赵昉 邓小戈 苏文静 赵国宁

　　作者单位：046000山西省长治医学院附属和平医院内分泌科(赵昉、赵国宁);中南大学湘雅二医院内分泌科(邓小戈);长治市人民医院干部科(苏文静)

　　通讯作者：邓小戈，E-mail:xiaogd2004@yahoo.com.cn

　　【摘要】 目的 探讨2型糖尿病(T2DM)早期患者血管内皮功能的变化及其临床意义。 方法选择44例新诊断无并发症的T2DM早期患者和40名年龄、性别等匹配的正常对照者。采集空腹静脉血测定FPG、FIns、HbA1c、TC、TG、HDL-C、LDL-C、UA、NO、内皮素1(ET-1)等，并行75g葡萄糖耐量试验测定2hPG。采用高分辨率血管外彩超测定肱动脉、颈动脉的血管内径及颈动脉内膜中层厚度(IMT)，以反应性充血前后血管内径变化百分比反映血管舒张功能。对IMT与各项指标的变化进行相关性分析。 结果 T2DM组与对照组之间FPG、FIns、2hPG、HbA1c、TG、TC、HDL-C、LDL-C、HOMA-IR、NO、ET-1差异均有统计学意义(P<0.05或P<0.01)，而性别、年龄、BMI、收缩压、舒张压、UA差异无统计学意义(P>0.05)。T2DM组基础血管内径、血流介导的内皮依赖性舒张功能和硝酸甘油介导的非内皮依赖性舒张功能与对照组之间差异有统计学意义(P<0.01)。基础血流在两组间差异无统计学意义(P>0.05)。不同部位IMT在不同人群中的密切相关因素是不同的。 结论 T2DM早期患者就有血管内皮功能损伤，不仅存在内皮依赖性血管舒张功能障碍，而且存在非内皮依赖性血管舒张功能障碍。

　　【关键词】糖尿病，2型;内皮依赖性血管舒张功能;超声;颈动脉

　　doi:10.3969/j.issn.1006-6187.2011.01.011

　　Clinical investigation on the endothelium-dependent vasodilation function in the early stage of type 2 diabetes mellitus

　　ZHAO Fang,DENG Xiao-ge,SU Wen-jing， et al.Department of Endocrinology, Heping Hospital of Changzhi Medical College, Changzhi 046000,China

　　Corresponding author:DENG Xiao-ge, E-mail: xiaogd2004@yahoo.com.cn

　　【Abstract】 Objective To study the alteration of endothelium-dependent vasodilation in the early stage of type 2 diabetes mellitus (T2DM). Methods 44 T2DM patients without vascular complications (T2DM) and 40 normal subjects (NC) were recruited. Fasting　plasma levels of glucose(FPG), insulin(FIns), hemoglobin A1c (HbA1c), total cholesterol(TC), triglyceride(TG), high density lipoprotein-cholesterol　(HDL-C),Low density lipoprotein-cholesterol(LDL-C), uric acid(UA), nitric oxide(NO) and endothelin-1(ET-1) were measured. Oral 75g glucose tolerance test was performed. The inner diameter of brachial artery and carotid artery and the intima-media thickness (IMT) of carotid artery were assayed by a high-resolution ultrasound system before and after reactive hyperemia. Vasodilation function was calculated as percent change in brachial artery diameter before and 1 min after reactive hyperemia (endothelium-dependent), and after sublingual glyceryl- trinitrate (endothelium-independent) therapy. Results FPG, FIns, 2hPG, HbA1c, TC, TG, HDL-C, LDL-C, HOMA-IR, NO and ET-1 were significantly different between T2DM and NC groups (P<0.05 or P<0.01). There were no significant differences between the two groups in age, sex, BMI, SBP, DBP and UA(P>0.05). Flow-mediated and GNT-induced vasodilation were lower in T2DM group than in NC group (all P<0.01). Conclusion The endothelium-dependent vasodilation and the endothelium-independent vasodilation are decreased in the early stage of T2DM.

　　【Key words】Diabetes mellitus, type 2; Endothelium-dependent vasodilation; Ultrasound; Carotid