糖耐量低减患者颈动脉内膜中层厚度与胰岛素敏感性的关系研究

Relationship between intima-media thickness of carotid arteries and insulin s ensitivity in patients with impaired glucose tolerance

目的:探讨糖耐量低减(IGT)患者颈动脉内膜中层厚度(IMT)值与机体胰岛素敏感性和胰岛素分泌功能的关系。方法:对47例按世界卫生组织1999年标准确诊的IGT患者和20名健康对照者进行研究。运用高分辨率B型超声仪检测受试者的颈动脉IMT,同时检测血糖、血清胰岛素、糖基化血红蛋白(HbA1c)、尿微量白蛋白排泌率(UAER)和血脂,并计算HOMA胰岛素抵抗指数(HOMAIR)和胰岛B细胞分泌指数(HOMAIS)以分别反映机体的胰岛素敏感性和胰岛素分泌功能。结果:IGT患者的颈动脉IMT值显著高于正常对照(P<0.01),HOMAIR指数和HOMAIS指数均低于正常对照(P<0.01)。进一步将患者分为合并空腹血糖异常(IFG)组(IGT1组)和单纯IGT组(IGT2组)后发现,IGT1组的颈动脉IMT值显著高于血糖相对较低的IGT2组(P<0.05)。线性相关分析显示,IGT患者的颈动脉IMT值均与HbA1c、空腹血糖、BMI、舒张压和HOMAIR指数呈显著正相关(P<0.5)。结论:IGT患者颈动脉IMT值高于正常人,而且与糖尿病患者胰岛素抵抗发生、发展有密切的关系。

Objective To investigate the relationship between intima-media thickness of carotid arteries （IMT） levels and insulin sensitivity in patients with impaired glucose tolerance （IGT） . Methods IMT of carotid arteries was determined with high-sensitive B-mode ultrasound in 47 patients with IGT and 20 normal controls. The plasma glucose, serum insulin, glycoslated hemoglobin （HbA1c）, urine albumin elution rate （UAER）, plasma lipids and lipoprotein were also measured. Moreover, homeostasis model analysis （HOMA） -insulin resistance index （HOMA-IR） and HOMA-islet secretion （HOMA-IS） were calculated to estimate the insulin sensitivity and islet function. Results In patients with IGT, IMT were increased, HOMA-IR index and HOMA-IS index were decreased as compared with normal subject （P 〈 0.01）. Moreover, IMT was thicker in IGT patients with impaired fasting glucose（IFG） than that in simple IGT patients . Liner regression analysis in IGT patients showed that, IMT positively correlated with fasting plasma glucose, HbA1c diastolic blood pressure, and HOMA-IR index respectively. Conclusion IMT of carotid arteries is thicker in patients with IGT than that in normal subjects, and play a role in the onset and development of insulin resistance in IGT.