血糖对血管内皮功能的影响及相关影响因素的分析

Effect of plasma glucose on the vascular endothelial function and analysis of relevant factors

目的：比较新诊断糖耐量异常（IGT）、2型糖尿病（T2DM）患者和正常对照血管内皮依赖性舒张功能（FMD）并探讨不同血糖水平时FMD的影响因素。方法：新诊断IGT和T2DM患者119人根据血糖高低分为3组：IGT组34人、DM1组（空腹血糖7～9mmol／L）52人、DM2组（空腹血糖9～10mmol／L）33人及正常对照组（NC）25人。所有受试者均进行血糖、血脂、胰岛素、糖化血红蛋白的检测，随后肱动脉超声检查评价FMD。结果：IGT组、DM1组、DM2组及NC组间FMD的差异有统计学意义（P=0．008）。偏相关分析显示FMD与胰岛素抵抗指数（HOMA—IRI）、血糖差值（DPG）、空腹血糖（FPG）、餐后血糖（PPG）呈高度负相关（P〈0．01），与HbA1c呈负相关（P〈0．05）；多元逐步回归分析显示与FMD有关的入选因子，在IGT组为WHR和HOMA—IRI；DM1组为HOMA—IRI，PPG和DPG；在DM2组为FIG和HOMA—β。结论：新诊断IGT和T2DM患者FMD与血糖尤其是血糖的波动相关；不同血糖水平时FMD的影响因素不同。

Objective To compare the flow-mediated dilatation （FMD） among the newly diagnosed impaired glucose tolerance （ IGT ） , type 2 diabetes mellitus （ T2 DM ） , and the normal controis （NC） and to analyze relevant factors under different glucose levels. Methods The study included IGT （n =34） , DM1 （n =52） , DM2 （n =33） and NC （n =25）. Levels of fasting plasma glucose （FPG）, 2-hour postprandial plasma glucose （PPG）, fasting insulin （FINS）, 2-hour postprandial insulin （PINS）, triglyceride （TG）, total cholesterol （TC）, and hemoglobinA1c （HbA1c） were determined in all participants. High resolution ultrasound examining FMD was performed to measure vascular endothelial function subsequently. Results There was statistically significant difference between IGT, DM, HG and NC group in FMD （P = 0. 008 ）. Partial correlation analysis found that a significant negative correlation existed between FMD and homeostasis model assessment- index （ HOMA- IRI ） , difference of plasma glucose （ DPG ） , FPG and PPG （ P 〈 0.01 ） , and a negative correlation between FMD and HbA1c （ P 〈 0.05 ）. Setting FMD as dependent variable to conduct multiple linear stepwise regression, in IGT group it was the waist/hip ratio （ WHR ） and HOMA-IRI that entered the regression equation; in DM1 group it was HOMA-IRI, PPG and DPG that entered the regression equation; in DM2 group it was FPG and HOMA-β that entered the regression equation. Conclusion There exists a flow-mediated vasodilatation dysfunction in patients of newly diagnosed IGT and T2DM. Effect of relevant factors on FMD differs with different glucose levels.