糖调节受损者血浆纤溶系统与颈动脉病变的关系研究

A study of the correlation between plasma fibrinolytic system and carotid artery disease in patients with impared glucose regulation

目的观察非糖尿病人群不同糖调节受损者(IGR)血浆纤溶系统和颈动脉内膜-中层厚度(IMT)病变的差异性,并分析其相关影响因素。方法以386例IGR、32例初诊糖尿病为研究对象,以50例健康者为正常对照组。应用发色底物法和酶联免疫吸附双抗体夹心法测定组织型纤溶酶原激活剂(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1)活性和D-二聚体(D-Dimer)含量。并通过彩色多普勒超声检查颈动脉IMT。结果①与对照组比较:IGR组PAI-1、t-PA、IMT差异有显著性(P<0.05);DM组PAI-1,t-PA差异有高度显著性(P<0.01),而IMT差异为P<0.05。IGR组与DM组比较:PAI-1和IMT差异均有显著性(P<0.01或P<0.05)。②IGR不同亚组与对照组比较:IFG组差异无显著性(P>0.05);IGT组PAI-1,IMT差异有显著性(P<0.05);IFG加IGT组PAI-1、t-PA、IMT差异均有显著性(P<0.01和P<0.05)。③在IGR组中分别以PAI-1和IMT为因变量,以年龄、性别、BMI、WHR、FBG、TG、TC、HbA1c等因素为自变量进行回归分析。显示年龄、TG、BMI、WHR和HbA1c为PAI-1的独立相关因素;而PAI-1、TC与IMT相关。结论①在IGR中IGT和IFG+IGT患者纤溶系统功能已出现紊乱且颈动脉内中膜厚度增厚,提示大血管病变已开始。②在IGR中多种代谢因素影响PAI-1和IMT水平。

Objective To investigate the difference between plasma fibrinolytic system and intima-media thickness of the carotid artery in non-diabetic patients with different degree of impared glucose regulation（IGR） and to analyse its relative risk factors.Methods 386 patients with IGR and 32 patients with newly diagnosed type-2 diabetes mellitus（DM） were chosen as researchers,and 50 healthy people were selected for control group.The tissue-type plasminogen activator（t-PA）,plasminogen activator inhibitor-1（PAI-1） activity,D-Dimer levels were measured by using chromogenic substrate method and double antibody sandwich enzyme-linked immunosorbent assay.The intima media thickness of carotid artery was detected by using color Doppler ultrasonography.Results ①Compared with control group： there were statistically difference of PAI-1,t-PA and IMT in IGR group（P〈0.05）;and there were statistically significant differences in PAI-1and t-PA in DM group（P〈0.01）,and there was statistical difference of IMT in DM group（P〈0.05）.Compared IGR group with DM group： there were statistical difference in PAI-1 and IMT（P〈0.01 or P〈0.05）.② Compared IGR subgroups with control group： there were not statistical difference in IFG subgroup（P〉0.05）;there were statistical differences of PAI-1 and IMT in IGT group（P〈0.05）;there were statistical differences of PAI-1,t-PA and IMT in the IFG plus IGT subgroup（P〈0.01 or P〈0.05）.③In IGR subgroup,the regression analysis was carried out, taking PAI-1 and IMT as the dependent variables,respectively,and taking age,sex,BMI,WHR,FBG,TG,TC and HbA1c as the independent variables.The data showed that age,TG,BMI,WHR and HbA1c were independent determinants of PAI-1 in these patients.The level of PAI-1,TC was positively correlated with IMT.Conclusion ①The fibrinolytic system function was irregular and intima media thickness of carotid artery has gradually been thickened in these patients with IGR subgroups,i.e.the IFG＋IGT subgroups,it indicated that great vascular disease developed.②The levels of PAI-1and IMT were influenced by many metabolism factors in patients with IGR.