强化生活方式干预对糖耐量异常人群亚临床动脉粥样硬化的影响

Effect of lifestyle intervention on the early arteriosclerosis among individuals with impaired glucose tolerance

目的探讨强化生活方式干预对糖耐量异常人群亚临床动脉粥样硬化的影响。方法符合糖耐量异常诊断标准的受试者127例,被随机分为强化生活方式干预组和非干预组(对照组)。共随访12个月。所有受试者在随访前后均测定体质指数(BMI)、腰围、腰臀比、收缩压、舒张压、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)和胰岛素抵抗指数(HOMA-IR),并测定颈股脉博波速度(cf-PWV)、心踝血管指数(CAVI)和踝臂指数(ABI)。结果两组基线时各项指标差异无统计学意义。随访资料显示,干预组应用强化生活方式干预12个月后BMI、腰围、腰臀比、血压、血脂、血糖、HbA1c及HOMA-IR与本组基线水平及对照组比较均显著降低(均P<0.05),对照组TG、LDL-C、2hPG、HbA1c较基线时升高(均P<0.05),其余指标无明显变化;与本组基线时水平及对照组随访时比较,干预组cf-PWV、CVAI显著降低(分别为10.5±3.1 vs 9.2±2.9和8.7±1.2 vs 6.8±1.7,均P<0.05),ABI明显升高(0.97±0.16 vs 1.05±0.17,P<0.05)。对照组cf-PWV、CVAI和ABI与基线时比较差异无统计学意义。结论在糖耐量异常人群中应用强化生活方式干预,可使各项代谢指标以及动脉管壁僵硬度或动脉弹性明显改善。

Objective To understand the effect of lifestyle intervention on the subclinical arteriosclerosis among individuals with impaired glucose tolerance （IGT） . Methods A total of 127 subjects with IGT were randomized into an lifestyle intervention group and control group. All subjects were followed up for 12 months. Before and after the follow-up, body mass index, waist circumference, waist-hip ratio, systolic pressure, diastolic pressure, total cholesterin, triglyceride, HDL-C, LDL-C, fasting plasma glucose, 2 hour postprandial plasma glucose, HbAlc and insulin resistant index （HOMA-IR）, as well as carotid-femoral pulse wave velocity （c{-PWV）, cardio-ankle vascular index （CAVI） and ankle-brachial index （ABI） were all measured. Results There were no significant differences among all the parameters in baseline level between two groups. However, 12 months after lifestyle intervention, body mass index, waist circumference, waist-hip ratio, blood pressure, lipid profile, plasma glucose, HbAle and HOMA-IR as well as cf- PWV and CAVI all significantly decreased （P〈0.05） compared to both baseline level and those in control group, while ABI increased （P〈0.05） . All parameters almost remained the same except for triglyceride,LDL-C, plasma glucose and HbAlc which elevated compared to baseline level （P〈0.05） in control group. Conclusions The lifestyle intervention has demonstrated a favorable effect on progression of arteriosclerosis among individuals with IGT by improving those important metabolic indicators and arterial elasticity closely related to arteriosclerosis, hence lifestyle modification maybe an effective therapeutic strategy to be adopted as a first step to slow early arteriosclerosis in asymptornatic individuals.