炎症因子与2型糖尿病患者颈动脉内膜中层厚度的关系

Relationship between level of inflammatory factors and carotid intima-media thickness in patients with type 2 diabetes mellitus

目的探讨炎症因子与2型糖尿病患者颈动脉内膜中层厚度（IMT）的关系。方法50例2型糖尿病患者，根据胰岛素抵抗指数分为胰岛素抵抗组（IR组）26例及非胰岛素抵抗组（NIR组）24例，同时选取24名健康体检者为对照组。3组患者均行超声检查颈动脉IMT，测定空腹血糖（FPG）、空腹胰岛素（FINS）、血脂、超敏C反应蛋白（hs．CRP）及肿瘤坏死因子（TNF-α）等指标，采用自我平衡模型分析法（HOMA）计算胰岛素抵抗指数（HOMA—IR）。结果对照组、NIR组及IR组患者的HOMA-IR、hs—CRP、TNF．d及IMT水平均逐渐增加，且3组间比较差异均有统计学意义[HOMA—IR：1．74±0．49、2．24±0．41、4．89±0．84（F=190．228，P〈0．01）；hs．CRP：（1．75±0．83）、（3，08±1．04）、（5．89±1．17）mg／L（F=106．523，P〈0．01）；TNF-α：（15．25±7．64）、（23．38±8．82）、（47．42±9．97）ng,／L，（F=89．210，P〈0．01）；IMT：（0．69±0．31）、（1．07±0．32）、（1．49±0．43）mm（F=30．942，P〈0．0I）]；相关性分析显示hs—CRP水平与HOMA。IR、IMT水平呈正相关（r值分别为0．453、0．395，P均〈0．05），TNF-α水平与HOMA．IR、IMT水平呈正相关（r值分别为0．428、0．376，P均〈0．05），HOMA—IR水平与IMT水平呈正相关（r=0．403，P〈0．05）。结论2型糖尿病患者存在炎症反应，并与胰岛素抵抗密切相关，炎症因子与胰岛素抵抗在2型糖尿病患者颈动脉粥样硬化的发生、发展过程中起着重要的作用。

Objective To explore the relationship between the levels of inflammatory factors and carotid intima-media thickness（IMT） in patients with type 2 diabetes mellitus （T2DM）. Methods Fifty patients with T2DM were recruited and divided into T2DM with insulin resistance（IR） group（26 patients） and T2DM without insulin resistance （ NIR ） group （ 24 patients ） according to insulin resistance index （ HOMA-IR ）. Twenty-four healthy individuals conducting physical examination were recruited as the healthy control group. All participants underwent carotid ultrasound IMT to assess carotid intima-media thickness. The level of fasting plasma glucose （FPG） ,fasting insulin（FINS）, blood lipids, high sensitivity C reactive protein （hs-CRP） and tumor necrosis factor-a（TNF-ot） were measured. Homeostasis model assessment （HOMA）index was used for quantitative analysis of HOMA-IR. Results The levels of HOMA-IR,hs-CRP,TNF-oL and IMT in control group,NIR group and IR group increased gradually and were significantly different（ HOMA-IR： （ 1.74 ±0. 49） vs. （2. 24 ±0.41 ） vs.（4.89±0.84）;F=190.228,P〈0.01）;hs-CRP（mg/L）：（1.75±0.83） vs. （3.08±1.04） vs. （5.89± 1.17） ;F= 106. 523,P 〈0.01） ;TNF-ct（ng/L） ：（15.25 ±7.64） vs. （23.38 ±8. 82） vs. （47.42 ±9.97） ;F= 89. 210,P〈0.01） ;IMT（mm） ：（0.69 ±0. 31） vs. （1.07 ±0. 32） vs. （1.49 ±0.43） ;F =30. 942,P 〈0.01） ± Correlation analysis showed that the level of hs-CRP was positively correlated with the levels of HOMA-IR and IMT（ r = 0. 453 and 0. 395 respectively, P 〈 0.05 ） ;The level of TNF-α was positively correlated with the levels of HOMA-IR and IMT （ r = 0. 428 and 0. 376 respectively, P 〈 0. 05 ） ; The level of HOMA-IR was positively correlated with the level of IMT（ r = 0. 403, P 〈 0. 05 ）. Conclusion Inflammatory activity is found in patients with T2DM, which is significantly correlated with insulin resistance. Inflammatory factors and insulin resistance play an important role in the occurrence and development of carotid atherosclerosis in patients with T2DM.