2型糖尿病患者肥胖状态与肱踝脉搏波传导速度的相关性

Abstract

目的探讨2型糖尿病(type 2 diabetes,T2DM)患者全身性肥胖(overall obesity,OO)、中心性肥胖(abdominal obesity,AO)状态与肱踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)的关联。方法以北京某社区T2DM患者为研究对象,收集人口学资料、体格检查数据、血液生化指标及baPWV。采用多元线性回归分析各肥胖指标与baPWV的关联,采用Logistic回归模型探讨肥胖状态与baPWV异常(baPWV≥1700 cm/s)的关联。结果共纳入2 048名研究对象,平均年龄(59.2±8.3)岁,baPWV异常率为49.7%。调整年龄、糖尿病病程、高血压等混杂因素后,多元线性回归发现体重指数(body mass index,BMI)与baPWV负相关、腰臀比(waist-to-hip ratio,WHR)与baPWV正相关。Logistic回归分析发现与BMI正常组相比,BMI肥胖组baPWV异常(OR=0.59,95%CI:0.44～0.78,P<0.001);与WHR正常组相比,WHR肥胖组baPWV异常(OR=1.46,95%CI:1.07～2.00,P<0.001);与既无OO也无AO组患者相比,无OO但有AO组患者baPWV异常(OR=1.67,95%CI:1.19～2.35,P=0.003)。结论 T2DM患者中,AO与baPWV间存在显著的关联,尤其是BMI不肥胖但WHR肥胖的糖尿病患者需要密切随访动脉僵硬度。

Objective The aim of this study was to investigate associations of overall obesity(OO) and abdominal obesity(AO) with brachial-ankle pulse wave velocity(baPWV) among type 2 diabetes(T2 DM) patients. Methods A community-based study for T2 DM patients was conducted in rural communities in Beijing.Every patient completed a questionnaire to collect demography, lifestyle and diseases history, and underwent physical examinations, baPWV assessments and blood biochemical tests. Multivariate linear regression was used to assess the relationship between obesity index and baPWV. Abnormal baPWV was defined as patients with baPWV≥1,700 cm/s. Logistic regression model was performed to explore the risk of abnormal baPWV after adjusting for poetential confounders step by step. Results A total of 2 048 T2 DM patients were recruited. The average age was(59.2±8.3) years and total prevalence of abnormal baPWV was 49.7%. After multivariable adjustment, linear regression showed that there was a negative correlation between body mass index(BMI) and baPWV and a positive correlation between waist-to-hip ratio(WHR) and baPWV. Compared to normal weight group, those with BMI≥28 kg/m~2 had lower risk of abnormal baPWV(OR=0.59, 95% CI: 0.44-0.78,P<0.001), but there was an increased risk of 46% among patients with obesity in WHR(OR=1.46, 95% CI:1.07-2.00,P=0.018). Compared to those without OO and AO, patients without OO but with AO had a 1.67-fold increasesd risk of abnormal baPWV(OR=1.67, 95% CI: 1.19-2.35,P=0.003). Conclusions Abdominal obesity is related with arterial stiffnening among T2 DM patients, and it is critical to evaluate arterial stiffness of T2 DM patients with abdmonal obesity and normal BMI in order to reduce future risk of cardiovascular diseases.