葡萄糖耐量低减与动脉粥样硬化

Impaired glucose tolerance and atherosclerosis

目的 观察葡萄糖耐量低减 (IGT)与动脉粥样硬化 (AS)的关系。方法 在曾经有血糖异常升高 (但未达糖尿病标准 )、患有心血管疾病 (如冠心病、中风或高血压 )或其危险因素 (如血脂异常 )的人群进行 75g口服葡萄糖耐量试验 (OGTT)筛查IGT病人 ,并同时记录病史、体检。空腹血脂指标由自动生化分析完成。同时用B型超声检查双侧颈总动脉 ,观察内膜连续性、内膜 中层厚度 (IMT)、斑块等指标。结果 IGT组 (n =5 1)的内膜连续性比正常糖耐量 (NGT)组 (n =97)明显差 (P <0 .0 5 ) ,IGT组双侧平均IMT和动脉粥样硬化 (AS)积分均显著高于NGT组 (均P <0 .0 5 ) ,IGT的平均IMT异常增高的发病率显著高于NGT。但以上指标IGT与糖尿病组 (n =73 )差异无显著性。多元分析发现 ,IGT的AS指标增加效应经同时校正甘油三酯、胆固醇、冠心病史、中风史、吸烟、性别、体重指数仍具有显著意义 ;但是分别校正年龄、腰臀围比值、高密度脂蛋白胆固醇和高血压病史 ,三种AS指标有不同程度的减弱。结论 与NGT人群相比 ,IGT人群已经存在明显的AS表现 ,其程度与糖尿病类似。IGT的动脉粥样硬化现象独立于部分心血管危险因子和已经存在的心血管疾病。

Objective To observe the relationship between impaired glucose tolerance (IGT) and atherosclerosis (AS). Methods The subjects were recruited among individuals who had previously abnormal glycaemia but were non-diabetic, and those who had cardiovascular disease (such as coronary heart disease, stroke or hypertension) or its risk factor (s) (such as blood lipid abnormality). All subjects underwent 75 g oral glucose tolerance test (OGTT) and physical examination. Their medical history was documented simultaneously. The fasting blood lipid profile was evaluated with an automatic biochemistry machine. By employing a high resolution B-mode ultrasonography with higher frequency probe as 7.5 MHz, the intima smoothness, and intima-media thickness (IMT) and plaque(s) were observed in bilateral common carotid arteries. Results The intima smoothness in subjects with IGT (n=51) was poorer than that in subjects with normal glucose tolerance (NGT) (n=97) (P<0.05), the mean values of IMT and atherosclerosis score as well as occurrence of abnormal mean IMT were all more marked in subjects with IGT than those in NGT (all P<0.05). All above parameters regarding atherosclerosis in subjects with IGT were similar to those in diabetics (n=73). Multivariable analysis demonstrated that the association of IGT with AS was independent of some of other variables, including triglyceride, total cholesterol, coronary heart disease, stroke, smoking, gender and body mass index, but not independent of age, waist-hip ratio, high density lipoprotein cholesterol and hypertension in various degrees. Conclusion Subjects with IGT, like diabetics, carry significant manifestations of AS as compared with subjects with NGT. And AS in cases of IGT is independent of coexisted cardiovascular diseases and some of the cardiovascular risk factors.