2型糖尿病患者餐后高脂血症与颈动脉及冠状动脉粥样硬化病变的关系  

The Relationship between Postprandial Hyperlipidemla and Carotid and Cornary Atheroslerosis in Type 2 Diabetic Patients

作　　者：任建民[1] 吴茂红[2] 王奉云[2] 肖晓燕[1] 孙磊[1] 

机构地区：[1]山东大学齐鲁医院内分泌科,山东省济南市250012 [2]莱芜市人民医院,山东省莱芜市271100

出　　处：《中国动脉硬化杂志》2006年第8期705-708,共4页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨2型糖尿病患者餐后高脂血症与颈动脉超声及冠状动脉粥样硬化病变的关系。方法按空腹甘油三酯和脂肪餐后4 h甘油三酯水平将90例糖尿病患者分为空腹高脂组、餐后正常组和餐后增高组,所有患者均测定空腹血糖、餐后2 h血糖、空腹胰岛素、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、体质指数和腰臀围比,并进行颈动脉彩色多普勒检查和冠状动脉造影检查,从而进行多元线性相关分析。结果空腹高脂组和餐后增高组患者颈动脉内膜中膜厚度(分别为1.12±0.73 mm和1.11±0.20 mm)、颈动脉斑块发生率(分别为83.3%和80.6%)、颈动脉斑块总积分(分别为3.52±0.52 mm和3.50±0.44 mm)和大血管病变发生率(分别为62.5%和54.8%)均明显高于餐后正常组(上述指标分别为0.73±0.22 mm、40%、2.60±0.25mm和20%),差异具有非常显著性统计学意义(P<0.01);而空腹高脂组与餐后增高组患者颈动脉内膜中膜厚度无统计学差异(P>0.05)。三组颈动脉血流动力学比较无统计学差异(P>0.05)。冠状动脉造影两支病变及多支病变发生率在空腹高脂组(29.2%和16.7%)和餐后增高组(29%和16.1%)均明显高于餐后正常组(11.4%和2.9%),差异有非常显著性统计学意义(P<0.01);单支病变发生率两组比较无明显差异(P>0.05);空腹高脂组与餐后增高组单支病变、两支病变、多支病变发生率比较均无明显差异(P>0.05);以颈动脉内膜中膜厚度为因变量,其他指标为自变量,进行多元线性相关分析,发现颈动脉内膜中膜厚度与脂肪餐试验4 h后血甘油三酯水平、体质指数、腰臀比呈正相关,相关系数分别为0.654 2(P<0.01)0、.547 2(P<0.01)和0.548 2(P<0.01)。结论2型糖尿病病人空腹甘油三酯正常但餐后甘油三酯增高与空腹甘油三酯增高与动脉粥样硬化有相关关系。Aim To explore the relationship between postprandial hyperlipidemla and carotid and comary atheroslerosis in type 2 diabetic patients. Methods According to blood triglyceride level（ fasting TG and TG4h）, ninety type 2 diabetic patients were enrolled and divided into three groups, including group Ⅰ （TG4h ≤ 2.0 mmol/L）, group Ⅱ （TG4h 〉 2.0 mmol/L） and group Ⅲ （high fasting blood triglyceride level）. All patients＇ fasting blood glucose, postprandial two hours blood glucose （PBG2h）, fasting blood insulin, glycosylated hemoglobin （HbAlc）, total cholesterol （TC）, total tfiglyceride （TG）, high density lipoprotein cholesterol （HDLC）, low density lipoprotein cholesterol （LDLC）, body mass index （BMI）and waist hip ratio （WHR） were measured. Meanwhile, they were detected by carotid color Doppler sonarography and coronary angiography. All results were analyzed in statistic method. Results Carotid artery intima-media thickness, carotid artery plaque, carotid artery plaque score, macrovascular complications in group Ⅱ （ 1.11 ± 0.20 mm, 80.6%, 3.50 ± 0.44 mm, 54.8% ） and group Ⅲ （ 1.12 ± 0.73 mm, 83.3 %, 3.52 ± 0.52 nun, 62.5 % ） were significantly higher tlian those in group I （0.73 ± 0.22 mm, 40 %, 2.60 ± 0.25 mm, 20% ） P 〈 0.01, while carotid artery intima-media thickness （IMT） in group Ⅱ and group Ⅲ were similar （ P 〉 0. 05）. The Vmax, Vmin, Vmin, PI and RI had no difference for the three groups （P〉0.05）. The double and triple vessel lesion in group Ⅱ （29%, 16.1%） and group Ⅲ （29.2%, 16.7%） were significantly higher than those in group Ⅰ （11.4%, 2.9 % ） P 〈 0.01 ; the single vessel lesion in group Ⅱ and group Ⅲ were similar （ P 〉 0.05 ）. The single vessel lesion, the double vessel and triple vessel lesion in group Ⅱ and group Ⅲ were similar（ P 〉 0.05）. Through multiple correlation analyzing,we found carotid artery＇s IMT was significantly and positively correlated with TCAh, BMI and

关 键 词：内科学 2型糖尿病 餐后高脂血症 颈动脉彩色多普勒检测 冠状动脉造影 

分 类 号：R587[医药卫生—内分泌]