Yamamoto M, Egusa G, Okubo M, Yamakido M
Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan.
Diabetes Care. 1998 Sep;21(9):1451-4. doi: 10.2337/diacare.21.9.1451.
Although persistent hyperglycemia contributes greatly to the progression of diabetic micro- and macroangiopathy, microangiopathy progresses more rapidly than macroangiopathy in some type 2 diabetic patients, with the opposite being true in others. This study was conducted to identify factors responsible for such dissociation.
Patients with proliferative diabetic retinopathy and a carotid intima-media thickness (IMT) level < or =1.0 mm were classified as the microangiopathy group (MIG); those with an IMT level >1.1 mm and without retinopathy or with background retinopathy were assigned to the macroangiopathy group (MAG). Only middle-aged patients, 50-69 years old, were included in this study. There were 54 patients in the MIG and 68 patients in the MAG.
Patients in the MIG were significantly younger at the onset of diabetes, and those in the MAG had a significantly higher mean ratio of apoprotein (apo) B to apoAI. The percentage of patients with a family history of diabetes was significantly higher in the MIG. Maternal inheritance was common among these patients. Those with obesity, a family history of diabetes, and younger onset of hypertension were more common in the MAG. In the multiple logistic regression analyses, maternal inheritance and early onset of diabetes were independent risk factors for the acceleration of microangiopathy. A personal history of obesity and a family history of hypertension were independently related to the development of macroangiopathy.
Our results suggest that patients with early onset and maternal inheritance of diabetes may have a high risk for the progression of diabetic microangiopathy, while patients with hyperlipidemia, a history of obesity, and a family history of hypertension seem prone to the development of atherosclerosis.
尽管持续性高血糖在糖尿病微血管和大血管病变进展中起很大作用，但在一些2型糖尿病患者中，微血管病变比大血管病变进展更快，而在另一些患者中情况则相反。本研究旨在确定导致这种分离的因素。
将患有增殖性糖尿病视网膜病变且颈动脉内膜中层厚度（IMT）水平≤1.0 mm的患者分类为微血管病变组（MIG）；将IMT水平>1.1 mm且无视网膜病变或仅有背景性视网膜病变的患者分配到大血管病变组（MAG）。本研究仅纳入50至69岁的中年患者。MIG组有54例患者，MAG组有68例患者。
MIG组患者糖尿病发病时明显更年轻，MAG组患者载脂蛋白（apo）B与apoAI的平均比值明显更高。MIG组中有糖尿病家族史的患者百分比明显更高。这些患者中母系遗传很常见。肥胖、有糖尿病家族史且高血压发病较早的患者在MAG组中更常见。在多因素逻辑回归分析中，母系遗传和糖尿病早发是微血管病变加速的独立危险因素。肥胖个人史和高血压家族史与大血管病变的发生独立相关。
我们的结果表明，糖尿病早发且有母系遗传的患者可能发生糖尿病微血管病变的风险较高，而高脂血症、肥胖史和高血压家族史的患者似乎易患动脉粥样硬化。
