不同糖耐量状态下黏附分子水平变化及其与颈动脉内膜中层厚度的关系

Relationship between the Thickness of Carotid Intimal-Medial and Serum Adhesion Molecule Levels in Populations of Different Glucose Tolerance

目的研究从糖耐量正常、糖耐量减低至糖尿病发展过程中可溶性血管细胞黏附分子-1(sVCAM-1)和可溶性细胞间黏附分子-1(sICAM-1)的变化,探讨二者与糖尿病早期动脉硬化颈动脉内膜中层厚度(IMT)的关系。方法选取糖耐量正常者30例(NGT组)、糖耐量减低者50例(IGT组)、2型糖尿病(T2DM)患者55例(T2DM组),检测3组受试者血生化指标及sVCAM-1、sICAM-1水平,用超声检测颈动脉IMT。结果 NGT组、IGT组、T2DM组受试者血sVCAM-1、sICAM-1水平及颈动脉IMT逐渐增高,组间两两比较差异有统计学意义(P<0.05)。相关研究显示,颈动脉IMT与血清sVCAM-1、sICAM-1成正相关,sICAM-1和sVCAM-1与体质指数、餐后2 h血糖、三酰甘油及胰岛素抵抗指数均呈正相关(P<0.05)。结论糖代谢异常早期即有炎症反应发生,并导致了血管内皮损伤,参与了糖尿病动脉硬化的整个进程。血清sVCAM-1和sICAM-1水平升高与肥胖、糖脂代谢异常及胰岛素抵抗有关。

Objective To investigate the changes of serum sVCAM -1 and sICAM -1 levels in normal glucose tolerance （NGT）, impaired glucose tolerance （IGT） and type 2 diabetes mellitus （DM） patients, as well as the associations of these changes with early diabetic atherosclerosis which is mirrored by the index of carotid intimal - medial thickness （IMT）. Methods A total of 135 （30 NGT, 50 IGT and 55 DM） subjects were enrolled, with their serum levels of sVCAM - 1 and sI- CAM - 1 determined by biochemistry and carotid IMT measured by ultrasonics. Results Carotid IMT measurements, serum sV- CAM - 1 and sICAM - 1 levels increased gradually in the order of NGT, IGT, and T2DM patients, with significant differencesbetween any two groups （ P 〈 O. 05 ） . This study also revealed positive correlations between IMT and serum sVCAM - 1, sICAM - 1 levels; positive correlations between serum sVCAM - 1, sICAM - 1 levels and body mass index （ BMI）, 2 - h plasma glu- cose （2 hPG）, triglyceride （TG） and homeostasis model assessment - insulin resistence （ HOMA - IR） （ P 〈 0. 05 ）. Conclusion Inflammatory reaction plays an important role during the early stage of diabetic atherosclerosis and also during its progression. The elevation of serum sVCAM -1 and s/CAM- 1 levels is correlated with of obesity, glycolipid metabolic disorder and insulin resistance.