糖代谢紊乱患者血管内皮功能的超声评价  

Evaluation of Vascular Endothelial Function in Patients with Disorders of Glucose Metabolism with High Resolution Sonography

作　　者：刘新秀[1] 严孙杰[2] 张松菁[2] 叶真[1] 林新霖[1] 陈玲[1] 甘玲[1] 

机构地区：[1]福建医科大学附属第一医院超声影像科,福建福州350005 [2]福建医科大学附属第一医院内分泌科,福建福州350005

出　　处：《中国临床医学》2007年第3期400-402,419,共4页Chinese Journal of Clinical Medicine

基　　金：福建省科技厅科研基金(2001Z036)

摘　　要：目的:通过高频超声检测糖耐量受损(IGT)、2型糖尿病(DM)患者的内皮依赖性血管舒张功能(EDF),同时观察血清超氧化岐化酶(SOD)、丙二醛(MDA),超敏C反应蛋白(hsCRP)、可溶性血管细胞黏附分子(sVCAM-1)的变化,评价超声在糖代谢紊乱患者内皮功能检测中的意义,以期为糖代谢紊乱血管病变的早期诊断、早期干预治疗提供科学的方法。方法:30例IGT患者、30例无并发症的2型DM患者及33名正常对照者(NGT)为研究对象。采集空腹静脉血测定葡萄糖(FPG)、胰岛素(FINS)、SOD、MDA、hsCRP、sVCAM-1,并行75 g口服葡萄糖耐量试验。采用高分辨率血管外彩超测定肱动脉的血管内径,以肱动脉反应性充血前后血管内径变化百分比反映EDF。结果:(1)IGT组、DM组的EDF较NGT组显著下降(均P<0.01),DM组较IGT组更低(P<0.01)。(2)IGT组、DM组的SOD较NGT组显著下降(均P<0.01),而MDA显著上升(均P<0.01)。DM组与IGT组比较SOD显著下降(P<0.01),MDA显著上升(P<0.01)。(3)hsCRP、sVCAM-1在NGT、IGT、DM组逐渐上升,两两比较差异均有统计学意义(均P<0.01)。(4)多因素逐步回归分析显示:EDF与HOMA-IR、hsCRP明显负相关。结论:糖耐量受损阶段即存在血管内皮依赖性舒张功能障碍,DM患者中损害较IGT患者明显,超声是评价血管内皮功能简便可靠的方法;胰岛素抵抗、hsCRP与IGT、2型DM患者的血管内皮细胞功能损伤密切相关。Objective：To observe the changes of the endothelium-dependent vasodilation （EDF） in the patients with impaired glucose tolerance （IGT） and type 2 diabetes mellitus （DM） with high resolution sonography. Methods： In this study, 30 patients with IGT, 30 patients with type 2 DM and 33 normal subjects （NGT） were recruited. Fasting glucose （FPG）, fasting insulin （FINS）, SOD, MDA, hsCRP, Svcam-1 were measured. The increased percentage of the brachial artery diameter （endothelium function） was meausred with high resolution external vascular ultrasound. Results： （1） In the IGT group and DM group, EDF were significantly lower than that in NGT group（ both P〈0. 01 ）, and EDF in the DM group was significantly lower than that in the IGT group （P〈0.01）. （2）SOD in the IGT group and DM group were significantly lower than that in the NGT group （ both P〈0.01）, but MDA in reverse （ both P〈0.01）. Compared with the IGT group, SOD in DM group was significantly lower （P〈0.01）, but MDA was significantly higher （P〈0.01）. （3） hsCRP and sVCAM-1 were raised progressively in the NGT, IGT, DM group s. The difference between two group s was significant （ both P〈0.01）. （ 4 ） Stepwise regression analysis showed that EDF was negatively related to HOMA-IR, hsCRP （r = -0. 059,-0. 447, both P〈0.01, n = 93）. Conclusion： EDF is impaired in patients with IGT while the impairment in patients with DM becomes more marked, is an accurate and convenientmethod to evaluate the brachial arterial endothelial function with uhrasonography. In sulin resistance and hsCRP are closely related to the impatiemt ot EDF in IGT and type 2 DM.

关 键 词：糖耐量受损 2型糖尿病 内皮依赖性血管舒张功能 肱动脉 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学]