新诊断2型糖尿病FMD与血脂的关系及罗格列酮的干预作用

Relationship Between Vascular Endothelial Function and Serum Lipid in Patients With Newly Diagnosed Type 2 Diabetes Mellitus and the Therapeutic Effect of Rosiglitazone

目的本研究通过检测新诊断2型糖尿病(T2DM)患者罗格列酮(RGZ)治疗前后血管内皮依赖性舒张功能(FMD)和血清脂质水平及其变化,探讨RGZ对T2DM血管内皮依赖性舒张功能的改善及对血清脂质的影响。方法新诊断T2DM患者71人分配至2组:罗格列酮+二甲双胍组37人;二甲双胍组34人,并选正常对照组30人。均进行空腹血糖(FPG)、餐后血糖(PPG)、肝肾功能、胰岛素、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、游离脂肪酸(FFA)的检测,随后肱动脉超声检查评价FMD。治疗组追踪观察12周后复测上述指标。结果治疗前T2DM与正常对照组FPG、PPG、HbA1C、TG、HDL-C、FFA、HOMA-IRI和FMD的差异有统计学意义(P<0.01);治疗前后罗格列酮+二甲双胍组在TG、FMD、FFA和HDL-C上的差异有统计学意义(P<0.01)。多元线性回归分析显示影响FMD的因素依次为FFA、SBP、HDL-C、FPG和TG(P<0.05)。结论新诊断T2DM患者存在FMD障碍,HDL-C水平降低和TG、FFA水平升高,相关分析提示T2DM患者FMD障碍与血脂水平有关;罗格列酮治疗可显著改善T2DM患者FPG、TG、FFA、HDL-C和FMD。

Objective To study the vascular endothelial function by measured brachial artery flow- mediated dilatation （FMD） and the relation between FMD and serum lipid profiles in patients with newly diagnosed type 2 diabetes mellitus （T2DM）. To investigate the beneficial mechanisms of rosiglitazone （RGZ） in improving vascular endothelial function by assessing FMD and serum lipid lever both before and after RGZ therapy. Methods Seventy- one patients with newly diagnosed T2DM were assigned into two groups, RGZ ＆ metformin group （n= 37） and metfon-nin group （n= 34）. Another 30 healthy persons were recruited as the control group. The levels of fasting plasma glucose （FPG）, postprandial plasma glucose （PPG）, hemoglobinA1c（HbA1c） , fasting insulin （Fins）, triglyceride （TG）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL- C） and free fatty acids （FFA） were determinecl in all participants subsequently. FMD was assessed by using high resolution ultrasound test for measuring the patients＇ vascular endothelial functions. All measurements were repeated twice in T2DM patients before and after a 12 - week therapy. Results There were statistically significant differences between T2DM patients and the control group from baseline in FPG, PPG, HbAlc, TG, HDL-C, FFA, HOMA-IRI and FMD （P〈O.O1）. At the endpoint of this 12- week study, FMD and HDL-C were significantly increased while TG and FFA were significantly decreased in the RGZ ＆ metformin group as compared with the metfonrmin alone group （P〈O. 01）. Multiple linear stepwise regression revealed that the influencing factors for FMD were FFA, SBP, HDL - C, FPG and TG in a descending series （ P〈 O. 0.5）. Conclusions There existed a flow- mediated vasodilatation dysfunction, reduced HDL- C level, and elevated TG and FFA levels in patients with T2DM. Pearson correlation analysis indicates that vascular endothelial dysfunction has a relationship with serum lipid. RGZ can significantly improve FPG, TG, FFA, HDL- C and FMD in patients with newly diagnosed T2DM.