与无视网膜病变的患者相比，患有视网膜病变的2型糖尿病患者的颈动脉斑块负担增加。
Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy.
作者信息
Alonso Núria, Traveset Alicia, Rubinat Esther, Ortega Emilio, Alcubierre Nuria, Sanahuja Jordi, Hernández Marta, Betriu Angels, Jurjo Carmen, Fernández Elvira, Mauricio Didac
机构信息
Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain.
Department of Ophthalmology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
出版信息
Cardiovasc Diabetol. 2015 Mar 18;14:33. doi: 10.1186/s12933-015-0196-1.
BACKGROUND
Cardiovascular disease (CVD) is the leading cause of mortality among subjects with type 2 diabetes (T2D), and diabetic retinopathy (DR) has been associated with an increased risk for CVD. The present study was designed to test the concept that T2D patients with DR, but without previous cardiovascular (CV) events and with normal renal function, have an increased atherosclerotic burden compared with patients without DR.
METHODS
A cross-sectional study was performed using patients with normal renal function (estimated glomerular filtration rate (eGFR) >60 ml/min) and without previous CV events. A total of 312 patients (men, 51%; mean age, 57 yrs; age range 40-75 yrs) were included in the study; 153 (49%) of the patients had DR. B-mode carotid ultrasound imaging was performed for all of the study subjects to measure the carotid intima-media thickness (cIMT) and carotid plaques in the common carotid artery (CCA), bifurcation and internal carotid artery (ICA).
RESULTS
The percentage of carotid plaques in T2D patients with DR was higher than in T2D patients without DR (68% vs. 52.2%, p = 0.0045), and patients with DR had a higher prevalence of ≥2 carotid plaques (44.4% vs. 21.4%; p < 0.0001). No differences were observed in the cIMT measured at different carotid regions between the patients with or without DR. Using multivariate logistic regression (adjustment for major risk factors for atherosclerosis), DR was independently associated with mean-internal cIMT (p = 0.0176), with the presence of carotid plaques (p = 0.0366) and with carotid plaque burden (≥2 plaques; p < 0.0001).
CONCLUSIONS
The present study shows that DR in T2D patients without CVD and with normal renal function is associated with a higher atherosclerotic burden (presence and number of plaques) in the carotid arteries. These patients may be at a higher risk for future CV events; therefore, an ultrasound examination of the carotid arteries should be considered in patients with DR for more careful and individualised CV assessment and follow-up.
背景
心血管疾病（CVD）是2型糖尿病（T2D）患者死亡的主要原因，而糖尿病视网膜病变（DR）与CVD风险增加有关。本研究旨在验证以下概念：与无DR的T2D患者相比，患有DR但无既往心血管（CV）事件且肾功能正常的T2D患者动脉粥样硬化负担增加。
方法
对肾功能正常（估计肾小球滤过率（eGFR）>60 ml/min）且无既往CV事件的患者进行了一项横断面研究。共有312例患者（男性占51%；平均年龄57岁；年龄范围40 - 75岁）纳入研究；其中153例（49%）患者患有DR。对所有研究对象进行B型颈动脉超声成像，以测量颈总动脉（CCA）、分叉处和颈内动脉（ICA）的颈动脉内膜中层厚度（cIMT）和颈动脉斑块。
结果
患有DR的T2D患者颈动脉斑块的百分比高于无DR的T2D患者（68%对52.2%，p = 0.0045），且DR患者中≥2个颈动脉斑块的患病率更高（44.4%对21.4%；p < 0.0001）。有无DR的患者在不同颈动脉区域测量的cIMT未观察到差异。使用多因素逻辑回归（对动脉粥样硬化的主要危险因素进行校正），DR与平均内膜cIMT独立相关（p = 0.0
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