Gül Kamile, Ustün Ihsan, Aydin Yusuf, Berker Dilek, Erol Kutlu, Unal Mustafa, Barazi Ayşe Ozden, Delibaşi Tuncay, Güler Serdar
Department of Endocrinology and Metabolism, Ankara Atatürk Education and Research Hospital, Ankara, Turkey.
Anadolu Kardiyol Derg. 2010 Feb;10(1):52-8. doi: 10.5152/akd.2010.012.
Atherosclerosis is the major cause of the morbidity and mortality in type 1 diabetes mellitus (DM). Carotid intima-media thickness (CIMT) is the early sign of atherosclerosis and thereby, also the sign of macrovascular diseases. In this study, we aimed to evaluate the CIMT in patients with type 1 DM, and its association with diabetic microvascular complications (nephropathy-retinopathy).
One hundred and thirteen consecutive patients with type 1 DM without macrovascular disease were enrolled into this cross-sectional study. Age, gender, and body mass index matched 59 healthy subjects, were taken as the control group. Microvascular complications in diabetic patients were scanned. Ultrasonographic analysis of the carotid artery was performed with a high-resolution ultrasound scanner. Student's t, Mann Whitney U, Chi-square and Kruskal-Wallis tests, as well as multiple linear regression analysis were used for the statistical analysis.
Patients with type 1 DM had significantly higher CIMT compared to control group (p<0001). The CIMT of the patients with microvascular complications (nephropathy and/or retinopathy) was significantly increased (0.70+/-0.11 mm) compared with the patients without complications (0.63+/-0.09 mm) (p=0.001). The increase in CIMT in type 1 DM in multiple regression analysis was dependent on the presence of proliferative retinopathy (beta=0.037, 95%CI 0.010-0.065, p=0.008), macroalbuminuria (beta=0.043, 95%CI 0.019-0.068, p=0.001), increased urinary albumin excretion (beta=0.00003, 95%CI 0.00001-0.00005, p=0.005) and duration of diabetes (beta=0.002, 95%CI 0.001-0.003, p=0.009).
Increment of CIMT in type 1 diabetic patients was associated with microvascular complications, suggesting that diabetic microangiopathy is related with macroangiopathy. Therefore, there is a need for prospective studies to show the effect of increased CIMT on prognosis of type 1 DM.
动脉粥样硬化是1型糖尿病（DM）发病和死亡的主要原因。颈动脉内膜中层厚度（CIMT）是动脉粥样硬化的早期征象，因此也是大血管疾病的征象。在本研究中，我们旨在评估1型糖尿病患者的CIMT及其与糖尿病微血管并发症（肾病 - 视网膜病变）的关联。
113例无大血管疾病的连续1型糖尿病患者被纳入本横断面研究。年龄、性别和体重指数匹配的59名健康受试者作为对照组。对糖尿病患者的微血管并发症进行扫描。使用高分辨率超声扫描仪对颈动脉进行超声分析。采用学生t检验、曼 - 惠特尼U检验、卡方检验和克鲁斯卡尔 - 沃利斯检验以及多元线性回归分析进行统计分析。
与对照组相比，1型糖尿病患者的CIMT显著更高（p<0.001）。有微血管并发症（肾病和/或视网膜病变）的患者的CIMT（0.70±0.11mm）与无并发症的患者（0.63±0.09mm）相比显著增加（p = 0.001）。在多元回归分析中，1型糖尿病患者CIMT的增加取决于增殖性视网膜病变的存在（β= 0.037，95%CI 0.010 - 0.065，p = 0.008）、大量白蛋白尿（β= 0.043，95%CI 0.019 - 0.068，p = 0.001）、尿白蛋白排泄增加（β= 0.00003，95%CI 0.00001 - 0.00005，p = 0.005）和糖尿病病程（β= 0.002，95%CI 0.001 - 0.003，p = 0.009）。
1型糖尿病患者CIMT的增加与微血管并发症相关，提示糖尿病微血管病变与大血管病变有关。因此，需要进行前瞻性研究以显示CIMT增加对1型糖尿病预后的影响。
