目的 评价高频超声对2型糖尿病(T2DM)合并微量白蛋白尿(MA)患者颈动脉粥样硬化的诊断价值.方法 将91例T2DM患者根据尿白蛋白排泄率(UAER)分为T2DM未合并MA患者组(T2DM1组)49例;T2DM合并MA患者组(T2DM2组)42例,利高频超声检测T2DM患者颈动脉内-中膜厚度(IMT)及粥样硬化斑块形成情况.同时获得血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、糖化血红蛋白(HbAlc)、尿酸(URIC)、血肌酐(CREA)、超敏C反应蛋白(HSCRP)、空腹血糖(FPG)、餐后2 h血糖(2hPG)、尿白蛋白排泄率(UAER)、体质指数(BMI)等指标.结果 T2DM2组2hPG、BMI、TC、CREA、UAER、HbAlc、IMT均高于T2DM1组,差异均有统计学意义(P<0.05).Pearson相关分析显示两组中IMT与CREA、UAER、HbAlc及病程呈正相关(r=0.311、P<0.05,r=0.309、P<0.05,r=0.441、P<0.05,r=0.350、P<0.05).在多元线性回归分析中,两组中UAER、HbAlc、病程是IMT的独立预测因子.两组组内斑块检出率:软斑>混合斑>硬斑,差异有统计学意义(P<0.05).结论 T2DM合并MA患者的颈动脉IMT增厚,UAER、HbAlc及病程与IMT密切相关.高频超声能够准确、快捷地检测T2DM合并MA患者颈动脉粥样硬化.%Objective To evaluate carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM) and microalbuminuria(MA) by using highfreguency ultrasound. Methods Ninty-one patients of T2DM were divided into two groups according to urinary albumin excretion rate(UAER):T2DM without MA(T2DM1 group, 49)and T2DM with MA(T2DM2 group, 42). The intimal-medical thickness (IMT)and the atherosclerotic plaques of carotid artery were observed in both groups with highfreguency ultrasound. Total cholesterol(TC), triglyceride(TG), low-density lipoprotein( LDL), high density lipoprotein ( HDL), glycosylated hemoglobin A1c ( HbA1c), uric acid ( URIC), creatinine (CREA), high-sensitivity C-reactive protein ( HSCRP), fasting plasma glucose ( FPG), 2h postprandial glycemia (2hPG) ,urinary albumin excretion rate(UAER) ,body mass index(BMI)were measured. Results The values of 2hPG,BMI,TC,CREA,UAER,HbA1c, IMT of T2DM2 group were significantly higher than those of T2DM1 group(P＜0. 05). Throngh pearson correlation analysis, IMT was positively and significantly associated with CREA(r=0. 311;P＜0. 05) ,UAER(r=0. 309;P＜0. 05) ,GHbA1c(r=0. 441;P＜0. 05 ) and course of disease(r=0. 350;P＜0. 05).Throngh Multivariate linear regression analysis, UAER,GHbA1c and course of disease were independent predictors of IMT in two groups. The detection rate of soft plaque was higher than that of hard plague and mixed plaques(P＜0. 05). Conclusions IMT of carotid in patients of T2DM with MA significantly increased compared with the patients of T2DM without MA. There were close correlation between IMT and UAER, HbA1c as well as course of disease. Highfrequency ultrasound is a convenient and effective method to evaluate carotid atherosclerosis of the patients of T2DM with MA.
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