血糖调节受损者的颈总动脉结构及功能改变

Structural and functional changes of common carotid artery in patients with impaired glucose regulation

目的采用高频超声射频数据处理技术评估血糖调节受损(IGR)患者的颈总动脉结构及功能改变,探讨其空腹血糖、负荷后血糖、胰岛素抵抗指数对数转换值(HOMA-IR)与颈总动脉内-中膜厚度(IMT)及弹性的相关性。方法对102例患者进行口服葡萄糖耐量试验(OGTT),其中IGR 57例(IGR组),45例糖耐量正常(NGT组)。使用高频超声射频数据处理技术分别获得两组患者颈动脉IMT、颈总动脉扩张性(CD)、单点脉搏波传播速度(PWVβ)和僵硬度(β)等参数,进行对比分析,并分析其与血糖、HOMA-IR的相关性。结果与NGT组相比,IGR组颈总动脉弹性已发生改变,β、PWVβ增高,CD降低,而IMT无明显改变。IGR组的CD、β、PWVβ均与空腹血糖、负荷后血糖、HOMA-IR呈正相关。结论糖代谢异常早期已存在动脉弹性参数异常,并与血糖及HOMA-IR相关,表明高血糖及胰岛素抵抗在动脉粥样硬化的发病中有重要作用。高频超声射频数据处理技术为早期诊断糖代谢异常患者的动脉病变提供了一种有效方法。

Objective To observe the changes of common carotid arterial structure and function in patients with impaired glucose regulation（IGR） using high frequency ultrasound radiofrequency data（RF-data） technology,so as to find out the correlation between fasting glucose,post-challenge glucose,derived insulin resistance（HOMA-IR） and common carotid arterial intima-media thickness,as well as elasticity.Methods Totally 102 patients were divided into IGR group（57 cases）and normal glucose tolerance group（NGT group,45 cases） according to the result of oral glucose tolerance test（OGTT）.All patients accepted carotid ultrasonography with RF-data.The differences of the values of carotid intima-media thickness（IMT）,carotid distensibility（CD）,local pulse wave velocity（PWVβ） and stiffness（β） were compared between the two groups,then the correlation of the above indexes with blood glucose and HOMA-IR were analyzed,respectively.Results Compared with NGT group,the common carotid arterial elasticity of the IGR group changed,common carotid arterial PWVβ and β increased while CD decreased,but no difference of IMT was found.The level of fasting glucose,post-challenge glucose and HOMA-IR positively correlated with PWVβ,β and CD.Conclusion The abnormality of arterial elasticity has existed in the early stage of abnormal glucose metabolism,and positively correlates with blood glucose and HOMA-IR,indicating that hyperglycemia and insulin resistance play an important role in the pathogenesis of atherosclerosis.RF-data technology is a valid approach to diagnose the early atherosclerosis in patients with IGR.