糖尿病及二甲双胍与腹主动脉瘤进展的相关性研究

Association of Diabetes Mellitus and Metformin Use with the Progression of Abdominal Aortic Aneurysm

摘要: 目的：分析糖尿病及二甲双胍与腹主动脉瘤(abdominal aortic aneurysm, AAA)进展之间的关系，为AAA合并糖尿病患者的临床治疗策略提供新的思路。方法：回顾性分析2018年1月至2023年12月期间于青岛大学附属医院确诊AAA患者的临床资料，根据是否合并糖尿病及糖尿病患者是否使用二甲双胍，将研究对象分为非糖尿病组(n=142)、糖尿病服用非二甲双胍组(n = 30)、糖尿病使用二甲双胍组(n = 41)。通过CT血管造影(CTA)评估患者AAA的最大直径，根据多次检查结果计算AAA的平均生长速率，并将年直径增长 ≥ 5 mm定义为AAA快速进展。通过基线分析以及多因素Logistic回归模型筛选AAA进展的独立影响因素。结果：与非糖尿病组相比，糖尿病组AAA最大直径较小，AAA直径生长速度较慢。多因素Logistic回归分析显示，糖尿病与AAA快速进展风险的降低独立相关。二甲双胍亚组分析显示，在合并糖尿病的AAA患者中，二甲双胍使用者的腹主动脉瘤生长速率低于未使用者，但单因素分析差异未达到统计学显著性，仅呈降低趋势。结论：糖尿病与AAA快速进展风险降低呈独立相关，而二甲双胍在此基础上可进一步减缓AAA的扩张。

Abstract: Objective: To investigate the associations of diabetes mellitus and metformin use with the progression of abdominal aortic aneurysm (AAA), and to provide potential insights for clinical management of patients with AAA and concomitant diabetes. Methods: A retrospective analysis was conducted on patients diagnosed with AAA at the Affiliated Hospital of Qingdao University between January 2018 and December 2023. Patients were categorized into three groups according to diabetes status and metformin use: non-diabetic group (n = 142), diabetic patients not treated with metformin (n = 30), and diabetic patients treated with metformin (n = 41). The maximal AAA diameter was assessed using computed tomography angiography (CTA). The mean annual growth rate of AAA was calculated based on serial imaging examinations, and rapid AAA progression was defined as an annual diameter increase ≥ 5 mm. Baseline characteristics were compared among groups, and multivariate logistic regression analysis was performed to identify independent factors associated with rapid AAA progression. Results: Compared with the non-diabetic group, patients with diabetes exhibited smaller maximal AAA diameters and slower AAA growth rates. Multivariate logistic regression analysis demonstrated that diabetes was independently associated with a reduced risk of rapid AAA progression. Among diabetic patients, the AAA growth rate in the metformin-treated group was lower than that in the non-metformin group; however, this difference did not reach statistical significance in univariate analysis and showed only a decreasing trend. Conclusions: Diabetes mellitus is independently associated with a reduced risk of rapid AAA progression. Metformin treatment may further attenuate AAA expansion in patients with AAA and concomitant diabetes.