor analysis showed hypertension,family history of diabetes and age are risk factors of carotid atherosclerosis (χ2 =42.322,9.682 and 140.658,all P<0.01).Multi-factor logistic regression analysis showed age was an independent risk factor of carotid atherosclerosis in patients with diabetes mellitus type 2.The risk factors scores of patients who were less than 45 years,45-65 years and over 65 years of age were (3.50 ±1.16)scores,(3.46 ±0. 92)scores and (3.21 ±0.88)scores,and the difference was statistically significant (F=5.781,P<0.001). There were significant differences between risk factors scores of different age groups ( t =2.084,2.002, 3.786,3.474,2.877 and 2.504,all P<0.05).In patients more than 65 years of age,the risk of atherosclerosis plaques is 28.732 times higher than that of patients less than 45 years of age.After controlling the age factor,the possibility of atherosclerosis plaque increased 1.201 times for each additional one point of score. Conclusions Most carotid artery plaques in patients with diabetes mellitus type 2 are located in the posterior wall of carotid sinus and are hyperechoic ,hypoechoic or isoechoic.Age is an independent risk factor for the formation of carotid plaque.Patients more than 45 years of age should undergo early intervention to avoid the occurrence of major vascular complications .