CAJ | 학술논문

目的比较颈动脉和下肢动脉超声对新诊断2型糖尿病患者动脉粥样硬化的检出率及与心脑血管事件的关系.方法选择上海交通大学附属第六人民医院内分泌科2007年8月—2008年7月148例新诊断2型糖尿病住院患者行颈动脉和下肢动脉多普勒超声检查.糖尿病动脉粥样硬化被定义为颈动脉或下肢动脉存在任何部位的动脉粥样硬化斑块.采用Kappa统计方法评价颈动脉和下肢动脉超声对糖尿病动脉粥样硬化检出率的差异.同时比较不同动脉粥样硬化分布类型间心脑血管事件发生率的差异.结果单纯以颈动脉或下肢动脉超声检测作为诊断依据,新诊断2型糖尿病动脉粥样硬化患病率分别为27.0％和62.2％,联合检测患病率为66.2％.颈动脉超声诊断的动脉粥样硬化与糖尿病动脉粥样硬化间的Kappa值为0.32(95％CI0.22 ～0.42),下肢动脉超声诊断的动脉粥样硬化与糖尿病动脉粥样硬化间的Kappa值为0.91 (95％ CI0.84 ～0.98).颈动脉和下肢动脉同时发生粥样硬化患者心脑血管事件发生率(26.5％)明显高于单纯颈动脉或单纯下肢动脉粥样硬化患者(分别为0％及10.3％).结论联合颈动脉和下肢动脉超声检查可以更加准确地反映2型糖尿病患者动脉粥样硬化病变.颈动脉和下肢动脉同时发生粥样硬化的2型糖尿病患者心脑血管事件发生率明显增高,应该更加积极干预以减少将来心脑血管事件的发生.
목적 비교경동맥화하지동맥초성대신진단2형당뇨병환자동맥죽양경화적검출솔급여심뇌혈관사건적관계.방법 선택상해교통대학부속제륙인민의원내분비과2007년8월—2008년7월148례신진단2형당뇨병주원환자행경동맥화하지동맥다보륵초성검사.당뇨병동맥죽양경화피정의위경동맥혹하지동맥존재임하부위적동맥죽양경화반괴.채용Kappa통계방법평개경동맥화하지동맥초성대당뇨병동맥죽양경화검출솔적차이.동시비교불동동맥죽양경화분포류형간심뇌혈관사건발생솔적차이.결과 단순이경동맥혹하지동맥초성검측작위진단의거,신진단2형당뇨병동맥죽양경화환병솔분별위27.0％화62.2％,연합검측환병솔위66.2％.경동맥초성진단적동맥죽양경화여당뇨병동맥죽양경화간적Kappa치위0.32(95％CI0.22 ～0.42),하지동맥초성진단적동맥죽양경화여당뇨병동맥죽양경화간적Kappa치위0.91 (95％ CI0.84 ～0.98).경동맥화하지동맥동시발생죽양경화환자심뇌혈관사건발생솔(26.5％)명현고우단순경동맥혹단순하지동맥죽양경화환자(분별위0％급10.3％).결론 연합경동맥화하지동맥초성검사가이경가준학지반영2형당뇨병환자동맥죽양경화병변.경동맥화하지동맥동시발생죽양경화적2형당뇨병환자심뇌혈관사건발생솔명현증고,응해경가적겁간예이감소장래심뇌혈관사건적발생.
Objective To compare the detection rates of atherosclerosis by carotid versus lower limb ultrasound in newly diagnosed type 2 diabetics and analyze the relationship between atherosclerosis and cardio-cerebrovascular events.Methods A total of 148 newly diagnosed type 2 diabetics were recruited.Both carotid and lower extremity atherosclerosis were assessed by Doppler ultrasound.Diabetic atherosclerosis was defined as the presence of either carotid or lower extremity plaques in any of the abovementioned arterial segments.A kappa value was computed to document the agreement between isolated carotid (or lower limb) atherosclerosis and diabetic atherosclerosis.The prevalence of cardio-cerebrovascular events was compared among different distribution types of atherosclerosis.Results According to the diagnostic criteria,the prevalence of diabetic atherosclerosis was 66.2％ in the newly diagnosed type 2 diabetes.Based on carotid or lower extremity ultrasound,the prevalence of diabetic atherosclerosis was 27.0％ and 62.2％ respectively in newly diagnosed type 2 diabetes.The kappa values for the agreement between carotid/lower limb atherosclerosis and diabetic atherosclerosis were 0.32/0.91 (95％ confidence interval 0.22-0.42 for carotid vs 0.84-0.98 for lower extremity).The combination of carotid and lower extremity arterial atherosclerosis was associated with a significantly increased detection rate of cardiocerebrovascular events (26.5％) versus those with either carotid or lower extremity arterial atherosclerosis (0％ and 10.3％ respectively).Conclusion The combination of carotid and lower extremity ultrasonography can more accurately reflect the athemsclerotic lesions in type 2 diabetes.Due to a higher prevalence of cardio-cerebrovascular events,type 2 diabetics with both carotid and lower extremity atherosclerosis should be managed more aggressively to reduce the risk of cardio-cerebrovascular events.