肥胖2型糖尿病患者血管内皮功能的影响因素及吡格列酮干预治疗

目的研究肥胖2型糖尿病患者血管内皮功能的影响因素及吡格列酮的治疗作用。方法新诊断肥胖2型糖尿病患者30例,正常对照组25例,治疗前后分别检测血清APN、HOMA-IR、TG、HDL、BMI,同时利用超声检测反应性充血肱动脉内径增加程度FMD。结果肥胖2型糖尿病患者FMD及APN水平较正常对照明显降低,吡格列酮治疗后FMD显著改善（7.15±3.20 vs10.36±4.55,P〈0.01）、APN升高（6.94±2.58 mg/L vs 9.77±3.16 mg/L,P〈0.01）。多元相关分析显示,FMD与APN、HDL呈显著正相关（r=0.592,r=0.306,P〈0.01）,与FBG、HOMA-IR呈负相关（r=-0.285,r=-0.291,P〈0.01）,与年龄、性别、BMI、TG无关。结论2型糖尿病患者存在明显的内皮功能紊乱及低脂联素血症,吡格列酮可通过多种途径起到改善血管内皮功能的作用。

Effects of pioglitazone on endothelial function and serum adiponectin in type 2 diabetic patients with obesity

Objective To investigate the effect of pioglitazone on endothelial dysfunction and serum adiponectin in newly detected type 2 diabetic patients with obesity.Methods The study included 30 type 2 diabetic patients with obesity and 25 healty subjects.The patients received pioglitazone at 15-30 mg daily for 16 weeks.The endothelium-dependent flow-mediated dilatatio（FMD）of brachial artery was determined with ultrasound,and the levels of APN,FBG,HDL,TG,HOMA-IR in all subjects were measured respectively at baseline and after treatment.Results Pioglitazone markedly improved FMD（7.15±3.20 vs 10.36±4.55,P〈0.01）and APN 6.94±2.58 mg/L vs 9.77 ±3.16 mg/L,P 〈0.01）,glycemic control and insulin sensitivity were improved.There was positive correlation between FMD and APN.Conclusion There are endothelial dysfunction and hypoadiponectin in type 2 diabetic patients with obesity,pioglitazone may improve endothelial function.