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目的:测定2型糖尿病患者接受强化治疗后动脉脉搏波传导速度(pulse wave velocity,PWV)、踝臂指数(ankle-brachial index,ABI)和颈动脉斑块的变化,探讨其临床意义及其在预防2型糖尿病大血管病变方面的监测作用。方法:选取2012年1月至2014年12月在上海市黄浦区豫园街道社区卫生服务中心随访管理的206例社区2型糖尿病患者,采取随机、对照的干预性研究方法,将患者分为干预组及常规组,比较干预前及24个月后2组患者间血糖、血脂、PWV、ABI和颈动脉超声观察指标的差异。结果:经2年的强化治疗,干预组与常规组间的收缩压、舒张压、尿蛋白、餐后2 h血糖(2h PG)、糖化血红蛋白(hemoglobin A1c,Hb A1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、PWV的差异有统计学意义(P<0.05)。干预组血压达标患者比不达标患者的PWV明显降低,差异有统计学意义(P<0.05);糖尿病病程(<5年)者Hb A1c达标者较不达标者PWV明显降低,差异有统计学意义(P<0.05)。结论:PWV、ABI和颈动脉斑块测定能客观反映2型糖尿病患者经强化治疗后血管结构和功能的变化,对监测、防治2型糖尿病的并发症,延缓或阻止动脉粥样硬化病变发展有一定的指导意义。
OBJECTIVE: To determine the changes of arterial pulse wave velocity (PWV), ankle-brachial index (ABI) and carotid plaque in type 2 diabetic patients after intensive treatment. To investigate the clinical significance of Prevention of type 2 diabetes in the monitoring of macrovascular disease. Methods: From January 2012 to December 2014, 206 community-based patients with type 2 diabetes underwent follow-up management in the Community Health Service Center of Yuyuan Street, Huangpu District, Shanghai. Randomized controlled trials were divided into intervention group And routine group. The differences of blood sugar, blood lipid, PWV, ABI and carotid artery ultrasound between the two groups before and 24 months after intervention were compared. Results: After 2 years of intensive treatment, systolic blood pressure, diastolic blood pressure, urine protein, 2h PG, hemoglobin A1c (Hb A1c), low density lipoprotein cholesterol There were significant differences in low density lipoprotein cholesterol (LDL-C) and PWV (P <0.05). The PWV of the intervention group was lower than that of the non-compliance group (P <0.05). The duration of diabetes (<5 years) was significantly lower than that of the non-compliance PWV of Hb A1c patients (P <0.05). Conclusion: The PWV, ABI and carotid artery plaque can objectively reflect the changes of vascular structure and function in patients with type 2 diabetes after intensive treatment. It is of great value in monitoring, preventing and treating the complications of type 2 diabetes, and retarding or preventing the development of atherosclerotic lesions A certain guiding significance.