老年糖代谢紊乱患者血管内皮功能与血小板膜糖蛋白的研究

Study on relation between vascular endothelial function and platelet membrane glycoprotein in old patients with T2DM,IGT and IFG

目的检测2型糖尿病(T2DM)、糖耐量异常(IGT)、空腹血糖受损(IFG)患者肱动脉内皮功能的变化与血小板活化程度的关系。方法分别选取老年T2DM(T2DM组)、IGT(IGT组)、IFG(IFG组)患者和健康体检者(对照组)各20例,空腹静脉血测定空腹血糖(FPG)、TG、TC、HDL-C、LDL-C、糖化血红蛋白(HbA1c)、血小板膜糖蛋白CD61和CD62P。采用高分辨率血管外彩色超声测定肱动脉血流介导的血管扩张功能(FMD)和含服硝酸甘油后肱动脉内径变化(NTG)。结果 T2DM组、IGT组、IFG组FMD较对照组明显下降,而T2DM组NTG较IGT组、IFG组、对照组明显下降(P<0.05)。多因素线性相关分析,FMD与FPG、TG、TC、LDL-C呈负相关。T2DM组、IGT组、IFG组CD61和CD62P较对照组明显升高(P<0.05)。CD61与FPG、TC、HbA1c、LDL-C呈正相关,与HDL-C呈负相关;CD62P与FPG、TG、TC、HbA1c、LDL-C呈正相关,与HDL-C呈负相关。FMD与CD61、CD62P呈负相关。结论内皮功能损害和血小板活化在T2DM前期就已经存在,两者互相促进。

Objective To study the relation between degree of platelet activation and the change of brachial artery endothelial function in elderly patients with type 2 diabetes mellitus（T2DM）,IGT and IFG. Methods Twenty patients with T2DM, IFG and IGT and 20 healthy persons （NC group） were enrolled. Fasting blood glucose（FPG）, TG, TC, HDL-C, LDL-C, glycosylated hemo- globin（HbAle） were measured, the expression of platelet membrane glycoprotein CD61 and CD62P was examined. Flow-mediated dilation（FMD） and nitroglycerin-induced dilation（NTG） of brachial artery were assessed using high-resolution color Doppler ultrasound. Results The degree of FMD in T2DM group,IGT group and IFG group was decreased significantly compared with NC group, and the degree of NTG in T2DM group was decreased compared with IGT group, IFG group and NC group （P 〈 0.05）. FMD was negatively correlated with FPG,TG,TC and LDL-C. The expression of CD61 and CD62P was significantly higher in T2DM group,IGT group and IFG group than in NC group. CD61 was positively correlated with FPG, TC, HbA1c and LDL-C, but negatively correlated with HDL-C, CD62P was pogKively correlated with FPG, TG, TC, HbAlc and LDL-C,but negatively correlated with HDL-C by multi-factor analysis of linear correlation. FMD was negatively correlated with CD61 and CD62P. Conclusion Endothelial dysfunction and platelet activation already exist in pre-diabetes stage,which play important roles in the occurrence and development of vascular disease in impaired glucose regulation and T2DM patients.