中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
21期
2440-2444
,共5页
李岩%王亚珍%郝志华%宋光耀%王丽红%焦丽娜
李巖%王亞珍%郝誌華%宋光耀%王麗紅%焦麗娜
리암%왕아진%학지화%송광요%왕려홍%초려나
颈动脉疾病%动脉粥样硬化%血红蛋白A,糖基化%颈动脉内-中膜厚度%超声检查,多普勒,彩色
頸動脈疾病%動脈粥樣硬化%血紅蛋白A,糖基化%頸動脈內-中膜厚度%超聲檢查,多普勒,綵色
경동맥질병%동맥죽양경화%혈홍단백A,당기화%경동맥내-중막후도%초성검사,다보륵,채색
Carotidarterydiseases%Atherosclerosis%HemoglobinA,glycosylated%Carotidintima-mediathick-ness%Ultrasonography,Doppler,color
目的：探讨无糖尿病病史的体检者糖化血红蛋白（HbA1c）与颈动脉内-中膜厚度（IMT）、动脉粥样硬化（ AS）的关系。方法选取2012年9月-2013年6月河北省人民医院体检中心的体检者4500例，均无糖尿病病史。进行实验室检查〔HbA1c、空腹血糖（ FPG）、血脂等〕及颈动脉超声检查，计算体质指数（ BMI）。根据HbA1c、FPG水平，将患者分别分为5个亚组： HbA1c≤5.0％为Hb1组， HbA1c5.1％～6.0％为Hb2组， HbA1c6.1％～7.0％为Hb3组， HbA1c7.1％～8.0％为Hb4组， HbA1c＞8.0％为Hb5组； FPG≤5.5 mmol/L为FP1组， FPG 5.6～6.0 mmol/L为FP2组， FPG 6.1～7.0 mmol/L为FP3组， FPG 7.1～8.0 mmol/L为FP4组， FPG＞8.0 mmol/L为FP5组。采用彩色多普勒超声检测颈动脉IMT，并计算斑块评分。分析颈动脉IMT的相关因素。结果（1）Hb2组年龄、LDL-C高于Hb1组而IMT低于 Hb1组； Hb3组年龄、 FPG、 TC 高于 Hb1组和Hb2组， BMI、 IMT、斑块积分高于 Hb2组，但LDL-C低于Hb2组； Hb4组年龄、 FPG、 IMT、斑块积分均高于Hb1组、 Hb2组、 Hb3组， TC、 LDL-C高于Hb1组和Hb2组， BMI高于Hb2组； Hb5组年龄高于Hb1组和Hb2组而低于Hb3组和Hb4组， FPG、 IMT、斑块评分高于其他4组， LDL-C高于Hb1组、 Hb2组和Hb3组， BMI、 TC高于Hb1组和Hb2组（P＜0.05）。（2） FP2组年龄、 BMI、TC、 TG、 LDL-C、斑块积分高于FP1组； FP3组年龄、 BMI、 HbA1c、 TG、 LDL-C、 IMT、斑块积分高于FP1组和FP2组，而HDL-C低于FP1组和FP2组， TC高于FP1组； FP4组年龄、 IMT、斑块评分高于FP1组、 FP2组和FP3组， BMI、 TG高于FP1组和FP2组， HDL-C低于FP1组和FP2组， LDL-C低于FP2组和FP3组； FP5组年龄高于FP1组、 FP2组、 FP3组而低于FP4组， HbA1c、 TC、 IMT、斑块评分高于其他4组， BMI高于FP1组和FP2组， TG高于FP1组、 FP2组和FP3组， HDL-C低于FP1组和FP2组， LDL-C高于FP1组和FP4组但低于FP3组（ P＜0.05）。（3）直线相关分析显示， IMT与HbA1c、 FPG、 BMI均呈正相关（r值分别为0.421、0.315、0.378，均P＜0.05）。（4） HbA1c不同水平组及FPG不同水平组AS患病率间有差异（P＜0.05）；其中Hb2组AS患病率低于Hb1组，然后随着HbA1c水平的逐步升高， AS患病率也逐步升高（ P＜0.005）； FP3组AS患病率低于FP1组，但FP4、 FP5组AS患病率高于FP1组、 FP2组和FP3组（P＜0.005）。结论无糖尿病病史的体检者HbA1c、 FPG、 BMI与颈动脉IMT呈正相关，检测这些指标有助于尽早发现糖尿病大血管病变如 AS，并协助预测心脑血管疾病的发生。
目的：探討無糖尿病病史的體檢者糖化血紅蛋白（HbA1c）與頸動脈內-中膜厚度（IMT）、動脈粥樣硬化（ AS）的關繫。方法選取2012年9月-2013年6月河北省人民醫院體檢中心的體檢者4500例，均無糖尿病病史。進行實驗室檢查〔HbA1c、空腹血糖（ FPG）、血脂等〕及頸動脈超聲檢查，計算體質指數（ BMI）。根據HbA1c、FPG水平，將患者分彆分為5箇亞組： HbA1c≤5.0％為Hb1組， HbA1c5.1％～6.0％為Hb2組， HbA1c6.1％～7.0％為Hb3組， HbA1c7.1％～8.0％為Hb4組， HbA1c＞8.0％為Hb5組； FPG≤5.5 mmol/L為FP1組， FPG 5.6～6.0 mmol/L為FP2組， FPG 6.1～7.0 mmol/L為FP3組， FPG 7.1～8.0 mmol/L為FP4組， FPG＞8.0 mmol/L為FP5組。採用綵色多普勒超聲檢測頸動脈IMT，併計算斑塊評分。分析頸動脈IMT的相關因素。