2型糖尿病糖耐量正常一级亲属心血管危险因素的干预研究

摘要

Objective Discuss cardiovascular risk factors intervention methods for FDRs of T2DM patients with normal glucose tolerance, and provide early references for the prophylaxis of T2DM CVD. Methods 60 cases of first-degree relatives of type 2 diabtes mellitus with normal glucose tolerance were randomly allocated to two groups:nutrition therapy intervention(40 cases), the control group(20 cases). Both groups were given to health lectures of diabetes and cardiovascular disease. To reasonable exercise guidance, periodic outpatient and telephone follow-up, risk factor surveillance, information analysis;the nutritious meals are provided for dynamic intervention group based on the above, and individualized intervention. Body mass index(BMI), waist hip rate, blood pressure, fasting blood glucose(FBG), fasting insulin and HOMA-IR, blood fat, urinary albumin and CRP were measured before and after intervention, and compared. According to”ischemic cardiovascular disease(ICVD) 10 year incidence risk assessment table”,calculate ICVD risk score for all subjects before and after intervention. And assess risk of its 10-year ICVD. Results After intervention, compared with the control group, multiple risk factors significantly improved of the intervention group at 6 months, 12 months, 24 months. Cardiovascular absolute risk level significantly lower. Conclusion T2DM with normal glucose tolerance FDRs exist multiple risk factors for CVD. Right nutrition comprehensive intervention can benefit maximization CVD. Long-term primary prevention for cardiovascular risk groups should be strengthen, and individualized prevention program should be selected.%目的：探讨糖耐量正常的2型糖尿病（T2DM）患者一级亲属（FDRs）群体心血管危险因素干预策略，为其心血管病（CVD）的早期预防提供参考依据。方法将60例糖耐量正常T2DM的FDRs随机分为干预组40例，对照组20例。两组均给予糖尿病、心血管疾病健康知识讲座，合理运动指导，定期门诊及电话随访，危险因素监测，信息化动态管理等，干预组在上述基础上予以相对固定的营养餐，进行个体化干预。比较干预前后两组的体质量指数（BMI）、腰臀比、血压、空腹血糖、血胰岛素水平、胰岛素抵抗指数（HOMA-IR）、血脂、尿微量白蛋白、C反应蛋白等指标，根据“缺血性心血管病（ICVD）10年发病危险评估量表”，对所有研究对象干预前后进行ICVD危险评分，评估CVD发病风险。结果干预后6、12、24个月，相比对照组，干预组多重危险因素明显回归，心血管绝对风险度明显降低。结论 T2DM糖耐量正常FDRs存在CVD的多重危险因素，合理的营养综合干预可使CVD获益最大化；对心血管高危群体应选择个体化预防方案，加强长期的一级预防。