初诊2型糖尿病患者尿微量白蛋白与血管内皮功能的关系

Correlation between micro-albuminuria and vascular endothelial function in newly diagnosed type 2 diabetes patients

目的观察伴或不伴微量白蛋白尿（MAU）初诊2型糖尿病患者血管内皮功能情况，探讨MAU与血管内皮功能的关系及其发生机制。方法将初诊2型糖尿病患者依据24小时尿微量白蛋白排泄率分为伴微量白蛋白尿组（MAU组）、不伴微量白蛋白尿组（NA组），MAU组34例，NA组96例，以50例正常受试者作为对照；采用彩色多普勒超声技术测定反应性充血时血流介导肱动脉舒张功能（FMD）和硝酸甘油介导的肱动脉舒张功能（NMD）。并测定空腹血糖（FBG）、糖化血红蛋白（HbA1c）、空腹胰岛素、血脂，并依据空腹血糖、空腹胰岛素计算胰岛素抵抗指数（HOMA—IR）。结果MAU组、NA组的FBG、甘油三酯（TG）、总胆固醇（TC）、HbA1c、HOMA—IR高于对照组（P〈0．01）；MAU组的FBG、TG、TC、HbA1c、HOMA—IR高于NA组（P〈0．01）。与对照组相比，MAU组、NA组的FMD均受损，但MAU组较NA组受损更为明显，三组间比较NMD无明显差异。结论初诊2型糖尿病患者已存在内皮功能受损，不伴MAU的患者血管内皮功能受损较轻，伴MAU的患者血管内皮功能受损更为严重，其发生与伴MAU的患者血糖、血脂紊乱程度及胰岛素抵抗程度更为严重有关。

Objection To observe vascular endothelial function in newly diagnosed type 2 diabetes patients with and without micro-albuminuria and explore the correlation between micro-albuminuria and vascular endothelial function and its pathogenesis. Methods The patients with type 2 diabetes were divided into two groups,normal albuminuria（NA） group and micro-albuminuria（MA） group. Fifty healthy volunteers were enrolled as control. All subjects were measured fasting blood glucose, blood lipid, HbAlc, fasting Serum insulin, according fasting blood glucose and fasting Serum insulin, insulin resistance index were calculated. Flow-mediated dilation （ FMD ） and nitroglycerin mediated dilation （ NMD ） of brachial artery were measured with high resolution uhrasound, FMD and NMD respectively represent endothelium-dependant vascular dilation function and endothelium-independent vascular dilation function. Results FBG,TG,TC, LDL-C, HbA1c, HOMAIR in NA group and MAU group were higher than those in normal control group （P 〈0.01 ）. FBG,TG,TC, LDL-C, HbA1c, HOMAIR in MAU group were higher than those in NA group（ P 〈 0.01 ）. Compared with the normal control group, FMD was impaired in NA group and MAU group ,which was worse in MAU group, there was no obviously difference in NMD among three groups. Conclution FMD was impaired in newly diagnosed type 2 diabetes;the more disorder of blood glucose, blood lipid, HOMAIR contribute to the more impaired FMD in patients with miero-albuminuria.