2型糖尿病患者护骨素与内皮依赖性血管舒张功能的关系

Relationship between plasma osteoprotegerin and endothelium-dependent arterial dilation in type 2 diabetic patients

目的探讨2型糖尿病患者护骨素与内皮依赖性血管舒张功能(EDAD)的关系。方法选择40例新诊断的2型糖尿病患者和46名健康个体。2型糖尿病患者采用胰岛素治疗6个月。血浆护骨素采用ELISA法测定。采用高分辨血管外超声法检测肱动脉血流介导的EDAD和硝酸甘油介导的内皮非依赖性血管舒张功能。结果2型糖尿病患者治疗前血浆护骨素为(3.44±0.52)ng/L,明显高于对照组(2.38±0.25)ng/L(P<0.01),治疗6个月后血浆护骨素水平明显降低(2.61±0.55)ng/L(P<0.01)。2型糖尿病患者治疗前EDAD为(3.19±0.52)%,明显低于对照组的(4.46±0.56)%(P<0.01),治疗6个月后明显改善(4.18±0.48)%(P<0.01)。多元相关分析显示,治疗前血浆护骨素与EDAD、空腹血糖(FPG)、HbA_(IC)、超敏C反应蛋白(CRP)相关(均P<0.01)。治疗前后护骨素的变化与EDAD、FPG、HbA_(IC) CRP的变化相关(P<0.01)。结论新诊断的2型糖尿病患者血浆护骨素水平明显增高,血浆护骨素与血管内皮功能相关。

Objective To research the relationship between plasma osteoprotegerin （OPG） level and endothelium-dependent arterial dilation （EDAD） in type 2 diabetic patients. Methods The subjects included 40 newly diagnosed type 2 diabetic patients and 46 healthy subjects. Insulin therapy were then given to all diabetic patients for 6 months. Plasma OPG was measured by a sandwich ELISA method, and brachial artery diameter was determined by high resolution ultrasound at rest after reactive hyperemia and after sublingual glyceryl trinitrate （GTN）. Results Plasma OPG level in diabetic patients before treatment was （3.44 ± 0.52）ng/L, which was significantly higher than that in control （2.38 ± 0.25 ）ng/L （P 〈 0.01 ）, and was decreased markedly after 6- month treatment （2.61 ±0.55） ng/L （P 〈0.01 ）. EDAD in patients before treatment was （3.19 ±0.52）%, which was significantly lower than that in control （4.46 ± 0.56 ） % （ P 〈 0.01 ）, and improved markedly after 6 months treatment （4.18 ± 0.48 ）% （P 〈 0.01 ）. In multivariate analysis, OPG was significantly associated with EDAD, fasting plasma glucose （FPG）, HbA,c and ultra sensitive C-reactive protein （CRP） at baseline （all P 〈 0.01 ）. The absolute change in OPG showed significant correlation with the changes in EDAD, FPG, HbA,c, and CRP in diabetic patients during the course of treatment （ all P 〈 0.01 ）. Conclusion Plasma OPG level is elevated in newly diagnosed diabetic patients and is significantly associated with vascular endothelial function.