2型糖尿病经颅多普勒改变与尿微量白蛋白及血浆内皮素关系研究

Relationships of cerebral hemodynamic changes measured by transcranial Doppler with levels of urinary albumin and plasma endothelin in patients of type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者经颅多普勒改变(TCD)与尿微量白蛋白(UAlb)及血浆内皮素(ET)的关系。方法根据尿白蛋白排泄率(UAER)将T2DM患者50例分为正常白蛋白尿组(NA)、微量白蛋白尿组(MA)、临床白蛋白尿组(ODN)三组,健康志愿者21例为对照组(NC)。采用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、血总胆固醇(TC)、甘油三酯(TG)、糖化血红蛋白和内皮素(ET)等。结果T2DM各亚组间TG、UAlb、ET有显著性差异(P<0.05)。除NA组ACA、PCA、BA外,T2DM各亚组受检动脉Vp值均明显高于NC组(P<0.05或P<0.01);T2DM各亚组间差异有显著性(P<0.05)。除NA组PCA外,T2DM各亚组受检动脉PI值均明显高于NC组(P<0.05或P<0.01);T2DM各亚组间亦有显著性差异(P<0.05)。多元逐步回归分析显示,T2DM患者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T2DM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T2DM脑血流动力学异常。

Objective To identify the relationship of cerebral hemodynamic changes with urinary albumin （UAlb） and plasma endothelin （ET） in type 2 diabetes mellitus. Methods Fifty eases of type 2 diabetes mellitus were divided into three groups according to urinary albumin excretion （URAE） ： Normoalbluminuria （NA） group, microalbluminuria （MA） group, overt diabetic nephropathy （ ODN ） group; Twenty - one healthy volunteers as normal control （NC）group .The flow velocities （Vp） and the pulsatility index （PI） of the extracanial carotid artery （ICA）, middle cerebral artery （MCA）, anterior cerebral （ACA）, posterior cerebral artery （PCA） and basilar artery （BA） were measured with transeranial Doppler （TC D）. UAIb and plasma ET were measured by radio innnunoassay （RIA） in all subjects. Results TG, UAlb, ET were different significantly among the subgroup in type2 diabetes mellitus （P 〈 0.05）.The Vp of all measured artery in type2 diabetes mellitus were significantly higher than those in NC group （ P 〈0.01 or P 〈 0.05） ;Excluded ACA,PCA and BA in NA group,the Vp were significant difference among the subgroup in type 2 diabetes mellitus （P〈0.05）. The PI of all measured artery in type 2 diabetes mellitus were significantly higher than those in NC group （ P 〈 0.01 or P 〈 0.05） ; excluded PCA in NA group, the PI were also significant difference among the subgroup in type 2 diabetes mellitus （P 〈0.05）. iutiple 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 UAlb and ET are major influencing factors of the cerebral hemodynamic changes in type 2 diabetes mellitus. Lipid metabolism is the next. UAlb and ET play a role in the initiation and progression of cerebral hemodynamie changes in type 2 diabetes mellitus. TCD is more useful in early diagnosis and treatment.