目的:探討老老年患者頸動脈中層厚度(IMT)及其相關危險因素的關系,為老老年患者心腦血管疾病的預防及治療提供臨床參考。方法:根據年齡將139例老老年患者納入分析,有血糖、血壓、血脂代謝紊亂的123例作為觀察組,無血糖、血壓、血脂代謝紊亂的16例作為對照組,分別進行頸動脈超聲檢查、動態血壓監測、糖化血紅蛋白及血脂等生化指標檢查,并結合臨床資料進行分析。結果: 老老年患者均無一例外地存在著IMT增厚,在相同的年齡情況下,吸煙史、血脂紊亂、糖調節異常、血管炎癥反應與IMT的增厚呈正相關,各組未顯示出統計學差異,IMT的發生發展與年齡、性別、吸煙史、血糖、血壓控制水平及血脂紊亂等因素在兩組對照中均未顯示出統計學差異,多因素Logistic回歸分析,顯示年齡、吸煙史及病程為危險因素(OR為0500～1196)。結論:老老年患者均不同程度地存在著IMT增厚,其中增齡是其最主要的危險因素,但是對合并有血糖、血壓、血脂代謝紊亂的老老年患者也應該積極重視對各種危險因素的篩選和干預,特別在疾病發生發展的早期可能對延緩病變的進展和減少心腦血管事件有一定意義,可是其用藥的安全性在該類患者就顯得尤為重要。
【摘要】 目的 研究合并2型糖尿病的冠心病患者冠狀動脈病變程度與血清視黃醇結合蛋白4（retinol-binding protein 4，RBP4）水平的相關性。 方法 2008年10月-2010年4月選擇性冠狀動脈造影確診的冠心病患者共120例，分為單純冠心病組（A組）60例和冠心病合并糖尿病組（B組）60例，檢測血糖、血脂、胰島素以及脂聯素、RBP4水平；根據冠狀動脈造影結果，以Gensini評分評判冠狀動脈病變程度。 結果 B組空腹血糖、胰島素、RBP4均顯著高于A組（Plt;0.05）；冠狀動脈病變程度更重（Plt;0.05）。相關性分析顯示RBP4水平與低密度脂蛋白膽固醇、胰島素抵抗和冠狀動脈病變積分呈正相關（r=0.312、0.322、0.314，Plt;0.05）。與脂聯素水平呈負相關（r=-0.362，Plt;0.01）。 結論 冠心病合并2型糖尿病患者RBP4明顯升高，且與冠狀動脈狹窄程度呈正相關。【Abstract】 Objective To explore the relationship between the level of serum retinol-binding protein 4 (RBP4) and the extent of coronary lesions in coronary heart disease (CHD) patients accompanied with type 2 diabetes mellitus (T2DM). Methods A total of 120 patients with CHD diagnosed by coronary arteriongraphy between October 2008 and April 2010 were enrolled. The patients were divided into two groups: CHD group (60 patients); CHD accompanied with T2DM group (60 patients). The levels of serum insulin, adiponectin and RBP4 were measured. All the patients underwent coronary angiography and the extent of coronary lesions was assessed quantitatively based on the Gensini′s scoring system. Results The levels of serum insulin, plasma RBP4 and the extent of coronary artery stenosis in CHD accompanied with T2DM group were significantly higher than those in CHD group (Plt;0.05). Correlation analysis showed that the level of RBP4 was positively correlated with LDL-C, insulin resistance index and the coronary artery narrow degree（r=0.312, 0.322, 0.314; Plt;0.05); and negatively correlated with adiponectin (r=-0.362, Plt;0.01). Conclusion The significant elevated plasma RBP4 in CHD patients accompanied with T2DM is positively correlated with the extent of coronary artery lesion.