代谢综合征患者餐后血脂对血管内皮功能的损害及其机制研究

目的 探讨代谢综合征(MS)患者餐后血脂与血管内皮功能损害的关系及其机制.方法 选择36名健康人为正常对照组,73例MS患者分为两组:空腹甘油三酯(TG)正常组(MS1)和空腹TG升高组(MS2).MS符合2004年中华医学会糖尿病学分会提出的诊断标准.收集受试者一般资料,于空腹及脂肪餐后4 h,分别采静脉血测血脂、一氧化氮(NO)、内皮素(ET);分别测血管内皮功能.结果 MS1、MS2在脂肪餐后4 h内皮依赖性血管舒张功能较空腹时明显降低(P<0.05,P<0.01).偏相关分析显示:内皮依赖性血管舒张功能与总胆固醇、TG、低密度脂蛋白-胆固醇呈负相关,偏相关系数依次为-0.41、-0.68、-0.36(P<0.01);与高密度脂蛋白-胆固醇呈正相关,偏相关系数为0.44(P<0.01).结论 (1)餐后血脂代谢紊乱,尤其是TG水平升高与MS患者血管内皮功能损害密切相关.(2)MS患者餐后血脂,特别是TG可能通过直接或间接途径导致血管内皮NO与ET失衡,从而引起血管内皮功能的损害.

Study on postprandial lipid injury to vascular endothelium and its mechanism in patients with metabolic syndrome

Objective To investigate postprandial lipid injury to vascular endothelium and its mechanism in patients with metabolic syndrome(MS). Methods 36 healthy human were chosen as normal control group and 73 MS patients were divided into fasting normal triglyceride(TC) group (MS1 ) and fasting high TG group (MS2). MS accorded with diagnostic criteria suggested by Chinese Diabetes Society in 2004. The subjects' common data were collected and venous blood samples were taken to measure lipid,nitric oxide (NO) and endothelin(ET) ,and endothelial function were measured respectively at the time point of 0 hour and 4 hours after fat meal. Results Endothelium-dependent vasodilation function fell more greatly at the time point of 4 hours than that of 0 hour after fat meal in MS, and MS2 (P < 0.05, P < 0.01). Partial correlation analysis showed that endothelium-dependent vasodilation function was negatively related to total cholesterol,TG and low density lipoprotein cholesterol (partial correlation coefficients were - 0. 41, - 0. 68 and -0.36,P <0.01 in turn),and was positively related to high density lipoprotein cholesterol (partial correlation coefficient was 0.44, P < 0.01). Conclusions (1) Metabolic disorder of lipid after fat meal, especially the increase of TG is closely related to vascular endothelial injury in patients with MS. (2) Postprandial lipid, especially TG can lead to imbalance of endothelial NO and ET by direct or indirect way in patients with MS,therefore cause endothelial dysfunction.