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目的探讨既往无冠心病(CHD)病史的青年男性2型糖尿病患者血浆睾酮(T)水平与心血管疾病(CVD)危险因子及Framingham风险评分(FRV)的关系。方法将120例患者按照血浆T浓度三分位分组,比较各组间CVD危险因子,如体重指数(BMI)、腰围、吸烟、血脂谱、糖化血红蛋白(HbA1c)、血尿酸、24 h尿微量白蛋白定量(UMA)、颈动脉内膜中层厚度(CIMT)、简易稳态模型法计算的胰岛素抵抗指数(HOMA-IR)及FRV非低危组(中危及高危组)比例等;分析血浆T与CVD各危险因子的相关性及其对FRV非低危组发生率的影响。结果随着血浆T浓度升高,BMI、腰围、血压、CIMT、HbA1c、HOMA-IR、超敏C反应蛋白(hs-CRP)、UMA、TG、TC、LDL-C及FRV非低危组比例等均降低(均P<0.05或P<0.01),HDL-C浓度增加(P<0.05);吸烟者比例、糖尿病病程、血尿酸及CVD家族史阳性者比例呈下降趋势,但是差异无统计学意义。相关性分析显示血浆T与BMI、腰围、CIMT、CAP、HbA1c、HOMA-IR、hs-CRP、UMA、血脂及FRV等均相关(均P<0.05或P<0.01)。Logistic回归分析显示血浆T是青年男性2型糖尿病患者FRV非低危组的保护性因素,其OR值为0.581(95%CI:0.478~0.704,P<0.01),在校正BMI、腰围、HbA1c、HOMA-IR、TG、TC、HDL-C及LDL-C后其OR值为0.787(95%CI:0.710~0.874,P<0.01)。结论青年男性2型糖尿病患者血浆T与多个CVD危险因子负相关,低血浆T可能是青年男性2型糖尿病患者CVD独立危险因子。
Objective To investigate the relationship between plasma testosterone (T) level and risk factors of cardiovascular disease (CVD) and Framingham risk score (FRV) in young male patients with type 2 diabetes mellitus without prior coronary heart disease (CHD). Methods One hundred and twenty patients were divided into three groups according to plasma T concentration. The risk factors such as body mass index (BMI), waist circumference, smoking, blood lipid profile, glycosylated hemoglobin (HbA1c), serum uric acid, (UMA), carotid artery intima-media thickness (CIMT), insulin resistance index (HOMA-IR) calculated by simple steady-state model and the proportion of non-low risk group of FRV Correlation between risk factors of CVD and its effect on the incidence of FRV in non - low risk group. Results With the increase of plasma T concentration, the proportion of non-low risk group of BMI, waist circumference, blood pressure, CIMT, HbA1c, HOMA-IR, hs- CRP, UMA, TG, TC, LDL- (P <0.05 or P <0.01), HDL-C concentration increased (P <0.05). The proportion of smokers, duration of diabetes, serum uric acid and CVD family history showed a decreasing trend, but the difference was not statistically significant significance. Correlation analysis showed that plasma T was correlated with BMI, waist circumference, CIMT, CAP, HbA1c, HOMA-IR, hs-CRP, UMA, lipids and FRV (all P <0.05 or P <0.01). Logistic regression analysis showed that plasma T was a protective factor in non-low-risk group with type 2 diabetes in young male patients with FRV. The OR was 0.581 (95% CI: 0.478-0.704, P <0.01) The OR of HOMA-IR, TG, TC, HDL-C and LDL-C was 0.787 (95% CI: 0.710-0.874, P <0.01). Conclusions There is a negative correlation between plasma T and CVD risk factors in type 2 diabetes in young men. Low plasma T may be an independent risk factor for CVD in type 2 diabetes mellitus in young men.