2型糖尿病人微血管舒张功能测定及其影响因素分析

Measurement and analysis of microcirculation dysfunction in type 2 diabetic patients

目的:用毛细血管恢复试验测定2型糖尿病人和糖耐量正常人的微血管舒张功能并分析其影响因素。方法:2型糖尿病患者共276人按性别(男/女)、病程(<5年,5-10年,≥10年)、家族史(有/无)及体型(体重指数≥25kg/m2/<25kg/m2)分组,比较毛细血管恢复率(%)的差异。同时,对20名糖耐量正常人进行微血管舒张功能的测定。结果:20名[平均年龄为(60.56±6.73)岁]口服糖耐量试验正常者的平均毛细血管恢复率为(36.50±9.48)%。2型糖尿病人平均年龄为(64.94±10.72)岁,平均毛细血管恢复率为(27.68±12.48)%,明显低于正常人(P<0.05)。随着糖尿病病程延长,毛细血管恢复率呈递减趋势,分别为(29.63±13.85)%、(27.45±12.23)%、(25.75±10.90)%(P<0.05)。有糖尿病家族史和体型肥胖者比对照组的毛细血管恢复率明显降低(P<0.05),但不同性别之间毛细血管恢复率没有显著差异。结论:2型糖尿病人毛细血管恢复率比糖耐量正常人明显降低,提示2型糖尿病人有明显的微血管舒张功能障碍,肥胖、病程和糖尿病家族史与微血管舒张功能的障碍密切相关。

AIM： To measure microcirculation function in type 2 diabetic patients and non - diabetic subjects with a new measurement method called capillary recruitment. METHODS： 276 type 2 diabetic patients in Shanghai downtown were enrolled and categorized into several groups, those with diabetes duration 〈5 years,5 -10 years or 310 years, those with body mass index ≥25 kg/m^2 or 〈25 kg/m^2 and those with or without family history of diabetes. We determined skin capillary recruitment after arterial occlusion with capillaroscopy and compared the percentage increase of capillary density among these groups. 20 non - diabetic subjects were also measured. RESULTS ： The average age of non - diabetic subjects was （60. 56 ±6. 73） years old. The average baseline capillary density was （36. 25 ± 8. 78）/mm^2, with an average peak capillary density of （48. 97 ± 10. 24）/mm^2. The average age of diabetic patients was （64.94 ± 10. 72） years old. The average baseline capillary density was （33.65 ± 9. 78 ）/mm^2, with an average peak capillary density of （42.70 ± 11.74）/mm^2. The diabetes duration increased, as did the percent increase of capillary density [ （29. 63% ± 13.85% ）, （27. 45% ± 12. 23% ）, （25. 75% ±10. 90% ）, respectively]. The percentage increase of those with diabetes family history or body mass index ≥ 25 kg/m^2 was significantly decreased in comparison with controls. There was no significant difference in the percent increase of capillary density between genders. CONCLUSION： We have evaluated the microcirculation function in type 2 diabetic patients and the results show a close relation between dysfunction of microcirculation and obesity, diabetes family history and diabetes duration.