2型糖尿病患者总胆汁酸、甘胆酸水平及辨证分型与糖尿病大血管病变的相关性

目的:探讨2型糖尿病(T2DM)患者血清总胆汁酸(TBA)、甘胆酸(CG)水平及中医辨证与糖尿病大血管病变之间的关系。方法:选取符合标准的患者125例,将其分为合并大血管病变组(A组)和无大血管病变组(B组)。A组64例,B组61例。观察两组患者之间TBA、CG的差异,探讨其与低密度脂蛋白胆固醇(LDL-C)以及大血管病变的关系。结果:A组患者糖尿病病程长于B组,LDL-C高于B组,而TBA及CG低于B组,差异均有统计学意义(P<0.05)。通过Logistic回归分析发现糖尿病病程和LDL-C是糖尿病大血管病变的危险因素(OR=5.155),而血清TBA和CG水平为糖尿病大血管病变的保护因素(OR=0.747,OR=0.856)。A组湿热困脾证患者占比较高(33/64),且TBA水平显著低于阴虚热盛证与气阴两虚证(P<0.05)。结论:TBA和CG可能促进LDL-C在人体内代谢清除,从而起到大血管的保护作用;湿热困脾证患者TBA水平较低,且在糖尿病大血管病变占比较高,因此对湿热困脾证患者临床上需紧密关注及预防大血管事件的发生发展。

Correlation between Diabetic Macroangiopathy and Total Bile Acid,Glycocholic acid and Syndrome Differentiation in Patients of Type 2 Diabetes Mellitus

Objective:To investigate the relationship between diabetic macroangiopathy and the levels of serum total bile acid(TBA),Cholyglycine(CG)and syndrome differentiation in type 2 diabetes mellitus(T2DM).Methods:Totally 125 cases who met the criteria of carotid plaques were selected,64 cases with macroangiopathy in group A and 61 cases without macroangiopathy in group B.The differences of TBA and CG between two groups and the relationship with LDL-C were observed.Results:Group A showed longer duration of diabetes mellitus than group A and higher LDL-C than group B,while group A showed lower TBA and CG than group B.The difference was statistically significant(P<0.05).Logistic regression analysis showed that diabetic duration and LDL-C were risk factors for diabetic macroangiopathy(OR=5.155),while that levels of TBA and CG were protective factors for diabetic macroangiopathy(OR=0.747,OR=0.856).According to TCM syndrome differentiation,it was found that the TBA level with dampness-heat syndrome was significantly lower than that with Yin deficiency and heat excess syndrome and Qi-Yin deficiency syndrome(P<0.05).Conclusion:TBA and CG may promote the metabolic clearance of LDL-C in the body,thus playing a protective role of large vessels;from the perspective of TCM dialectical classification,patients with damp-heat-trapped spleen type have a lower level of TBA,and a higher proportion of diabetic macroangiopathy,so for this type of patients in clinical need to pay close attention to and prevent the occurrence of macrovascular events.