糖尿病前期患者的脂联素水平及与血管内皮功能变化的关系

Relation between serum adiponectin and the changes of endothelial function in prediabetic patients

目的检测糖尿病前期、2型糖尿病患者的血清脂联素、超氧化歧化酶(SOD)、丙二醛水平,分析与血管内皮功能改变的关系。方法选择2012-01-12福建医科大学附属第一医院内分泌科就诊的初诊血糖异常患者96例,分为2型糖尿病无血管并发症患者(糖尿病组)30例、2型糖尿病并大血管并发症患者36例(合并症组)和糖耐量受损组(IGT组)30例,并与门诊体检健康者33人(对照组)比较。抽取空腹静脉血分别测定葡萄糖、胰岛素、脂联素、SOD、丙二醛,并行75g葡萄糖耐量试验(OGTT),测服糖后2h血糖(2hPG);采用高分辨率血管外彩超,测定肱动脉基础及反应性充血后的血管内径,以肱动脉反应性充血前后血管内径变化百分比反映内皮依赖性血流介导的血管舒张功能(EDF)。结果与对照组比较,IGT组、糖尿病组、合并症组EDF[(10.46±4.54)%、(7.59±3.29)%、(5.17±2.11)%比(13.08±4.90)%]、SOD[(88.26±5.23)、(77.92±4.95)、(68.05±5.88)比(102.52±4.30)mU/L]、脂联素[(10.08±2.09)、(7.89±2.01)、(5.79±1.56)比(12.05±2.21)mg/L]明显降低,而丙二醛明显升高[(5.00±0.38)、(5.35±0.44)、(6.02±0.24)比(4.08±0.13)nmol/L]。多因素逐步回归分析结果显示,胰岛素抵抗指数(HOMA-IR)和脂联素是影响EDF的独立危险因素(β=-0.447、0.362,均P<0.01)。HOMA-IR和SOD是影响脂联素的独立危险因素(β=-0.098、0.166,均P<0.01)。结论 HOMA-IR和脂联素与EDF的损害密切相关。脂联素可作为糖尿病内皮功能损伤的预测因子。

Objective To detect the levels of serum adiponectin, superoxide dismutase （SOD）, and maleic dialdehyde （MAD） in the patients with impaired glucose tolerance（IGT）, type 2 diabetes,and to analyze their relation with endothelial function changes. Methods A total of 96 patients who were newly diagnosed with blood glucose abnormality in Endocrinology Department of Fujian Medical University between January and December 2012 were enrolled. They were divided into impaired glucose tolerance group （IGT group, n=30 ） , type-2 diabetes mellitus with vascular complications [complication group, n=36）, and type 2 diabetes mellitus without macrovascular complications （diabetes group, n=30）. And 33 healthy physical examinees served as control group. The fasting venous blood was eollected to detect glucose （FPG） , insulin（FINS）, adiponectin, SOD, and MDA. Then 2 hour plasma glucose （2hPG） was determined after a 75 g oral glucose tolerance test （OGTT）. The inner diameter of brachial artery was measured by high-resolution ultrasound system before and after the reactive hyperemia. And endotbelium-dependent flow-mediated dilation （EDF） was assessed by the percent changes in brachial artery diameter before and after reactive hyperemia. Results As compared with those in control group, EDF, SOD and adiponectin were significantly decreased while MDA was obviously increased in the IGT group, diabetic group, and complication group [EDF： （10.46±4.54）%, （7.59±3.29）%, （5.17±2.11）% vs （13.08±4.90）%; SOD： （88.26±5.23）, （77.92±4.95}, （68.05±5.88） vs （102.52±4.30}mU/L; adiponeetin： （10.08±2.09）, （7.89±2.01）, （5.79±1.56） vs （12.05±2.21）mg/L; MDA： （5.00±0.38）, （5.35±0.44）, （6.02±0.24） vs （4.08±0.13）nmol/L]. Multi-factor stepwise regression analysis showed that insulin resistance （HOMA-IR） and adiponectin were independ- ent risk factors of EDF （β were -0. 447 and 0. 362 respectively, both P〈0.01）, HOMA-IR and SOD were also the independent risk factors of adiponectin （β were -0. 098 and 0. 166 respectively, both P〈%0.01）. Conclusions Ad iponectin and HOMA-IR are closely related to impaired EDF. Adiponectin can be served as a predictor of diabetic endothelial dysfunction.