糖调节受损患者动脉硬化的临床研究

目的探讨糖尿病(DM)前期及早期患者颈动脉内膜中层厚度(IMT)、颈股动脉脉搏波速度(cfPWV)及踝臂指数(ABI)与动脉硬化发展的关系。方法纳入新诊断的31例2型DM患者(DM组),286例糖调节受损者(IGR组),包括空腹血糖受损(I-IFG)36例和餐后血糖受损(I-IGT)108例,IFG+IGT 142例。自健康体检人群选择年龄、性别与DM组匹配的102例作为健康对照组(CON组)。测量身高、体质量、腰围、臀围、血压、体质量指数(BMI)、胰岛素抵抗指数(ISI)。测量IMT、cfPWV及ABI。比较各组指标,进行相关性分析。结果5组对象的年龄、性别、吸烟史、收缩压、舒张压、TC、TG、HDL-C、LDL-C、脂蛋白A(Apo A)、脂蛋白B(Apo B)值差异无统计学意义(均为P>0.05)。与CON组相比,后4组BMI、腰臀比(W/R)、ISI均明显升高(均为P<0.05),但后4组间差异无统计学意义(均为P>0.05)。与CON组相比,IMT在IFG+IGT、I-IGT和DM组逐渐增厚,cfPWV逐渐增快,ABI明显下降(均为P<0.05),在I-IFG则无此表现(均为P>0.05)。其中I-IGT和DM组较IFG+IGT组IMT增厚更明显(P<0.05),DM组较I-IGT组增厚明显,但未达到统计学差异(P>0.05)。cfPWV在IFG+IGT、I-IGT和DM组逐渐升高,组间比较差异有统计学意义(均为P<0.05)。ABI在IFG+IGT、I-IGT和DM组逐渐下降,组间比较差异有统计学意义,DM组较I-IGT组下降明显,但无统计学意义。相关分析显示,在I-IGT组IMT、cfPWV与ISI呈负相关,与BMI、腰臀比呈正相关,而ABI与ISI呈正相关,与BMI、腰臀比呈负相关。结论IMT、cfPWV和ABI能较好地反映糖尿病临床前期动脉硬化,ISI、BMI、W/R为新诊断DM患者动脉硬化的危险因素。cfPWV较IMT、ABI更敏感,I-IFG可能并非早期动脉硬化的危险因素。

Clinical research on atherosclerosis in patients with impaired glucose regulation

Objective To observe the changes of atherosclerosis indexes in patients with impaired glucose regulation（IGR） and to investigate their relation to atherosclerotic risk factors. Methods A total of 31 newly diagnosed type 2 diabetes mellitus （DM） patients, 286 IGR patients including 36 isolated impaired fasting glycaemia （I-IFG）, 108 isolated impaired glucose tolerance （I-IGT） and 142 IFG ＋ IGT, another 102 healthy controls matched for age and sex were enrolled in the study. The clinical data including age, sex, smoking, body mass index, blood pressure, fasting and postprandial 2 hours blood glucose （OGTT）, fasting lipid, fasting insulin and waist hip ratio （W/R） were collected. Intimal-medial thickness （IMT）, carotid-femoral pulse wave velocity （cfPWV） and ankle-brachial index （ABI） were detected. Results The basic data of the five groups were similar （ all P 〉 0. 05）. Compared to the control group, the other 4 groups had higher BMI, W/R and ISI （ all P 〈 0. 05 ）, but no significances were found among them （ all P 〉 0. 05 ）. Compared to the control group, IFG ＋ IGT, I-IGT and DM groups had increasing IMT, cfPWV and decreasing ABI （ all P 〈 0. 05） except I-IFG group （P 〉 0. 05 ）. Significance was found in cfPWV between DM and I-IGT group, but not in ABI and IMT. Correlation analysis showed that in I-IGT group, IMT and cfPWV were negatively related to ISI, and positively correlated to BMI and W/R. ABI was positively correlated with ISI, and negatively related to BMI and W/R （ all P 〈 0. 05）. Conclusions IMT, cfPWV and ABI are indicators of atherosclerosis in IGR patients, and cfPWV is more sensitive than IMT and ABI, I-IFG may be not risk factor of atherosclerosis.