2型糖尿病患者糖化血红蛋白与脉搏波传导速度及内皮依赖性血管舒张功能的关系研究

HbAlc is positively associated with pulse wave velocity and Flow-mediated dilation in the patients with type 2 diabetes

目的探讨2型糖尿病患者不同糖化血红蛋白（HbAlc）水平与踝臂动脉脉搏波传导速度（baPWV）及内皮依赖性血管舒张功能（FMD）的关系。方法对338例2型糖尿病患者按HbAlC水平分为正常组（A组，HbAlc≤6．0％，74例），正常高值组（B组，6．0％〈HbAlC≤6．5％，102例）和升高组162例（c组，HbAlC〉6．5％），测量BaPWV及FMD作为反映大动脉硬度及血管舒张功能的指标。结果与A组比较，B、c组BaPWV明显增高[（1734±343）cm／s与（1537±313）cm／s；1853±364）cm／s与（1537±313）cm／s；P均〈0．001），与B组比较，c组BaPWV明显升高[（1853±364）cm／s与（1734±343）cm／s；P=0．006）。与A组比较，B、c组FMD明显减低[（4．20±3．13）％与（5．29±3．92）％；（4．09±2．79）％与（5．29±3．92）％；P均〈0．01）]。直线相关分析显示，BaPWV与HbAlc水平呈正相关（r=0．53，P〈0．01），与FMD水平呈负相关（r=-0．25，P〈0．01）。Logistic回归分析显示，HbAlc（OR32．19，95％CI11．26—53．12；P〈0．001）与年龄（OR14．21，95％CI11．43—17．00；P〈0．001）、收缩压（OR7．36，95％C16．12～8．59；P〈0．001）和胆固醇（OR40．31，95％CI9．97—70．64；P=0．009）为影响BaPWV的独立危险因素。结论2型糖尿病患者BaPWV与HbAlc水平密切相关，将HbAlc控制在理想水平是降低大动脉硬化的手段之一。

Objective To investigate the association between HbAlc status, arterial stiffness and endothelial function in subjects with type 2 diabetes mellitus （DM）. Methods The study group consisted of 338 DM patients,including 74 subjects with normal HbAlc （ ≤ 6.0% ） （Group A）, 102 subjects with mildly increased HbAlc （HbAlc increased by less than 6. 5% ） （Group B）and 162 patients with high HbAle level （ HbA1 c increased by more than 6. 5% ） （ Group C）. All patients were evaluated for glucose, HbAl c, TC and TG. Pulse wave velocity （PWV） and flow-mediated dialation （ FMD ） were performed simultaneously. Results Compared with Group A,Group B and C had higher baPWV（ [ 1734 ± 343 ] cm/s vs. [ 1537 ± 313 ] cm/s and [ 1853 ± 364] cm/s vs. [ 1537 ± 313 ] cm/s）. Patients in Group C had a higher baPWV than those in Group B （ [ 1853 ± 364 ] cm/s vs. [ 1734 ±343 ] cm/s, P = 0. 006）. The patients in group A had a lower level of FMD than that of group B and C （[4.20±3. 131% vs [5.29 ±3.92]% ,[4.09 ±2.79]% vs. [5.29 ±3.921%,P〈 0.01 ）. Leaner association analysis showed a positive correlation between baPWV and HbAlc （ r = 0. 53, P 〈 0. 01 ）. baPWV was negatively correlated with FMD （r = -0. 25 ,P 〈0. 01 ）. Logistic regression analysis showed thatHbAlc （OR32.19%,CI 11.26 -53.1.2,P〈0.001）,age （OR 14. 21,95% CI 11.43 - 17.00,P 〈 0. 001 ） , systolic blood pressure （ OR 7.36,95 % CI 6. 12-8.59） and TC （ OR ：0. 31,95 % CI ： 9. 97-70. 64） were independent predictors for the increased arterial stiffness （baPWV）. Conclusion Arterial stiffness parameters varied significantly across subgroups of patients with different levels of HbAlc and the arterial stiffness was positively associated with deranged glucose homeostasis.