糖尿病大血管病变

　　【摘要】 目的 探讨糖代谢异常对肱动脉内皮功能及颈动脉内-中膜厚度(IMT)的影响。 方法 将128例新诊断轻、中度高血压患者根据75 g OGTT结果分为糖耐量正常(NGT)组39例、IGR组42例和T2DM组47例，检测各组FPG、2 hPG、FIns、2 hIns、HbA1c、血脂、高敏C反应蛋白(hsC-RP)、胱抑素C(Cys-C)、肱动脉内皮功能和颈动脉IMT。 结果 NGT、IGR、T2DM组肱动脉内皮依赖性舒张功能(EDD)两两比较差异均有统计学意义[(7.64±0.96) vs (5.85±0.92)，(7.64±0.96) vs (4.22±0.86)，(5.85±0.92) vs (4.22±0.86)，P<0.05或P<0.01]。T2DM组IMT与NGT、IGR组比较差异均有统计学意义[(0.89±0.07) vs (1.20±0.09)，(0.96±0.12) vs (1.20±0.09)，P<0.05]。Logistic多元逐步回归分析结果显示，EDD与FPG、2 hPG、2 hIns、HbA1c和Cys-C呈负相关，IMT与TC、TG和LDL-C呈正相关(P<0.05)。 结论 在NGT-IGR-T2DM发展过程中，肱动脉EDD逐渐减退，颈动脉IMT逐渐增加。

　　【关键词】 糖尿病，2型;糖代谢异常;内皮功能;动脉内-中膜厚度

　　【Abstract】 Objective To evaluate the Effect of abnormal glucose metabolism on brachial artery endothelial function and carotid intima-media thickness (IMT). Methods A total of 128 subjects were divided into three groups according to the results of 75 g OGTT：39 cases in normal glucose tolerance (NGT) group, 42 cases in IGR group, and 47 cases in T2DM group. FPG, 2 hPG, FIns, 2 hIns, HbA1c, blood lipids, high-sensitivity C-reactive protein (hsC-RP) and cystatin C (Cys-C) were measured in each group. Ultrasound was used to test their brachial artery endothelial function and carotid IMT. Results The differences of brachial artery endothelium-dependent dilation (EDD) were statistically significant among the NGT group, IGR group and T2DM group [(7.64±0.96) vs (5.85±0.92), (7.64±0.96) vs (4.22±0.86), (5.85±0.92) vs (4.22±0.86), P<0.05 or P<0.01]. Carotid IMT in T2DM group was significantly higher than that in NGT or IGR group [(0.89±0.07) vs (1.20±0.09), (0.96±0.12) vs (1.20±0.09), P<0.05]. Stepwise Logistic regression analysis showed that EDD was negatively related to FPG, 2 hPG, 2 hIns, HbA1c and Cys-C, while IMT was positively related to TC, TG and LDL-C (P<0.05). Conclusion In the development from NGT to IGR to T2DM, brachial artery EDD decreased and carotid IMT increased gradually.

　　【Key words】Diabetes mellitus，type 2;Abnormal glucose metabolism;Endothelial function;Intima-media thickness (IMT)