单纯糖耐量受损者与空腹血糖受损并糖耐量受损者内皮功能及代谢异常的比较

Comparison the endothelial function and metabolic disorder between pure impaired glucose tolerance and impaired fasting glucose combined with impaired glucose tolerance

目的比较单纯糖耐量受损者（I-IGT）和空腹血糖受损并糖耐量受损者（IFG＋IGT）的内皮功能及代谢异常。方法根据2005年国际糖尿病联盟标准男性腰围≥90 cm、女性腰围≥80 cm为肥胖,分肥胖组与非肥胖组,选择2008年1月-2012年3月钦州市第二人民医院体检人员,包括I-IGT（D组）83例（非肥胖即D1组41例,肥胖即D2组42例）和IFG＋IGT（E组）72例（非肥胖即E1组30例,肥胖即E2组42例）,以正常糖耐量者（N组）142例（非肥胖即N1组75例,肥胖即N2组67例）作对照,采用口服葡萄糖耐量试验及胰岛素释放试验检测血糖、免疫活性胰岛素,同时检测空腹血脂、游离脂肪酸（FFA）、脂联素（APN）、超敏C反应蛋白（hs-CRP）、内皮素（SET）,留取晨尿测定内皮素（UET）、尿微量白蛋白（MUA）。测量腰围、血压、身高和体质量。计算平均动脉压（MAP）、血糖曲线下面积（glu AUC）、10-30 min胰岛素净增值与血糖净增值的比值（ΔI/ΔG）、β细胞功能指数（HOMA-β）和胰岛素抵抗指数（HOMA-IR）等。结果校正性别、年龄后,E组与D组、E2组与D2组的hs-CRP、MUA、SET、UET比较,差异有统计学意义（P〈0.05或P〈0.01）;E1组与D1组的UET比较,差异有统计学意义（P〈0.05）;E组与D组的三酰甘油（TG）、高密度脂蛋白胆固醇（HDL）、FFA、APN、空腹血糖（FPG）、糖耐量2 h血糖（2 h PG）、glu AUC、ΔI30/ΔG30、ΔI20/ΔG20、ΔI10/ΔG10、HOMA-β和HOMA-IR比较,差异有统计学意义（P〈0.05或P〈0.01）;E1组与D1组的TG、HDL、FFA、APN、FPG、glu AUC、HOMA-IR、HOMA-β、ΔI30/ΔG30、ΔI20/ΔG20、ΔI10/ΔG10比较,差异有统计学意义（P〈0.05或P〈0.01）;E2组与D2组的MAP、TG、HDL、FFA、APN、HOMA-IR、HOMA-β、FPG、2 h PG、glu AUC、ΔI20/ΔG20和ΔI10/ΔG10比较,差异有统计学意义（P〈0.05）。结论与I-IGT比较,IFG＋IGT内皮损害更严重,肥胖者大血管和微血管均加重,非肥胖者微血管加重明显;IFG＋IGT肥胖者血压增高更明显,TG和FFA增高,HDL和APN降低;无论肥胖与否,血糖紊乱更重且胰岛功能下降,特别是早期相的下降及胰岛素抵抗更明显。

Objective To compare the difference of endothelial function and metabolic disorder between pure impaired glucose tolerance（I-IGT） and impaired fasting glucose combined with impaired glucose tolerance（IFG＋IGT）. Methods Patients were divided into obesity group and non-obesity group according to the 2005 international diabetes federation standard that male waist more than 90 cm or female waist more than 80 cm,and were regarded as obesity.Physical examination personnel from January 2008 to March 2012 of the Second People′s Hospital were selected and contained IIGT（group D,n=83,non-obesity was 41 cases as group D1 and obesity was 42 cases as group D2）,compared with IFG＋IGT（group E,n=72,obesity was 42 cases as group E2 and non-obesity was 30 cases as group D1） and normal glucosetolerance（group N,n=142,non-obesity was 75 cases as group N1 and obesity was 67 cases as group N2） as control.Oral glucose tolerance test and insulin releasing test were conducted to detect blood glucose and immunereactive insulin.At the same time,fasting lipid,free fatty acid（FFA）,adiponectin（APN）,hypersensitive c-reactive protein（hs-CRP） and endothelin（SET） was tested respectively.Urine endothelin（UET） and urine microalbminurin were tested by returning the morning urine.Waistline,blood pressure,height and body mass was tested respectively.Mean arterial pressure（MAP）,area under the curve of glucose（glu AUC）,the ratio of insulin net added value and blood glucose net added value in 10 to 30 minutes（ΔI/ΔG）,β-cell function index（HOMA-β） and insulin resistance index（HOMA-IR） were counted. Results After adjustment sex and age,the difference of hs-CRP,MUA,SET and UET was statistically significant when group E and group D compared with group E2 and group D2（P〈0.05 or P〈0.01）.The difference of UET was statistically significant when group E1 compared with group D1（P〈0.05）.The difference of TG,HDL,FFA,APN,FPG,2 hP G,glu AUC,ΔI30/ΔG30,ΔI20/ΔG20,ΔI10/ΔG10,HOMA-β and HOMA-IR was statistically significant when group E compared with group D（P〈0.05 or P〈0.01）.The difference of TG,HDL,FFA,APN,FPG,glu AUC,HOMA-IR,HOMA-β,ΔI30/ΔG30,ΔI20/ΔG20 and ΔI10/ΔG10 was statistically significant when group E1 compared with group D1（P〈0.05 or P〈0.01）.The difference of MAP,TG,HDL,FFA,APN,HOMA-IR,HOMA-β,FPG,2 hP G,glu AUC,ΔI20/ΔG20 and ΔI10/ΔG10 was statistically significant when group E2 compared with group D2（P〈0.05）. Conclusion Comparing with I-IGT,the endothelial damage in IFG ＋IGT is more serious,both of large blood vessels and capillaries in obesities aggravates and the capillaries in non-obesity aggravates obvious;blood pressure increases in IFG ＋IGT obesities is more obvious;TG and FFA increases while HDL and APN decreases;dysglycemia is more serious,islet function declines especially in the early and insulin resistance is more obvious.