Bangalore Medical College and Research Institute, Bangalore.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Carotid atherosclerosis is increased 3 fold in people with DM. Several theories have been proposed that increased Urinary Albumin Excretion Rate (UAER) is associated with impairment of endothelial function leading to atherosclerosis. Calf circumference is considered a surrogate marker of lean mass. Visceral fat gene expression is considered more proatherogenic than subcutaneous adipocytes. It is newly proposed that waist-to-calf circumference ratio(WCR) is one of the best anthropometric measures indicative of carotid atherosclerosis.
This cross sectional study was conducted in the hospitals attached to Bangalore medical college and research institute. Relevant history taken, clinical examination and laboratory investigations was done on 140 patients of type 2 diabetes mellitus, correlation of waist-calf ratio and urine albumin creatinine ratio(UACR) with carotid intima media thickness (CIMT) was done in these individuals. Chi square/Fischer exact test has been used to find the significance of study parameters on categorical scale between 2 or more groups. Pearson correlation between study variables is performed to find the degree if relationship.
Among 140 patients in our study 86 were females and 54 were males with mean age 54.05+/- 11.29 years. Mean +=- SD of HbA1c was 9.04+/- 2.67. Mean +/- SD of WCR was 3.09+/- 0.32. It was observed that 48, 65 and 27 patients were having normoalbuminuria, microalbuminuria and macroalbuminuria respectively. Mean avg CIMT was 0.78+/- 0.075. Pearon's correlation coefficient used in our study was showing strong positive correlation between WCR and CIMT (0.841) and also between UACR and CIMT. There was a linear correlation between WCR and UACR with CIMT and the correlation was statistically significant P value <0.001.
Cardiovascular complications are an important cause of mortality and morbidity in type 2 DM. Screening of all diabetics for carotid atherosclerosis by carotid ultrasonography is cumbersome and not cost effective. Hence simple anthropometric measurements of body fat distribution like WCR can be used when assessing vascular risk profile. Microalbuminuria now-a-days is considered to be an atherosclerosis risk factor and predicts future cardiovascular complications in diabetic patients. In our study, it was found that WCR and UACR were strongly positively correlated with carotid atherosclerosis as measured by CIMT.
目的：本研究旨在探讨腰围与小腿围比值（WCR）与颈动脉内膜中层厚度（CIMT）的相关性，评估其作为预测颈动脉粥样硬化的指标。
材料与方法：本研究为横断面研究，在班加罗尔医学院和研究所附属医院进行。纳入 140 例 2 型糖尿病患者，记录其一般资料、临床特征和实验室检查结果，采用超声检测颈动脉内膜中层厚度，并分析 WCR 与尿白蛋白肌酐比值（UACR）与 CIMT 的相关性。
结果：140 例患者中，女性 86 例，男性 54 例，平均年龄 54.05±11.29 岁。糖化血红蛋白（HbA1c）平均水平为 9.04±2.67，WCR 平均水平为 3.09±0.32。根据尿白蛋白排泄率将患者分为正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组，三组患者分别有 48、65 和 27 例。CIMT 的平均水平为 0.78±0.075。Pearson 相关分析显示，WCR 与 CIMT 呈强正相关（r=0.841），UACR 与 CIMT 也呈强正相关（r=0.828）。WCR 和 UACR 与 CIMT 之间存在线性相关，相关性具有统计学意义（P 值均＜0.001）。
结论：心血管并发症是 2 型糖尿病患者死亡和致残的重要原因。采用颈动脉超声筛查所有糖尿病患者的颈动脉粥样硬化较为繁琐且不具成本效益。因此，在评估血管风险谱时，可以使用 WCR 等简单的体脂分布的人体测量学指标。目前，微量白蛋白尿被认为是动脉粥样硬化的危险因素，并可预测糖尿病患者未来发生心血管并发症的风险。本研究发现，WCR 和 UACR 与 CIMT 呈强正相关，提示其与颈动脉粥样硬化密切相关。
