伴有2型糖尿病的冠心病患者血管内皮功能的研究

Study of endothelial function in patients with stable angina assoiciated with or without diabetes

目的 :研究慢性稳定型心绞痛患者中 2型糖尿病对其血管内皮功能的作用。方法 :运用高分辨率多普勒超声仪测定 6 5例慢性稳定型心绞痛患者 [冠心病组 ,有陈旧性心肌梗死史 ,或经冠状动脉造影证实为冠心病者 ,其中有 2型糖尿病者 16例 (糖尿病组 ) ;无 2型糖尿病者 49例 (无糖尿病组 ) ,伴有陈旧性心肌梗死者 5 0例 ]及 10例对照者 (对照组 )的右肱动脉内皮依赖的血流量介导的扩张反应 (FMD)及内皮独立的硝酸甘油介导的扩张反应 (GTN MD)。结果 :冠心病患者无糖尿病组的FMD及GTN MD均较对照组显著降低 [FMD :(4 .2 0±3.10 ) %∶(7.48± 2 .36 ) % ,P <0 .0 1;GTN MD :(13.76± 3.0 9) %∶(2 1.5 6± 4.76 ) % ,P <0 .0 1],糖尿病组亦较无糖尿病组显著降低 [(FMD∶(2 .2 3± 1.81) %∶(4 .2 0± 3.10 ) % ,P <0 .0 1;GTN MD :(11.71± 3.84) %∶(13.76± 3.0 9) % ,P <0 .0 5 ]。单因素回归分析提示慢性稳定型心绞痛患者的FMD与陈旧性心肌梗死 (r =0 .37,P=0 .0 0 2 )及 2型糖尿病 (r =0 .2 8,P =0 .0 2 )显著相关 ,而GTN MD仅与 2型糖尿病显著负相关 (r =0 .2 6 ,P=0 .0 4) ,与陈旧性心肌梗死无相关性。结论 :2型糖尿病在冠心病患者的动脉粥样硬化形成中既损伤了血管内皮功能 。

Objective:To investigate the effect of 2 type diabetes mellitus on endothelial function of patients with stable angina. Method:High resolution external vascular ultrasound was used to assess the endothelium-dependent flow-mediated dilatation (FMD) and endothelium-independent glyceryl trinitrate-mediated dilatation (GTN-MD) of right brachial artery in 65 cases with stable angina and 10 controls. There are 16 patients with diabetes, 49 patients without diabets.Result:FMD and GTN-MD were significantly decreased in patients with diabetes compared with the group of patients without diabets and the control group (FMD%: 2.23± 1.81 vs 4.20± 3.10vs 7.48 ± 2.36, P< 0.01; GTN-MD%: 11.71± 3.84 vs 13.76± 3.09vs 21.56 ± 4.76, P< 0.01). However, univariate regression analysis showed that FMD in patient with stable angina was significant related with previous myocardial infarction (r= 0.37, P= 0.002), and diabetes (r= 0.28, P= 0.02); but GTN-MD was only associated with diabetes (r= 0.26, P= 0.04). Conclusion:2 type diabets mellitus is related to endothelial dysfunction in patients with coronary artery disease.