新诊断2型糖尿病患者血管内皮功能的多因素分析

Multiple-factor analysis of vascular endothelial function in newly diagnosed type 2 diabetes mellitus

目的探讨新诊断2型糖尿病患者血管内皮舒张功能与相关因素间的关系。方法选择我院新确诊的2型糖尿病患者84例,年龄均<60岁,分为早发亚组(年龄≤40岁)和非早发亚组(>40岁),非糖尿病对照组40例。应用美国HP-5500彩色多普勒超声仪测定基础状态、加压后和服用硝酸甘油后肱动脉内径的变化和血流速度。同时测定高敏C反应蛋白(HsCRP)、血糖、血脂等生化指标。结果糖尿病早发亚组和非早发亚组的HsCRP、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后血糖(PPG)、糖化血红蛋白(HbA1c)均显著高于非糖尿病对照组(P<0.05),肱动脉内皮内径变化率显著小于非糖尿病对照组(P<0.05)。内皮依赖性血管舒张功能与HsCRP(r=-0.221,P<0.05)、FPG(r=-0.408,P<0.01)、低密度脂蛋白胆固醇(LDL-C)(r=-0.349,P<0.01)、HbA1c(r=-0.562,P<0.01)、PPG(r=-0.465,P<0.01)呈负相关,与高密度脂蛋白胆固醇(HDL-C)(r=0.279,P<0.05)呈正相关。其中HbA1c、HDL-C、LDL-C与HsCRP为独立影响因素。结论2型糖尿病患者在发病初期已经存在血管舒张功能的损害,且与众多的因素有关。

Objective To appraise the relationship between the vascular endothelial function and correlative factors in newly diagnosed type 2 diabetes patients. Methods 84 newly diagnosed type 2 diabetes patients under 60 years old were divided into two subgroups： early onset subgroup （age ≤40）and non-early onset subgroup（age 〉40）. 40 non diabetes patients were taken as the control group. The internal diameters of the artery at basal state and after applying pressure or taking nitroglycerine were measured by HP-5500 Color Doppler. Correlative factors such as HsCRP,HbA1C,LDL-C,HDL-C,PPG etc. were measured. Results The levels of HsCRP,SBP, DBP,FPG,PPG, H bAlc were significantly higher in the early onset and non-early onset subgroups than those of the control group（P〈0.05）. Comparing with the control group, the proportion of brachial artery diameters in the early onset sub-group and non-early onset sub-group showed an obvious decrease statistically （P〈0.05）. It was negatively correlated with fasting blood glucose （r = - 0. 408, P 〈 0.01） , postprandial blood glucose （ r = -0.465,P〈0.01）,HbA1c（r =-0.562,P〈0.01）,LDL-C （r= -0.349,P〈0.01）and HsCRP（r=-0.221, P〈0.05）, but positively correlated with HDL-C（r= 0. 279, P〈0.05）. HbA1 c, HDL-C, LDL-C and CRP were independent influencing factors. Conclusions Impaired vascular endothelial function is already present in early type 2 diabetes mellitus, and is influenced by multiple factors. （Shanghai Med J, 2005, 28：1027- 1029）