糖尿病患者餐后血脂与颈动脉内-中膜厚度的相关性及其临床价值

Correlations between Postprandial Blood Lipids and Carotid Artery Intima-media Thickness in Diabetic Patients and the Clinical Value

目的探讨糖尿病患者餐后血脂与颈动脉内-中膜厚度的相关性及其临床价值。方法选取2017年7月-2018年7月我院收治的糖尿病患者50例作为研究组,选取同期门诊体检者50例作为对照组,均在进食脂肪负荷餐前及餐后4 h采集肘静脉血,进行空腹血糖及餐后4 h血糖、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胰岛素的测定,应用彩色多普勒超声显像仪测定颈动脉内-中膜厚度。结果研究组餐后4 h的血糖值高于对照组(P<0.05);研究组与对照组餐前、餐后4 h的胰岛素水平对比,无显著差异(P>0.05),研究组颈动脉内-中膜厚度明显大于对照组(P<0.05)。研究组与对照组餐后4h TG水平均较餐前升高,且研究组高于对照组(P<0.05)。研究组与对照组餐后4 h的TC水平与餐前对比无明显差异(P>0.05)。研究组与对照组餐后4 h的HDL-C水平均较餐前降低,且研究组低于对照组(P<0.05),研究组与对照组餐后4 h的LDL-C水平与餐前对比无明显差异(P>0.05)。相关分析显示年龄、餐前胰岛素、餐后4h TG与颈动脉内-中膜厚度独立显著相关。结论与普通人群相比,糖尿病患者存在明显的餐后血脂代谢紊乱;其中年龄、餐后高胰岛素血症、高TG血症是早期动脉粥样硬化的独立危险因素。

Objective To investigate the correlations between postprandial blood lipids and carotid artery intima-mediathickness in diabetic patients and their clinical value. Methods Fifty patients with diabetes treated in our hospital between July2017 and July 2018 were selected as the research group, while another 50 health examinees in the outpatient clinic served as thecontrol group. All the subjects had their elbow vein blood collected before a meal loaded with fat and four hours after the meal.Their fasting blood glucose and their levels of blood glucose, total cholesterol（TC）, triglyceride（TG）, low density lipoproteincholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C） and insulin four hours after the meal were detected, whilecarotid intima-media thickness was measured by color Doppler ultrasonography. Results The blood glucose level of the studygroup 4 hours after a meal was higher than that of the control group （P〈0. 05）. There was no significant difference in the insulinlevel between the two groups before a meal or 4 hours after the meal （P〉0. 05）. The carotid artery intima-media thickness of thestudy group was significantly larger than that of the control group （P〈0. 05）. The TG level increased four hours after the meal inboth groups, especially in the study group （P〈0. 05）. There was no significant difference in TC levels four hours after the mealbetween the two groups （P〉0. 05）. The HDL-C level decreased in both groups four hours after the meal, especially in the studygroup （P〈 0. 05 ）. There was no significant difference in LDL - C levels between the two groups four hours after the meal（P〉0. 05）. Correlation analysis showed that age, preprandial insulin and postprandial 4hTG were independently associated with carotid artery intima-media thickness. Conclusion Compared with the general population, diabetic patients have obvious postprandialdyslipidemia disorders, and age, postprandial hyperinsulinemia, and high TG are independent risk factors for early atherosclerosis.