| Objective: To investigate the relationship between the intima media thickness(IMT)of different sites and different clinical macrovascular disease in patients with type 2diabetes mellitus(T2DM).Methods:Clinical data of 680 patients including 365 male patients(53.68%) and315 female patients(46.32%)were collected, who were diagnosed as T2 DM in the Department of Endocrinology, the First Affiliated Hospital of Dalian Medical University from June 2013 to June 2014, aging from 21 to 89 years old. Among all the enrolled cases, 107 cases were with coronary artery disease(CAD), 43 cases were with cerebrovascular disease(CVD), 10 cases were with peripheral artery disease(PAD), 37 cases were with multiple macrovascular disease(MAD), 483 cases without clinical macrovascular disease were considered as the control group. All the subjects’ gender,age, duration of T2 DM, smoking history, family history, previous history pulse was recorded. Their height, weight, waist circumference(WC), systolic blood pressure(SBP), diastolic blood pressure(DBP) was measured, and calculate the pulse pressure difference(PPD). Their body mass index(BMI) and pulse pressure was calculated.Their fasting blood glucose(FPG), glycosylated hemoglobin(Hb A1c), uric acid(UA),total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C), apolipoprotein A(Apo A) was also detected. All the patients accepted the ultrasound examination of carotid arteries and peripheral arteries by the specially-assigned person in department of Ultrasound with the same machine, including both sides of the common carotid arteries(CCA), the carotid bifurcation(CBIF), the internal carotid arteries(ICA), the max carotid arteries asthe carotid intima-media thickness(max-IMT), femoral arteries and popliteal arteries.Results: 1.There were significant differences between each study group and control group in proportion of male, family history of DM, with hypertension, average age, duration of T2DM(P < 0.05). There were significant differences between CAD group and CVD group compared with control group in BMI(P <0.01). There were significant differences between CVD group and PAD group compared with control group in SBP(P<0.05). There were significant differences between CAD group, CVD group and PAD group compared with control group in PPD(P < 0.01). There were significant differences between MAD group and control group in FBG(P<0.01). No significant differences were observed in smoking, WC, DBP, Hb A1 c, UA, TC, TG,HDL-C, LDL-C and Apo A(P>0.05).2.There were significant differences between CAD group and control group in left side of CCA-IMT, both side of ICA-IMT, right side of CBIF-IMT, both side of popliteal arteries IMT(P < 0.05). There were significant differences between CVD group and control group in both side of CCA-IMT, right side of ICA-IMT, right side of carotid IMT(max-IMT),both side of popliteal arteries IMT(P < 0.05). There were significant differences between PAD group and control group in both side of CCA-IMT,left side of ICA-IMT, both side of CBIF-IMT, both side of carotid IMT(max-IMT),both side of femoral arteries IMT, both side of popliteal arteries IMT(P<0.05). There were significant differences between MAD group and control group in each examined arteries IMT(P<0.001).3.Single factor’s logistic regression analysis showed that age, duration of T2 DM,with hypertension, PPD and left sites of CCA-IMT, both side of ICA-IMT, right side of CBIF-IMT, both side of popliteal arteries IMT were the risk factors of coronary artery disease in T2 DM patients. Age, duration of T2 DM, with hypertension, BMI, SBP, PPD and both sites of CCA-IMT, both side of ICA-IMT, right side of carotid IMT, both side of femoral arteries IMT, both side of popliteal arteries IMT were the risk factors of cerebrovascular disease in T2 DM patients. Age, duration of T2 DM, SBP, PPD and both sites of CCA-IMT, left side of ICA-IMT, both side of CBIF-IMT, both side of carotidIMT, both side of femoral arteries IMT, both side of popliteal arteries IMT were the risk factors of lower-extremity arterial disease in T2 DM patients. Age, duration of T2 DM,with hypertension, family history of DM, DBP, FPG and each examined arteries IMT were the risk factors of multiple macrovascular disease in T2 DM patients.4.Multiple factors’ logistic regression analysis showed that age, duration of T2 DM,with hypertension were the independent risk factors of cardiovascular disease in T2 DM patients. Age and PPD were the independent risk factors of cerebrovascular disease in T2 DM patients. PPD and left side of popliteal arteries IMT were the independent risk factors of lower-extremity arterial disease in T2 DM patients. Age and duration of T2 DM were the independent risk factors of multiple macrovascular disease in T2 DM patients. However, the other sites of IMT were not counted in the equation.5.According to ROC curve analysis of the diagnosis tangency point of left side of popliteal artery IMT. Tangent point value of left side of popliteal artery was 1.3 mm,the area under the curve was 0.807, while the sensitivity and specificity of lower-extremity arterial disease in T2 DM patients were 60.00% and 85.48%respectively.Conclusion:1.There are correlation between LCCA-IMT, LICA-IMT, RCA-IMT and macrovascular disease in T2 DM patients. There are correlation between LCBIF-IMT,LCA-IMT and lower-extremity arterial disease in T2 DM patients. There are correlation between RCCA-IMT and cerebrovascular disease and lower-extremity arterial disease in T2 DM patients. There are correlation between RICA-IMT and coronary artery disease and cerebrovascular disease in T2 DM patients. There are correlation between RCBIF-IMT and coronary artery disease and lower-extremity arterial disease in T2 DM patients.2.There are correlation between both side of popliteal arteries IMT and macrovascular disease in T2 DM patients. There are correlation between both side of femoral arteries IMT and cerebrovascular disease and lower-extremity arterial disease in T2 DM patients.3.Left popliteal arteries IMT is probably the independent risk factor of lower-extremity arterial disease in T2 DM patients, weighing more than other sites. We suggest that the T2 DM patients with left popliteal arteries IMT > 1.3 mm should take further lower limb arterial angiogrphy or measurement of Ankle Brachial Index(ABI). |
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