老年DM患者脂餐后脂蛋白(a)水平变化及其对血管内皮功能的影响

The Change of Postprandial Lipoprotein(a) and Its Effect on Endothelial Function in Elderly Patients with Type 2 Diabetes Melletus

目的:探讨老年2型糖尿病(2-DM)患者脂肪餐负荷后脂蛋白a[LP(a)]水平变化及其对血管内皮功能的影响。方法:选取25例老年2-DM患者(DM组)及24例健康志愿者(对照组),均给与脂肪餐试验,分别于空腹和餐后2、4、6h抽血化验LP(a),采用B超检测空腹颈动脉内中膜厚度(IMTc)和血管内皮依赖性舒张功能(FMD0)及餐后4hFMD4。结果:与空腹时比较,脂餐后各时段2组自身LP(a)的水平比较差异不明显,与对照组比较,DM组空腹及餐后LP(a)的水平、IMTc、FMD0均明显增高(P<0.05);LP(a)水平与IMTc、FMD呈正相关(r=0.36、0.45,均P<0.05)。结论:老年DM患者有明显的LP(a)血症,LP(a)血症可以一过性损伤血管内皮功能,是动脉粥样硬化的独立危险因素。

Objective; To explore the change of postprandial lipoprotein（a） and its effect on endothelial function in elderly patients with type 2 diabetes melletus（DM）. Methods; The subjects were assigned to two groups; the elderly type 2-DM group and the healthy control group. Lipoprotein（a） was measured before and 2, 4 and 6 h after a fatty meal （600 kcal, 60% fat, 14% protein, 26% carbohydrate）. Carotid IMT, FMD fasting and 4 h after the meal were measured by ultrasonography. Results： Compared with the healthy control group, a slight increase of LPa, IMTc and ΔFMD and a slight decrease of FMD0 and FMD4 were found in type 2 DM group （P〈0.05）; FMD4 was significantly declined after the meal in both groups. The level of lipoprotein（a） was positively correlated with IMTc （r= 0. 11, P〈0. 05） and AFMD （r= 0.02, P〈0.05）. Conclusion： The increased lipoprotein（a） level in the elderly type 2 DM induced endothelial dysfunction and was one independent risk factor of atherosclerosis.