不同病程2型糖尿病患者内皮依赖性血管舒张功能的变化

Change of endothelial dependent vasodilation in patients with different courses of type 2 diabetes

目的探讨不同病程2型糖尿病(type 2 diabetes mellitus,T2DM)患者内皮依赖性血管舒张功能(flow-mediated dila-tion,FMD)的变化以及FMD与空腹血糖及糖化血清蛋白的关系。方法随机选择住院的T2DM患者100例(T2DM组),根据患病时间的长短,分为3个亚组,病程小于1年的37例(T2DM1组),病程1-5年的33例(T2DM2组);病程5-10年的30例(T2DM3组);另选年龄、性别相匹配的健康对照者40例(NC组)。所有对象均接受高频超声检测肱动脉血管FMD,同时检测所有受试对象空腹血糖(fasting plasma glucose,FPG)、糖化血清蛋白(glycated albumin,GA)、甘油三酯(triglyceride,TG)、胆固醇(total cholesterol,TC)、低密度脂蛋白(low-density lipoprotein cholesterol,LDL-C)水平及其他代谢指标,并计算胰岛素抵抗指数(homeostatic model assessment-insulin resistance,HOMA-IR)指标。结果与NC组相比,T2DM三组患者FMD显著下降(P<0.01),而GA、FPG、HOMA-IR、TG、TC、LDL-C水平显著增高(P<0.05)。T2DM2、T2DM3组GA、FPG、HOMA-IR、TG、TC、LDL-C较T2DM1组明显升高(P<0.05),而T2DM2组与T2DM3组之间各指标无明显差异(P>0.05)。结论 2型糖尿病患者无论病程长短,其内皮依赖性血管舒张功能(FMD)均已经明显下降,且随着2型糖尿病病程的延长,血管内皮功能逐渐降低,表明其更易发生糖尿病血管病变。

Objective To investigate the changes of endothelial dependent dilation（FMD） in the different disease course patients with type 2 diabetes,and the relationship between FMD and fasting plasma glucose,glycosylated serum protein.Methods One hundred patients with T2DM were collected and divided into 3 groups according to the duration of the disease：〈1 year group（n=37）,1-5 years group（n=33）,5-10 years group（n=33）.Forty normal controls with matched age and sex were chosen as control group.All subjects underwent high frequency ultrasound to detect the brachial artery FMD.Fasting plasma glucose（FPG）,glycosylated serum protein（GA）,triglyceride（TG）,cholesterol（TC）,low density lipoprotein（LDL-C）,fasting insulin levels and other metabolic markers were simultaneously detected,and the insulin resistance index（HOMA-IR） was calculated.Results Compared with NC group,FMD decreased significantly in T2DM group（P〈0.01）,while GA,FPG,HOMA-IR,TG,TC,LDL levels increased significantly（P〈0.05）.FPG,HOMA-IR,GA,TG,TC,LDL in 1-5 years group and 5-10 years group were significantly higher than those in 〈1 year group（P〈0.05）,but there was no significant difference between 1-5 years group and 5-10 years group（P〉0.05）.Conclusion The endothelium-dependent dilation（FMD）significantly decreases in type 2 diabetes patients,and with the extension of the disease duration,vascular endothelial function reduces gradually,which suggests that FMD is more susceptible to develope the diabetic vascular diseases.