結果（1）Hb2組年齡、LDL-C高于Hb1組而IMT低于 Hb1組； Hb3組年齡、 FPG、 TC 高于 Hb1組和Hb2組， BMI、 IMT、斑塊積分高于 Hb2組，但LDL-C低于Hb2組； Hb4組年齡、 FPG、 IMT、斑塊積分均高于Hb1組、 Hb2組、 Hb3組， TC、 LDL-C高于Hb1組和Hb2組， BMI高于Hb2組； Hb5組年齡高于Hb1組和Hb2組而低于Hb3組和Hb4組， FPG、 IMT、斑塊評分高于其他4組， LDL-C高于Hb1組、 Hb2組和Hb3組， BMI、 TC高于Hb1組和Hb2組（P＜0.05）。（2） FP2組年齡、 BMI、TC、 TG、 LDL-C、斑塊積分高于FP1組； FP3組年齡、 BMI、 HbA1c、 TG、 LDL-C、 IMT、斑塊積分高于FP1組和FP2組，而HDL-C低于FP1組和FP2組， TC高于FP1組； FP4組年齡、 IMT、斑塊評分高于FP1組、 FP2組和FP3組， BMI、 TG高于FP1組和FP2組， HDL-C低于FP1組和FP2組， LDL-C低于FP2組和FP3組； FP5組年齡高于FP1組、 FP2組、 FP3組而低于FP4組， HbA1c、 TC、 IMT、斑塊評分高于其他4組， BMI高于FP1組和FP2組， TG高于FP1組、 FP2組和FP3組， HDL-C低于FP1組和FP2組， LDL-C高于FP1組和FP4組但低于FP3組（ P＜0.05）。（3）直線相關分析顯示， IMT與HbA1c、 FPG、 BMI均呈正相關（r值分彆為0.421、0.315、0.378，均P＜0.05）。（4） HbA1c不同水平組及FPG不同水平組AS患病率間有差異（P＜0.05）；其中Hb2組AS患病率低于Hb1組，然後隨著HbA1c水平的逐步升高， AS患病率也逐步升高（ P＜0.005）； FP3組AS患病率低于FP1組，但FP4、 FP5組AS患病率高于FP1組、 FP2組和FP3組（P＜0.005）。結論無糖尿病病史的體檢者HbA1c、 FPG、 BMI與頸動脈IMT呈正相關，檢測這些指標有助于儘早髮現糖尿病大血管病變如 AS，併協助預測心腦血管疾病的髮生。
목적：탐토무당뇨병병사적체검자당화혈홍단백（HbA1c）여경동맥내-중막후도（IMT）、동맥죽양경화（ AS）적관계。방법선취2012년9월-2013년6월하북성인민의원체검중심적체검자4500례，균무당뇨병병사。진행실험실검사〔HbA1c、공복혈당（ FPG）、혈지등〕급경동맥초성검사，계산체질지수（ BMI）。근거HbA1c、FPG수평，장환자분별분위5개아조： HbA1c≤5.0％위Hb1조， HbA1c5.1％～6.0％위Hb2조， HbA1c6.1％～7.0％위Hb3조， HbA1c7.1％～8.0％위Hb4조， HbA1c＞8.0％위Hb5조； FPG≤5.5 mmol/L위FP1조， FPG 5.6～6.0 mmol/L위FP2조， FPG 6.1～7.0 mmol/L위FP3조， FPG 7.1～8.0 mmol/L위FP4조， FPG＞8.0 mmol/L위FP5조。채용채색다보륵초성검측경동맥IMT，병계산반괴평분。분석경동맥IMT적상관인소。결과（1）Hb2조년령、LDL-C고우Hb1조이IMT저우 Hb1조； Hb3조년령、 FPG、 TC 고우 Hb1조화Hb2조， BMI、 IMT、반괴적분고우 Hb2조，단LDL-C저우Hb2조； Hb4조년령、 FPG、 IMT、반괴적분균고우Hb1조、 Hb2조、 Hb3조， TC、 LDL-C고우Hb1조화Hb2조， BMI고우Hb2조； Hb5조년령고우Hb1조화Hb2조이저우Hb3조화Hb4조， FPG、 IMT、반괴평분고우기타4조， LDL-C고우Hb1조、 Hb2조화Hb3조， BMI、 TC고우Hb1조화Hb2조（P＜0.05）。（2） FP2조년령、 BMI、TC、 TG、 LDL-C、반괴적분고우FP1조； FP3조년령、 BMI、 HbA1c、 TG、 LDL-C、 IMT、반괴적분고우FP1조화FP2조，이HDL-C저우FP1조화FP2조， TC고우FP1조； FP4조년령、 IMT、반괴평분고우FP1조、 FP2조화FP3조， BMI、 TG고우FP1조화FP2조， HDL-C저우FP1조화FP2조， LDL-C저우FP2조화FP3조； FP5조년령고우FP1조、 FP2조、 FP3조이저우FP4조， HbA1c、 TC、 IMT、반괴평분고우기타4조， BMI고우FP1조화FP2조， TG고우FP1조、 FP2조화FP3조， HDL-C저우FP1조화FP2조， LDL-C고우FP1조화FP4조단저우FP3조（ P＜0.05）。（3）직선상관분석현시， IMT여HbA1c、 FPG、 BMI균정정상관（r치분별위0.421、0.315、0.378，균P＜0.05）。（4） HbA1c불동수평조급FPG불동수평조AS환병솔간유차이（P＜0.05）；기중Hb2조AS환병솔저우Hb1조，연후수착HbA1c수평적축보승고， AS환병솔야축보승고（ P＜0.005）； FP3조AS환병솔저우FP1조，단FP4、 FP5조AS환병솔고우FP1조、 FP2조화FP3조（P＜0.005）。결론무당뇨병병사적체검자HbA1c、 FPG、 BMI여경동맥IMT정정상관，검측저사지표유조우진조발현당뇨병대혈관병변여 AS，병협조예측심뇌혈관질병적발생。
