氧化应激与糖耐量异常患者早期动脉硬化的关系及机制探讨

摘要：目的观察从糖耐量正常、糖耐量受损（IGT）iS!；糖尿病（DM）发展过程中血清丙二醛（MDA）、超氧化物歧化酶（SOD）和血清可溶性细胞间黏附因子-1（sICAM-1）、可溶性血管细胞黏附因子-1（sVCAM-1）的变化，探讨其致糖尿病早期动脉硬化的机制。方法93例初诊患者，其中糖耐量正常（NGT）组30例，IGT组28例，2型糖尿病（T2DM）$H35例，测定MDA、SOD、sICAM-1和sVCAM-1及超声检测颈动脉内膜中层厚度。结果从糖耐量正常、糖耐量受损至糖尿病，随着糖代谢异常的加重，颈动脉内膜中层逐渐增厚，MDA、sICAM-1和sVCAM-1逐渐升高，血SOD逐渐降低fP〈0．05）。颈动脉IMT与血清MDA、slCAM-1、sVCAM-1呈正相关，与血清SOD呈负相关；血清sICAM-1、sVCAM-1和MDA呈正相关，与SOD呈负相关。结论糖代谢异常早期即有氧化应激发生并导致了血管内皮损伤，其机制可能和血中slCAM-1与sVCAM-1升高所导致的糖代谢异常患者血管内皮细胞损伤有关。

The Relationship between the Early Atherosclerosis and Oxidative Stress in the Populations with Abnormal Glucose Metabolism and Study of its Mechanisms

Objective To investigate the change of serum malondialdehyde （MDA）, superoxide dismutase （SOD） and soluble intercellular adhesion molecule-1 （sICAM-1）, soluble vascular cell adhesion molecular-1（sVCAM-1） in normal glucose tolerance （NGT）, impaired glucose tolerance （IGT） and type 2 diabetes mellitus （T2DM） patients, and explore the mechanism of early atherosclerosis induced by diabetes. Methods The level of serum MDA, SOD and slCAM-1, sVCAM-1 in 93 subjects including 30 with NGT, 28 with IGT and 35 with DM was measured by biochemistry and their carotid IMT was detected by ultrasonics. Results From NGT, IGT to DM, the carotid IMT was increased gradually with the aggravation of abnormal glucose metabolism, whereas the level of serum SOD decreased and MDA increased respectively （P〈0.05）. This study showed the positive correlation between IMT and serum MDA and negative correlation between IMT and serum SOD （P〈0.05）; There was significantly positive correlation of sICAM-1, sVCAM-1 with the serum level of MDA （P〈0.05）, and negative correlation of slCAM-1, sVCAM-1 with the serum level of SOD （P〈0.05）. Conclusion Oxidative stress plays an important role in the early stage of diabetic atherosclerosis and its progression. The mechanism of oxidative stress in atherosclerosis may be related to the increase of slCAM-1, sVCAM-1 and impaired vasodilatation function.