糖耐量异常与颈动脉血管壁弹性的关系及相关因素分析

Relationship between impaired glucose tolerance and early-stage carotid atherosclerosis stiffness and related factors

目的在一组选择人群中调查糖耐量异常(IGT)患者的早期血管病变状况。方法按照葡萄糖耐量试验(OGTT)结果将120例受试者分为糖耐量正常组(NGT)60例和IGT组60例,进行颈动脉超声检查,利用超声机带的血管回声跟踪技术,测量并计算出压力应变弹性系数(Eρ)、僵硬度(β)、和动脉顺应性(AC)。受试者均检测血糖、血脂、胰岛素水平。结果在IGT组β值和Eρ值均较NGT组升高,8.96±1.39 vs 7.17±1.25,(121.37±10.18)kPavs(96.42±7.64)kPa(P<0.05),AC值有所下降(0.78±0.11)mm2/kPa vs(0.95±0.10)mm2/kPa(P<0.05)。IGT组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、胰岛素抵抗指数对数转换值(HOMA-IR)较NGT组升高(均P<0.05)。单因素相关分析显示颈动脉僵硬度β值与HOMA-IR、餐后2小时血糖、TG、TC呈正相关(r=0.818,0.769,0.846,0.632,均P<0.05)。结论与NGT相比,IGT已经具有较显著意义的颈动脉弹性指标的改变,表明早期动脉硬化改变早在IGT阶段就已经开始。血糖、特别是OGTT 2小时血糖、HOMA-IR及血脂与糖代谢异常患者的早期血管病变指标有相关性。

Objective To investigate the early-stage blood vessel state among people with impaired glucose tolerance. Methods 120 patients were divided into normal glucose tolerance group（NGT group,60 cases） and impaired glucose tolerance group （IGT group, 60 cases） by the result 75 g oral glucose tolerance test（75 g OGTT）. Carotid artery stiffness indexes including pressure-strain elastic modulus Eρ, stiffness parameter 13 and arterial compliance AC were calculated by E-tracking（ET） technique of ultrasonic instrument and E-DMS. Meanwhile, blood glucose, plasma lipid and insulin lelvel were measured in all subjects. Results β-value and E9 value in IGT group were higher than those in NGT group, 8. 96 ±1.39 vs 7.17±1.25,（121.37±10.18） kPa vs （96.42±7.64） kPa（P 〈0.05）. AC value descended in IGT group comparing with NGT group （0.78±0.11） mm^2/kPa vs （0.95±0.19） mm^2/kPa（both P 〈 0.05）. The level of total cholesterol（TC）,triglyceride （TG）,low-density lipoprotein cholesterol（LDL-C） and HOMA- IR in IGT group were significently higher than those in NGT group（all P 〈0.05）. Single-factor regression analysis revealed a positive correlation between carotid artery stiffness β value and HOMA-IR, 2 hPG, TG, TC. Conclusion Comparing with those in NGT group, carotid artery elastic indexes were significantly changed in IGT group. Blood glucose level, specially for OGTT 2 hPG, HOMA-IR and blood lipid in impaired glucose metabolism patients were related to early-stage blood vessel degeneration indexes.