摘要目的 探讨二甲双胍是否可以预防2型糖尿病(T2DM)患者发生动脉粥样硬化(AS).方法 140例T2DM患者分为二甲双胍组(75例)和非二甲双胍组(65例),进行强化血糖、血压、血脂控制100周,记录强化治疗前后随访指标,进行统计学分析.以颈总动脉内中膜厚度(CC-IMT)为AS观测指标.结果 经过100周强化代谢控制后,两组舒张压(DBP)、空腹血糖、餐后2 h血糖、糖化血红蛋白、甘油三酯(TG)、总胆固醇(TC)(P<0.05)均明显下降;二甲双胍组的体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)和CC-IMT降低(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平有所升高(P<0.05);100周时二甲双胍组的BMI[(23.1±0.98)kg/m2、HOMA-IR(1.68±0.20)及CC-IMT(0.55±0.13)mm]均较非二甲双胍组低[(24.1±0.05)kg/m2,(2.03±1.38),(0.70±0.15)mm,P<0.05].CC-IMT与BMI(r=0.489,P<0.05)、TC(r=0.429,P<0.05)、LDL-C(r=0.426,P<0.05)、HOMA-IR(r=0.428,P<0.05)呈正相关.结论 二甲双胍可以降低T2DM患者的CC-IMT,对T2DM患者发生AS具有一级预防作用.

abstractsObjective To investigate the preventive action of metformin for atherosclerosis (AS) in patients with type 2 diabetes mellitus (T2DM).Methods A total of 140 cases with T2DM were assigned to 2 groups taking metformin (n = 75) or not (n = 65).All cases received intensive control of blood glucose,blood pressure and blood lipids for 100 weeks.The data before and after intensive control were recorded and statistically analyzed.Common carotid intima-media thickness (CC-IMT) was the efficacy endpoint of AS.Results Diastolic blood pressure (DBP),fasting blood glucose,post 2-hour blood glucose,glycated hemoglobin Alc,triglyceride (TG) and total cholesterol (TC) decreased in both groups after intensive metabolic control for 100 weeks (P<0.05).Body mass index (BMI),HOMA insulin resistance index (HOMA-IR) and CC-IMT decreased in metformin group (P<0.05) while high-density lipoprotein cholesterol (HDL-C) increased (P<0.05).BMI (23.1±0.98) kg/m2,HOMA-IR (1.68±0.20) and CC-IMT(0.55±0.13)nun in metformin group were lower than those in non-metformin group [(24.1±0.05) kg/m2,2.03±1.38,(0.70±0.15)mm)] at 100 week (P<0.05).CC-IMT was positively correlated with BMI (r = 0.489,P<0.05),TC (r = 0.429,P<0.05),low-density lipoprotein cholesterol (LDL-C) (r = 0.426,P<0.05) and HOMA-IR (r = 0.428,P<0.05).Conclusion Metformin attenuates CC-IMT of patients with T2DM and it has the primary preventive effect upon AS in patients with T2DM.