2型糖尿病病人脑血流动力学改变与尿清蛋白及血浆内皮素的关系

The Relationship between Cerebral Hemodynamic Changes, Urinary Albumin and Plasma Endothelin in Patients with Type 2 Diabetes

目的探讨2型糖尿病(2型DM)病人经颅多普勒改变与尿微量清蛋白(UAlb)及血浆内皮素(ET)的关系。方法健康志愿者21例为对照组(Ⅰ组),根据尿清蛋白排泄率(UAER)将2型DM病人50例分为正常清蛋白尿组(Ⅱ组)、微量清蛋白尿组(Ⅲ组)、临床清蛋白尿组(Ⅳ组)。采用经颅多普勒(TCD)检测颈内动脉(ICA)、大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)、基底动脉(BA)收缩期峰血流速度(Vp)和脉动指数(PI),测定UAlb、及血脂等。结果2型DM各亚组间TG、UAlb、ET有统计学意义(P<0.05)。多元逐步回归分析显示,2型DM病人脑血流动力学改变与UAlb、ET、TG呈正相关(β=0.326,P<0.001;β=0.298,P<0.001;β=0.157,P<0.05)。结论UAlb和ET参与了2型DM脑血流动力学改变的发生和发展。TCD有助于早期发现和防治2型DM脑血流动力学异常。

Objective To identify the relationship between cerebral hemodynamic changes,Urinary albumin (UAlb) and plasma endothelin (ET) in patients (pts) with type 2 diabetes.Methods The control group (GroupⅠ) included 21 volunteers.Fifty patients (pts) with type 2 diabetes mellitus were divided into three groups according to urinary albumin excretion (URAE):20 pts with normal abluminuria (GroupⅡ),16 pts with micro-albluminuria (GroupⅢ),14 pts with clinical diabetic nephropathy (Group Ⅳ).The flow velocities and the pulsatility index (PI) of the extra cranial carotid artery (ECA), middle cerebral artery (MCA),anterior cerebral(ACA),posterior cerebral artery(PCA) and basilar artery (BA) were measured by transcranial Doppler (TCD).UAlb and plasma ET were measured by radio immunoassay(RIA) in all subjects.Results triglyceride,UAlb,ET were different significantly among the pts with type 2 diabetes mellitus.The Vps of all measured artery in pts with type 2 diabetes mellitus were significantly higher than that in GroupⅠ(P<0.01 or P<0.05) but for ACA,PCA and BA in GroupⅠ.The Vps were significant difference among the pts with type 2 diabetes mellitus(P<0.05).Mutiple regression analysis showed that cerebral hemodynamic changes were correlated with UAlb,ET,TG respectively (β=0.326,P<0.001;β=0.298,P<0.001;β=0.157,P<0.05).Conclusion The results suggest that UAlb and ET be the major factors for the cerebral hemodynamic changes in type 2 diabetes.Ualb and ET play a role in the initiation and progress of the cerebral hemodynamic changes in type 2 diabetes. TCD is a more useful way in early diagnosis and treatment for pts with type 2 diabetes.