ObjectiveToinvestigatetherelationshipbetweenhemoglobinA1c(HbA1c)andcarotidintima-media thickness ( IMT) , atherosclerosis ( AS) among people who received health check -up without a history of diabetes .Methods A total of 4 500 cases without a history of diabetes who received health check -up from September 2012 to June 2013 in physical examination center of Hebei Provincial People′s Hospital, were selected as study subjects.Laboratory tests 〔HbA1c, fasting blood glucose ( FPG ) , blood lipid〕 and carotid ultrasonography were performed , body mass index ( BMI ) was calculat-ed.According to levels of HbA 1c and FPG, the patients were divided into 5 subgroups: HbA1c≤5.0%for the Hb1 group, HbA1c 5.1%~6.0%for the Hb2 group, HbA1c6.1%~7.0%for the Hb3 group, HbA1c7.1%~8.0%for the Hb4 group, HbA1c>8.0%for the Hb5 group; FPG≤5.5 mmol/L for the FP1 group, FPG 5.6~6.0 mmol/L for the FP2 group, FPG 6.1~7.0 mmol/L for the FP3 group, FPG 7.1~8.0 mmol/L for the group FP4, FPG>8.0 mmol/L for the FP5 group.The carotid IMT was detected by color Doppler ultrasound , and the plaque score was calculated .The relevant factors for carotid IMT were ana-lyzed.Results The age and level of LDL-C in Hb2 group were significantly higher than those in Hb 1 group, but IMT was sig-nificantly lower than that in Hb1 group; The age, levels of FPG and TC in Hb3 group were significantly higher than those in Hb 1 group and Hb2 group; BMI, IMT and plaque score in Hb3 group were significantly higher than those in Hb 2 group, but LDL-C level in Hb3 group was significantly lower than that in Hb 2 group; The age , levels of FPG and IMT , and plaque score in group Hb4 were significantly higher than those in Hb 1 group, Hb2 group and Hb3 group, while the TC and LDL-C level in Hb4 group were significantly higher than those in Hb 1 group and Hb2 group; BMI in Hb4 group was significantly higher than that in Hb 2 group; The age in group Hb5 was significantly higher than that in Hb 1 group and Hb2 group, but was significantly lower than that in Hb3 group and Hb4 group; The FPG level , IMT and plaque score in Hb 5 group were significantly higher than those in other four groups, LDL-C level in Hb5 group was significantly higher than that in Hb 1 group, Hb2 group and Hb3 group; BMI and TC level in Hb5 group were significantly higher than those in Hb 1 group and Hb2 group (P<0.05) .The age, BMI, levels of TC, TG and LDL-C, and plaque score in FP2 group were significantly higher than those in FP 1 group; The age, BMI, levels of HbA1c, TG and