| Objective : By studying the relationship of Carotid atherosclerosis with ambulatory blood pressure , blood fat, glycosylated hemoglobin (HbA1c), urine albumin and insulin level in type 2 diabetes mellitus(DM) patients,uniting neck artery ultrasound to examine carotid internal-midia thickness(IMT),calculating the check-out ratio of athrosclerosis plaques,to analyse the effect of blood pressure and DM on the occurrence and development of artery atherosclerosis.The emphasis is analyzing the occurring mechanism of the blood pressure change of early stage and its effect on artery athrosclerosis.This study supply the theory and clinic base to the method of preventing and treating artery athrosclerosis in lowering blood pressure and blood fat.Method : 123patients with type 2 DM are divided into 2 groups based on their BP, group A (simple DM group) and group B (DM and hypertension group), group C is health control group without DM or hypertension .The objects of study are examined by color Doppler sonography which was operated by specially assigned person to measure Carotid artery IMT and calculate the check-out ratio of plaques.The BP are measured by ambulatory blood pressure monitoring (ABPM).At the same time,biood fat , blood glucose , HbA1c, urine albumin of 24hours are measured .Record above-mentioned data and manage statistic analysis.Result: 1.In the objects of study at the same age,the IMT of group B is higher than thatof group A and group C obviously ,the difference has statistic significance(P<0.05).The IMT of group A is higher than that of group C, the difference has statistic significance(P<0.05).Inside the group ,the patients whose Carotid artery has pathology of plaques or thickened IMT comparing with the patients whose Carotid artery is normal ,the difference of incidence of cerebral stroke has statistic significance(P<0.01).2.The 24h SBP, 24hDBP , d SBP , dDBP, n SBP, nDBP, 24h load value of SBP, 24h load value of DBP of group B is obviously higher than that of group A and group C.24h load value of SBP , 24h load value of DBP of group A is higher than that of group C.The percentage of reduced night time SBP and the percentage of reduced night time DBP of group A is lower than that of group C (P<0.01).In group A,the patients with neuropathy comparing with the patients without neuropathy,the percentage of reduced night time SBP and the percentage of reduced night time DBP are lower obviously(P<0.05).The patients whose blood pressure allorhythmia between day and night has disappeared compared with the patients whose blood pressure allorhythmia between day and night is normal ,IMT is thicker and the urine albumin is higher(P<0.05).3. Correlation analysis showed that 24hPP , dPP, nPP, 24h SBP, dSBP and age are post correlated significantly with IMT.Multivariate analysis showed that the order of the factors which effect artery atherosclerosis of Type 2 DM is WHR, BMI, HbA1c, LDL-c, nPP, nSBP, dPP, 24hSBP , dSBP and TC。Conclusion :1 .DM and hypertension are both independent risk factors of artery atherosclerosis and they have intimate relationship.2.There is both increase of blood pressure and disappearence of blood pressure allorhythmia between day and night in group of DM and hypertension.In simple DM patients without Hypertension, blood pressure allorhythmia between day and night has disappeared.The IMT of these patients become thicker.The reason of this change in blood pressue is related to DM neuropathy and DM nephropathy.In future ,DM patients should be examined by color Doppler sonography and ABPM regularly,so the blood pressure change and athrosclerosis can be discovered as soon as possible . DMneuropathy and DM nephropathy should be positively treated .It is significant in preventing and treating artery athrosclerosis.3.The data showed that the ambulatory pulse pressure was the most important BP parameter during the development of carotid athrosclerosis in hypertension and it can also work as a effective index of evaluation degree of carotid athrosclerosis.
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