糖耐量异常和2型糖尿病患者内皮依赖性血管舒张功能的变化及其影响因素分析

目的:观察糖耐量异常(IGT)和2型糖尿病(T2DM)患者内皮依赖性血管舒张功能(FMD)的变化及其影响因素.方法:IGT及T2DM患者共124例,分成IGT组(36例)、糖尿病无血管病变组(DM1组,57例)、糖尿病有血管病变组(DM2组,31例),另选年龄性别匹配的正常人为正常对照组(NC组,25例).用高分辨超声技术检测FMD,亚硝酸还原法检测血清一氧化氮(NO);ELISA法检测血清肿瘤坏死因子(TNF-α)和高敏C反应蛋白(hs-CRP),同时检测血糖、血脂及其他代谢指标.结果:与正常对照组比较,IGT和T2DM组甘油三脂(TG)、胆固醇(TC)、hs-CRP、TNF-α均显著升高(P＜0.05),高密度脂蛋白(HDL-C)、NO和FMD下降(P＜0.05),随着糖尿病病程的进展,FMD呈不断下降的趋势.直线相关分析显示IGT和T2DM患者FMD与糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、TG、TC、hs-CRP、TNF-α呈负相关(P＜0.01),与NO和HDL-C呈正相关(P＜0.01),多元逐步回归分析显示影响FMD的因素依次为NO,HbA1c,HDL-C,HOMA-IR,TNF-α及hs-CRP.结论:IGT及2型糖尿病患者存在血管内皮依赖性血管舒张功能受损,且与高血糖、胰岛素抵抗、高血脂和炎症反应等因素有关.

Changes of endothelium-dependent vasodilation in patients withimpaired glucose tolerance and Type 2 diabetes

OBJECTIVE: To investigate the changes of endothelium-dependent flow-mediated dilation (FMD) in patients with impaired glucose tolerance (IGT) and Type 2 diabetes(T2DM) and its influencing factors. METHODS: The patients with IGT and T2DM were divided into IGT group(n=36), T2DM without vascular complication group(DM1;n=57), and T2DM with vascular complication group(DM2;n=31).And 25 normal subjects served as controls (NC group). The FMD was measured by high resolution ultrasound.The serum levels of tumor necrosis factor-alpha(TNF-alpha) and high sensitive C-reactive protein (hs-CRP) were detected with ELISA, and nitric oxide(NO) with Griess Reaction. The serum glucose, lipids, and other indexes were also detected. RESULTS: Compared with the NC group, the serum levels of triglyceride(TG) total cholesterol(TC), low density lipoprotein-cholesterol(LDL-C), hs-CRP, and TNF-alpha significantly increased (P<0.05), but the serum levels of high density lipoprotein-cholesterol (HDL-C), the NO, and FMD significantly decreased (P<0.05) in the IGT, DM1, and DM2 group. With the progress of diabetes, FMD level descended. Pearson correlation analysis showed a negative correlation between FMD and glycosylated hemoglobin (HbA1c), insulin resistant index (HOMA-IR),TG,TC,hs-CRP, and TNF-alpha(P<0.01), but a positive correlation between FMD and NO,HDL-C(P<0.01) in IGT and T2DM patients. In multiple linear stepwise regression with FMD as dependent variable, NO,HbA(1)c,HDL-C,HOMA-IR, TNF-alpha, and hs-CRP showed a significant association with FMD(P<0.01). CONCLUSION: Endothelium-dependent vasodilation is impaired in patients with IGT and T2DM,which is associated with hyperglycaemia, insulin-resistance, hyperlipemia, and inflammation.