LDL-C, IMT and plaque score in FP3 group were significantly higher than those in FP 1 group and FP2 group, while the HDL-C level in FP3 group was significantly lower than that in FP 1 group and FP2 group; TC level in FP3 group was significantly higher than that in FP 1 group; The age, IMT, plaque score in FP4 group were significantly higher than those in FP1 group, FP2 group and FP3 group; BMI and TG level in FP4 group were significantly higher than those in FP 1 group and FP2 group, while HDL-C level in FP4 group was significantly lower than that in FP 1 group and FP2 group; LDL-C level in FP4 group was significantly lower than that in FP 2 group and FP3 group; The age in FP5 group was significantly higher than that in FP1 group, FP2 group and FP3 group, but was significantly lower than that in FP4 group; Levels of HbA1c and TC, IMT and plaque score in FP5 group were significantly higher than those in the other four groups; BMI in FP5 group was significantly higher than that in FP1 group and FP2 group; TG level in FP5 group was significantly higher than that in FP 1 group, FP2 group and FP3 group; HDL-C level in FP5 group was significantly lower than that in FP 1 group and FP2 group; LDL-C level in FP5 group was significantly higher than that in FP 1 group and FP4 group, but was significantly lower than that in FP 3 group ( P<0.05) .Linear correlation analysis showed that IMT was positively correlated with levels of HbA 1c , FPG and BMI ( r=0.421, 0.315, and 0.378, respectively, all P<0.05) .There was significant difference in AS prevalence among groups with different HbA1c levels and among groups with different FPG levels (P<0.05); AS prevalence in Hb2 group was lower than Hb1 group, then with the increase of HbA1c level, AS prevalence increased gradually (P<0.005); The AS prevalence in FP3 group was significantly lower higher than that in FP1 group, AS prevalence in FP4 and FP5 group was significantly higher than that in the FP1, FP2 and FP3 group (P<0.005) .Conclusion The carotid artery IMT is positively correlated with levels of HbA 1c and FPG, BMI among people who received health check -up without a history of diabetes , detection of these indicators may contrib-ute to finding diabetes macroangiopathy as early as possible , and may contribute to predicting the occurrence of cardiovascular and cerebrovascular diseases .
