2型糖尿病大血管病变患者的内皮功能与胰岛素抵抗的相关性研究

The endothelial function and it＇s Relationship with Insulin resistance in patients of type 2 diabetic macro-vascular disease

目的 探讨2型糖尿病大血管病变的血管内皮功能与胰岛素抵抗的关系.方法 分别测定糖尿病并发大血管病变组、糖尿病无并发症组与正常对照组的空腹血糖（FPG）、空腹胰岛素（FINS）、糖化血红蛋白A1C（HbA1c）、血清甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白-胆固醇（LDL-C）、高密度-胆固醇（HDL-C）、内皮素-1（ET-1）、血管性血友病因子（vWF）、纤溶酶原激活物抑制物-1（PAI-1）水平和胰岛素抵抗指数（HOMA-IR）. 结果 （1） 2型糖尿病患者FPG、HbA1C、TG、LDL-C及HOMA-IR水平均高于正常对照组,而糖尿病并发大血管病变组患者LDL-C、FINS与HOMA-IR均高于糖尿病无并发症组（均P＜0.01）.（2）2型糖尿病患者ET-1、vWF与PAI-1水平均较正常组明显升高,而糖尿病并发大血管病变组ET-1、vWF水平又明显高于糖尿病无并发症组（均P＜0.01）.（3）2型糖尿病患者ET-1、PAI-1与 HOMA-IR呈正相关.结论 2型糖尿病患者内皮功能受损,而在并发大血管病变时,内皮功能损伤与胰岛素抵抗呈进一步加重;内皮功能障碍与胰岛素抵抗具有相关性,内皮功能障碍与胰岛素抵抗的干预有助于糖尿病性大血管病变的防治.

Objective To investigate the endothelial function and it＇s relationship with insulin resistance in patients of type 2 diabetic macro-vascular disease. Methods Plasma endothelin -1 （ET-1）, von Willebrand factor （vWF） and plasminogen acti- vator inhibitor -1 （PA1-1） were determined in the group of type 2 diabetic patients with macro-vascular diseases, the group of type 2 diabetic patients without complications and the control group. Insulin resistance was assessed by homeostasismodel assessment（HOMA-IR）. Results （1） FPG, HbA1C, TG, LDL-C and HOMA-IR in the type 2 diabetes patients were higher than those in the controls, while LDL-C, FINS and HOMA-IR in diabetic patients with macro-vascular diseases were higher those in diabetic patients without complications（P〈0.01）. （2） The plasma levels of ET-1, vWF and PAl-1 in the type 2 diabetes patients were higher than those in the controls, while The plasma levels of ET-1 and vWF in diabetic patients with macro-vascular diseases were higher those in diabetic patients without complications （P〈0.01）. （3） ET-1, PAl-1 and HOMA-IR in the type 2 diabetic patients was positively related. Conclusions Endothelial function in patients with type 2 diabetes was impaired, while the endothelial dysfunction and insulin resistance in type 2 diabetic patients with macro-vascular diseases further increased. Endothelial dysfunction and insulin resistance is associated in those patients. The intervention of endothelial dysfunction and insulin resistance would contribute the prevention and treatment of diabetic macrovascular disease.