糖耐量受损人群颈动脉内中膜厚度与各代谢指标的关系

The study on the association of the carotid intima-media thickness with the metabolic indices in impaired glucose tolerant subjects

目的探讨不同糖耐量人群颈动脉内中膜厚度(IMT)的差异及其与各代谢指标的相关关系.方法收集11名正常人、12例单纯性肥胖患者、新诊68例糖耐量受损(IGT)患者及25例空腹血糖受损(IFG)合并IGT患者的临床资料,利用Bergman最小模型技术(MMM)计算胰岛素敏感指数(ISI),并以彩色多普勒超声测量受试者的颈总动脉(CCA)和颈内动脉(ICA)的IMT.结果(1)CCA-IMT在IGT组及IFG+IGT组显著高于正常组及肥胖组(P值分别为＜0.01及＜0.05),但前两组之间及后两组之间差异均无统计学意义;ICA-IMT在各组间差异无统计学意义.(2)相关研究显示,在所有IGT患者中(包括IFG+IGT),CCA-IMT与年龄、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及ISI呈显著正相关,与体质指数(BMI)及腰围呈显著负相关(P＜0.05～0.01);ICA-IMT与年龄、TC及ISI呈显著正相关,与BMI呈显著负相关(P＜0.05～0.01).(3)偏相关分析显示,在校正了年龄因素的影响后,CCA-IMT及ICA-IMT值与TC、LDL-C、BMI、腰围及ISI值之间无显著相关.结论初发的IGT患者中颈动脉IMT值已有显著升高,而在校正了年龄因素的影响后,没有观察到包括血脂异常、胰岛素抵抗及中心性肥胖在内的各种代谢异常状态对早期动脉粥样硬化(AS)的影响.由此预示IGT是早期AS的独立危险因素.

Objective To investigate whether early carotid atherosclerosis indicated by intima-media thickness (IMT) is different among different glucose tolerant state and to study the association of IMT with the metabolic indices in IGT subjects. Methods Eleven normal control subjects, 12 obese subjects with normal glucose tolerance, 68 newly diagnosed impaired glucose tolerance(IGT) subjects and 25 IGT plus impaired fasting glucose(IFG) subjects were recruited. The insulin sensitivity index (ISI) was assessed by using Bergman’s minimal model method (MMM), and IMT of CCA and ICA were measured using B mode colorful Doppler ultrasonography. Results (1) Compared with normal group and obese group, the CCA-IMT value were significantly increased in IGT and IGT plus IFG groups (P<0.01,P<0.05 respectively), and there was no difference between normal and obese groups and between IGT and IGT plus IFG groups. The ICA-IMT values showed no difference among all these four groups. (2) When the IGT and IGT plus IFG groups were considered as whole, the CCA-IMT value was positively correlated with age, TC, LDL, and ISI, and negatively associated with BMI, WHR(r=0.327, 0.293,0.304, 0.363, -0.310, -0.326 respectively, all P<0.05). The ICA-IMT values were also positively correlated with age, TC, ISI, but negatively associated with BMI, WHR (r= 0.406, 0.267, 0.342, -0.699 respectively, P<0.001, <0.05, <0.05, <0.001 respectively)(3) Partial analyses showed that when adjusted by age, the associations between IMT(CCA-IMT and ICA-IMT) and the above factors were no longer existed. Conclusion In Shanghai district the carotid artery IMT values are significantly increased among those newly diagnosed IGT, which predicts IGT as an independent vascular risk factor. But after being adjusted by age, the metabolic indices such as dislipidemia, insulin resistance and central obesity do not show any impact on the early atherosclerosis.