单纯糖耐量受损者的内皮功能改变及危险因素分析  

The changes of endothelial function and the risk factors in isolated impaired glucose tolerance

作　　者：吕以培[1] 黄文萍[1] 车红英[1] 张素华[1] 黄中莹[1] 陈建西[1] 杨丕坚[1] 李舒敏[1] 卢伟波[1] 罗文意[1] 

机构地区：[1]广西钦州市第二人民医院内分泌科,广西钦州535000

出　　处：《右江民族医学院学报》2013年第5期598-601,共4页Journal of Youjiang Medical University for Nationalities

基　　金：广西科学研究与技术开发计划项目基金(桂科攻0816004-26)

摘　　要：目的探讨单纯糖耐量受损(I-IGT)者的内皮功能改变和危险因素的特点。方法按2005年国际糖尿病联盟肥胖标准分肥胖和非肥胖组,选择I-IGT 83例(肥胖即D2亚组42例;非肥胖即D1亚组41例),与糖耐量正常者142例(肥胖即N2亚组67例;非肥胖即N1亚组75例)作比较,做口服葡萄糖耐量试验及胰岛素释放试验,检测0min、10min、20min、30min、60min、120min血糖、免疫活性胰岛素,同时检测空腹血脂、游离脂肪酸、脂联素、超敏C反应蛋白(hs-CRP)、血清内皮素(SET),留取晨尿测定尿内皮素(UET)与尿微量白蛋白(U-MA),记录糖尿病家族史并观察血压、身高和体重,测定肱动脉休息时、加压及服用硝酸甘油后的内径变化。结果校正性别、年龄后I-IGT与糖耐量正常者、D2亚组与N2亚组以及D1亚组与N1亚组比较,U-MA、hs-CRP、UET和SET均有上升而内皮依赖性血管舒张功能和内皮非依赖性血管舒张功能下降有明显改变(P<0.05或P<0.01),D2亚组与D1亚组比较hs-CRP有显著改变(P<0.01);多元回归分析显示,以内皮指标为因变量能进入方程的有糖尿病家族史、肥胖、血压、脂代谢、血糖及胰岛分泌功能等指标。结论 I-IGT非肥胖者和肥胖者主要表现为大血管混合微血管内皮改变,肥胖者大血管内皮改变较为严重;内皮功能改变的危险因素与糖尿病家族史外,还与肥胖、血压增高、脂代谢紊乱、血糖增高及胰岛功能的改变等代谢性因素密切相关。Objective To explore characteristics of risk factors and of changes in endothelial function in isolated impaired glucose tolerance （I-IGT）. Methods 83 patients with I-IGT were divided into two groups of obesity （subgroup D2, n = 42） and non- obesity （subgroup D1, n = 41）, according to the obesity standards of IDF 2005, and we compared I-IGT group with 142 cases of normal glucose tolerance （subgroup N2, obesity, n = 67 and subgroup N1, non-obesity, n =75）. Oral glucose tolerance test and insulin release test were performed, and monitored the levels of glucose and insulin at 0 rain, 10 min,20min, 30 min,60 rain and 120min for all cases within tests, and also measured the levels of fasting of blood lipids, free fatty acids, adiponectin and serum endothelin- 1 （SET）, and urine endothelin- 1 （UET）, high- sensitivity C- reactive protein （hs- CRP） and urea- microalbumin （U- MA） after collecting urina sanguinis. Recorded family history of diabetes and monitored the blood pressure, height and weight. The arteria brachialis diameter was detected at rest and after elevating arteria brachialis pressure and after sublingual administration nitroglycerin. Resuits Levels of U-MA, hs-CRP, UET and SET were higher but endothelium-dependent vasodilatation and endothelium-independent vasodilatation were lower in I-IGT than normal glucose tolerance, in subgroup D2 than subgroup N2, and in subgroup D1 than subgroup N1 after correction for sex and age （ P d0.05 or P 0.01）. Compared the hs-CRP levels of subgroupD2 and subgroup D1, there was statistically significant difference （ P 〈0. 01）. The multivariate regression analysis, family history of diabetes mellitus, obesity, blood pressure, lipid metabolism, blood glucose, insulin secretion and so on were significant independent predictors for the index of endothelial function. Conclusion The changes of endothelial function of macrovascular and microvacular were mainly observed in obesity and non-obesity of I-IGT, but macrovacular changes were more

关 键 词：糖耐量受损 肥胖症 内皮缩血管肽类 危险因素 代谢 

分 类 号：R587.1[医药卫生—内分泌]