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目的超声动态评价强化治疗对初诊2型糖尿病(T2DM)患者亚临床动脉粥样硬化(AS)的价值。方法随访135例T2DM患者3年,根据入组时间分为强化治疗组(75例)和常规治疗组(60例)。观察干预3年后两组患者的代谢控制情况及颈总动脉(CCA)、髂总动脉(CIA)、股总动脉(CFA)内膜-中层厚度(IMT)和AS斑块的变化情况。结果强化治疗组的各动脉内膜-中层增厚率均低于常规治疗组,均有统计学差异(均P<0.05)。比较两组患者斑块分布情况,干预1年后和2年后强化治疗组股动脉斑块好转率高于常规治疗组(x～2=5.49、8.39,均P<005),其余指标好转率均无统计学差异(均P>0.05)。结论强化治疗后T2DM患者CCA、CIA及CFA内膜-中层增厚明显减少,但对血管内已形成的AS斑块改善不明显。高频超声可作为首选观察随访手段。
Objective To evaluate the value of intensive therapy in the treatment of subclinical atherosclerosis (AS) in newly diagnosed type 2 diabetes mellitus (T2DM). Methods 135 patients with T2DM were followed up for 3 years and divided into intensive therapy group (75 cases) and conventional therapy group (60 cases) according to the time of admission. Metabolic control and changes of carotid artery (CCA), common iliac artery (CIA), common carotid artery (CFA) intima-media thickness (IMT) and AS plaque were observed in the two groups after intervention for 3 years. Results The thickening rate of intima-media of arteries in intensive treatment group was lower than that of conventional treatment group (all P <0.05). The plaque distribution was compared between the two groups. The improvement rate of femoral plaque in the intensive treatment group after 1 year and 2 years after intervention was higher than that in the conventional treatment group (x ~ 2 = 5.49, 8.39, all P <005) No statistical difference (all P> 0.05). Conclusions The thickening of CCA, CIA and CFA in the intima-media of T2DM patients after intensive treatment was significantly reduced, but the improvement of intravascular AS plaques was not obvious. High-frequency ultrasound can be used as the preferred observation follow-up means.