目的: 测定2型糖尿病患者接受强化治疗后动脉脉搏波传导速度（pulse wave velocity,PWV）、踝臂指数（ankle-brachial index,ABI）和颈动脉斑块的变化,探讨其临床意义及其在预防2型糖尿病大血管病变方面的监测作用。方法: 选取2012年1月至2014年12月在上海市黄浦区豫园街道社区卫生服务中心随访管理的206例社区2型糖尿病患者,采取随机、对照的干预性研究方法,将患者分为干预组及常规组,比较干预前及24个月后2组患者间血糖、血脂、PWV、ABI和颈动脉超声观察指标的差异。结果: 经2年的强化治疗,干预组与常规组间的收缩压、舒张压、尿蛋白、餐后2 h血糖（2hPG）、糖化血红蛋白（hemoglobin A1c,HbA1c）、低密度脂蛋白胆固醇（low density lipoprotein cholesterol,LDL-C）、PWV的差异有统计学意义（P<0.05）。干预组血压达标患者比不达标患者的PWV明显降低,差异有统计学意义（P<0.05）;糖尿病病程（<5年）者HbA1c达标者较不达标者PWV明显降低,差异有统计学意义（P<0.05）。结论: PWV、ABI和颈动脉斑块测定能客观反映2型糖尿病患者经强化治疗后血管结构和功能的变化,对监测、防治2型糖尿病的并发症,延缓或阻止动脉粥样硬化病变发展有一定的指导意义。
Objective: To investigate the changes in arterial pulse wave velocity(PWV), ankle brachial index (ABI) and carotid plaque in type 2 diabetes mellitu patients receiving 2-year intensive therapy,and analyze their clinical significance and monitoring role on the prevention of large blood vessel lesions in type 2 diabetes mellitus patients. Methods: Two hundred and six patients with type 2 diabetes from January 2012 to December 2014 at Yuyuan Community Health Service Center, Huangpu District were enrolled. Patients were randomly divided into 2 groups: patients in group A received intensive therapy for 2 years , while patients in group B were given conventional therapy. Differences in blood glucose, blood lipid, PWV, ABI and carotid artery ultrasound indices between the two groups were compared after 24 months follow up. Results: Differences in systolic blood pressure,diastolic blood pressure,urinary protein,postprandial 2 hours blood glucose (2hPG), glycosylated hemoglobin (HbA1c),low density lipoprotein cholesterol (LDL-C), PWV were statistically significant between the two groups（P<0.05）. PWV was significantly lower in blood pressure controlled patients than in uncontrolled patients (P<0.05). In patients with course of diabetes <5 years, PWV in those with HbA1c controlled was significantly lower than those with HbA1c not controlled （P<0.05）. Conclusions: PWV, ABI and carotid artery plaque can objectively reflect the changes in structure and function of blood vessels for patients with type 2 diabetes mellitus, which has a guiding significance for prevention and delay of diabetic complication such as atherosclerosis.
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