糖耐量减低患者是否需要早期干预 内皮相关因子异常与心血管疾病的危险性

Whether the patients with impaired glucose tolerance requiring early intervention or not: abnormality of endothelium-related indices and risk of cardiovascular disease

目的：探讨糖耐量减低患者是否具有与糖尿病患者相似的内皮相关因子异常，了解内皮相关因子与心血管疾病危险因素的关系。 方法：①选择2002-06／2003-05在首都医科大学附属北京同仁医院心血管中心门诊就诊和住院患者89例。设糖耐量减低者38例为糖耐量减低组，男21例，女17例。设明确除外冠心病的患者20例为单纯糖尿病组，男10例，女10例。设确诊为糖尿病合并冠心病患者31例为糖尿病合并冠心病组，男19例，女12例。选择同期本院进行健康体检健康者20人为对照组，男10人，女10人。均对检测项目均知情同意。②用酶联免疫吸附法检测血浆血管性假性血友病因子、凝血酶调节蛋白、纤溶酶原激活物抑制物1水平。③计量资料差异性测定采用单因素方差分析，q检验(方差齐时)及扩展了的t检验(方差不齐时)。数据间相关性采用多元线性逐步回归检验。 结果：患者89例及健康者20人均进入结果分析。①血管性假性血友病因子：糖耐量减低组和单纯糖尿病组及糖尿病合并冠心病组明显高于对照组(P<0．01)。②凝血酶调节蛋白水平：糖耐量减低组、单纯糖尿病组、糖尿病合并冠心病组、对照组相近(P>0．05)。③纤溶酶原激活物抑 制物1水平：糖耐量减低组、单纯糖尿病组、糖尿病合并冠心病组明显高于对照组(P<0．05～0．01)；糖耐量减低组高于单纯糖尿病组的糖尿病合并冠心病组(P<0．01)。④相关性：糖耐量减低组患者血管性假性血友病因子与C肽呈显著正相关(r=0．442，P<0．05)；纤溶酶原激活物抑制物1与饮酒史无明显相关性(r=0．469，P=0．07)，与总胆固醇、病程呈显著正相关(r=0．659，0．766，P<0．01)。而糖尿病患者血管性假性血友病因子与病程呈显著正相关(r=0．316，P<0．05)；Ln(凝血酶调节蛋白)与糖化血红蛋白呈显著正相关(r=0．292，P=0．046)；纤溶酶原激活物抑制物1与性别、血小板计数、凝血酶原时间、糖化血红蛋白呈显著正相关(r=0．447～0．86，P<0．05～0．01)。 结论：①糖耐量减低作为糖尿病的前驱阶段，已经存在内皮相关因子水平的异常，主要反映为血管性假性血友病因子、纤溶酶原激活物抑制物1水平异常。②糖耐量减低内皮相关因子异常与糖尿病相比在与病程相关方面具有相似性，这反映了糖耐量减低发展为糖尿病过程的某种连续性。③糖耐量减低患者与糖尿病、糖尿病合并冠心病患者内皮相关因子异常方面具有某些相似性，糖耐量减低患者可能与糖尿病具有相类似的致心血管疾病的危险性。

AIM： To study the abnormality of endothelium-related indices, which was in the diabetes patients, whether in patients with impaired glucose tolerance （IGT） or not, and understand the relation between endothelium-related indices and the risk of cardiovascular disease. METHODS： ① Eighty-nine patients, who were hospitalized and diagnosed in out-patient clinic of Cardiovascular Therapy Center, Beijing Tongren Hospital Affiliated to Capital University of Medical Sciences from June 2002 to May 2003, were selected. The 38 patients with IGT were considered as IGT group, including 21 males and 17 females. The 20 patients without coronary heart disease were considered as simple diabetes group, including 10 males and 10 females. The 31 patients with diabetes combined with coronary heart disease were considered as diabetes combined with coronary heart disease group, including 19 males and 12 females. Twenty healthy people, who made health examination at the same period in this hospital, were selected as controlled group, including 10 males and 10 females. They were all agreed to take the experiment. ② The von Willebrand＇s disease factors in plasm, adjusted protein of thrombase and inhibitor 1 of activator of plasminogen were detected with enzymelinked immuno-sorbent assay. ③ The difference of measurement data was detected with single factor analysis of variance, q-test （when the variance was regular） and expanded t-test （when the variance was irregular）. The correlation among data was tested with multiple linear stepwise regression. RESULTS： Eighty-nine patients and 20 healthy people were all involved in the result analysis. ① The yon Willebrand＇s disease factors： It was significantly higher in the IGF group, simple diabetes group and diabetes combined with coronary heart disease group than that in the controlled group （P 〈 0.01 ）. ② Level of adjusted protein of thrombase： It was similar in the IGF group, simple diabetes group and diabetes combined with coronary heart disease group and controlled group （P 〉 0.05）. ③ Level of inhibitor 1 of activator of plasminogen： It was higher significantly in the IGF group, simple diabetes group and diabetes combined with coronary heart disease group than that in the controlled group （P 〈 0.05-0.01 ）; It was higher in the IGT group than that in the simple diabetes group, and diabetes combined with coronary heart disease group （P 〈 0.01 ）. ④ Correlation： The yon Willebrand＇s disease factors in patients of IGT group had significantly positive correlation with C peptide （r=-0.442,P 〈 0.05）; The inhibitor 1 of activator of plasminogen had insignificant correlation with drinking history （r=0.469,P=0.07）, and had obviously positive correlation with total cholesterol and progress （r=-0.659, 0.766,P 〈 0.01 ）. The von Willebrand＇s disease in diabetes patients had markedly positive correlation with progress （r=0.316, P 〈 0.05）; Ln （adjusted protein of thrombase） had significantly positive correlation with glycosylated ferrohemoglobin （r =0.292,P=0.046）; The inhibitor 1 of activator of plasminogen had significantly positive correlation with sex, platelet counting, prothrombin time and glycosylated ferrohemoglobin （r=-0.447-0.86, P 〈 0.05-0.01 ）. CONCLUSION： ① There is the abnormality of endothelium-related indices in the patients with IGT that is the early period of diabetes, which mainly reflects the abnormality of level of yon Willebrand＇s disease factors and inhibitor 1 of activator of plasminogen. ② IGT has the similar abnormality of endothelium-related indices as diabetes, which is related with progress. It reflects that the development of IGT is a certain of continuum in diabetes progress. ③ The abnormality of endothelium-related indices in the patients with IGT is similar to those with diabetes or with diabetes and coronary heart disease. The patients with IGT may have the similar risk induce to cardiovascular disease with the diabetes.