2型糖尿病患者微血管病变与血液流变学变化、胰岛素抵抗的相关性

Relationship of hemorheology and insulin resistance to microangiopathy in type 2 diabetes

目的 :研究血液流变学变化和胰岛素抵抗与 2型糖尿病微血管病变的关系。方法 :检测 10 6例 2型糖尿病患者 ,其中有微血管并发症 5 3例 ,无微血管并发症 5 3例 ,以及 5 3例正常对照组的血液流变学、空腹血糖、空腹胰岛素 ,计算胰岛素敏感性指数 (ISI) ,并进行比较。结果 :糖尿病两组全血粘度和血浆粘度均显著高于正常对照组 ;ISI则显著低于正常对照组 (P<0 .0 1)。糖尿病有微血管病变组全血粘度和血浆粘度显著高于无微血管病变组 ;ISI显著低于无微血管病变组 (P<0 .0 1)。多元逐步回归分析显示 ,2型糖尿病微血管病变与糖尿病病程、血糖、全血粘度和血浆粘度呈显著正相关 (r=0 .62 4,0 .42 8,0 .3 46,0 .3 82 ,P值分别 <0 .0 0 1,0 .0 1,0 .0 5 ,0 .0 1) ,与 ISI呈显著负相关 (r=-0 .3 5 2 ,P<0 .0 5 )。结论 :2型糖尿病微血管病变患者存在持续性的高血糖、高血液粘度 ,糖尿病病程的延长 ,严重的胰岛素抵抗为 2型糖尿病微血管病变的主要危险因素。

Objective: To investigate the relationship of hemorheology and insulin resistance to microangiopathy in type 2 diabetes . Methods:Hemorheology, fasting blood sugar and insulin, and insulin sensitivity index (ISI) were determined in 106 patients of type 2 diabetes (53 with microangiopathy and 53 without microangiopathy) and 53 healthy objects. Results: Whole blood and plasma viscosity significantly increased, and ISI decreased in diabetics and those with microangiopathy, compared with healthy objects and diabetics without microangiopathy (P<0.01), respectively. Multiple stepwise regression analysis showed that microangiopathy was positively correlated with the course, blood sugar, and whole blood and plasma viscosity(r=0.624, 0.428, 0.346, and 0.382, respectively; P<0.001-0.05), and negatively with ISI (r=-0.352, P<0.05). Conclusion: There exist high levels of blood sugar and viscosity in type 2 diabetics with microangiopathy, and the longer course and severe insulin resistance are main risk factors for them.