老年糖代谢异常患者血清炎症因子的变化

Study on the Change of Inflammatory Factors in the Elderly Patients with Abnormal Glucose Metabolism

目的研究老年患者在糖代谢异常各个阶段的炎症因子:血清C反应蛋白(CRP)的变化与糖代谢异常不同阶段血管病变的关系,探讨其临床意义。方法选取120例受试者,其中男性64例,女性56例,年龄(60+2.1)岁。经2次75g葡萄糖耐量试验(OGTT)确诊。正常糖耐量(NGT)组24例,糖耐量受损I(GT)组和2型糖尿病D(M)组各48例。合并大血管病变者48例(2型DM组23例,IGT组21例,NGT组4例),微血管病变17例〔2型DM组16例,IGT组24h尿白蛋白排泄率(UEAR)>20μgm/in(30mg/24h)者1例〕。所有受试者测量身高、体重、腰围、臀围、血压、血糖、血清胰岛素、血脂、24h微量UEAR及血清CRP,计算体质指数B(MI)、腰臀比W(HR)、胰岛素分泌指数H(oma-β)和胰岛素敏感性指数H(omaI-R),并进行比较。结果2型DM和IGT组的大血管病变发生率相似(P>0.05),均高于NGT组(P<0.05)。微血管病变的发生率2型DM组最高(P<0.05),其他组差别无统计学意义(P>0.05)。CRP在2型DM组最高,相关分析显示,CRP与甘油三酯、舒张压等呈正相关,与高密度脂蛋白、Homa-β呈负相关。以是否合并血管病变分组的观察发现,CRP在合并大血管病变组最高(P<0.05),无血管病变组最低(P<0.05)。结论老年患者在IGT阶段即可出现与DM阶段相似的大血管病变,血清CRP的升高可作为糖代谢异常患者大血管病变的标志物。

Objective To study the variation of serum CRP in different stages of abnormal glucose metabolism, analyze the relationship between the levels of CRP and macro- and micro-angiopathy in the elderly patients with DM and with impaired glucose tolerance, and to explore its clinical significance. Methods 120 subjects were selected and divided into three groups, including DM group with 48 cases, IGT 48 cases and NGT 24 cases, according their fasting and 2-hour after meal blood glucoses. The body height, body weight, waistline, hipline, blood pressure, blood glucose, serum insulin, blood lipids, microulbuminuria and CRP were detected in all the subjects. Then the body mass index, waist-to-hip ratio, Homa-β and Homa-IR were calculated and analyzed. Results The prevalence of macroangiopathy was similar in diabetes mellitus group and in abnormal glucose tolerance group, and both were higher than that in normal glucose tolerance group. The prevalence of microangiopathy in diabetes mellitus group was highest among three groups. And there was no significant difference between the prevalence of microanglopathy in two other groups. The level of CRP was highest in diabetes mellitus group, and the analysis showed that CRP was positively related to serum triglyceride and blood pressure （diastolic pressure） and negatively related to HDL-C and Homa-β. Through the observation based on the groups with or without anglopathy, we found that CPR was highest in group with macroanglopathy, lowest in group without anglopathy. Conclusion The results showed that macroanglopathy could also occur in the abnormal glucose tolerance stage as those in the diabetes mellitus stage in elderly people. Increased serum CRP level could be considered as the marker of macroangiopathy.