2型糖尿病患者胰岛素抵抗、血管内皮细胞功能与微量白蛋白尿  

Insulin resistance and endothelial function in type 2 diabetic patients:in relation to microalbuminuria

作　　者：索丽霞[1] 余叶蓉[1] 喻红玲[1] 王椿[1] 唐红[1] 陆志铭[1] 张祥迅[1] 王嘉南[1] 赵桂芝[1] 

机构地区：[1]四川大学华西医院内分泌科

出　　处：《中华内分泌代谢杂志》2004年第1期26-29,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：四川省卫生厅科研基金项目 (1 999年~ 2 0 0 1年 )

摘　　要：目的　观察伴或不伴微量白蛋白尿的 2型糖尿病 (DM )患者胰岛素抵抗 (IR)状态及内皮细胞功能 ,探讨 2型DM大血管病变危险性增加的发病机制。方法　伴微量白蛋白尿的 2型DM组 (DM MA)、尿白蛋白正常的 2型DM组 (DM NA)及正常对照组 (NC)各 12例。 3组研究对象均采用正常血糖高胰岛素钳夹试验评价其外周组织葡萄糖利用率 (GDR) ,采用彩色多普勒超声技术测定其内皮细胞依赖性血管舒张功能 (EDV)以及非内皮细胞性血管舒张功能 (EIV)。结果　DM组GDR明显低于正常对照组 ,且DM MA组GDR较DM NA组更低〔对照组 (13 .0 6± 1.98)mg·kg-1·min-1,DM MA和DM NA组分别为 (7.90± 1.79)、(9.46± 1.5 2 )mg·kg-1·min-1,P <0 .0 5或P <0 .0 1〕。两组DM患者的EDV较正常对照组降低 (均P <0 .0 5 ) ,且DM MA组EDV受损程度重于DM NA组 (P <0 .0 5 )。 3组间的EIV差异无显著性。DM组的血游离脂肪酸 (FFA)水平明显高于正常对照组 (P <0 .0 5 ) ,其中DM MA组FFA水平最高。偏相关分析显示 :GDR与EDV呈显著正相关 (r=0 .47,P <0 .0 1,n =3 6)。结论　与尿白蛋白正常的 2型DM患者相比 ,伴有微量白蛋白尿的 2型DM患者具有更严重的IR ,EDV明显受损和较高的血FFA水平。提示伴微量白蛋白尿的 2型DM患者大血管病变危险性增高的机?Objective To observe insulin resistance (IR)and endothelial function in type 2 diabetic patients with and without microalbuminuria and to explore its pathogenesis of increasing macrovascular risk. Methods Twelve type 2 diabetic patients with microalbuminuria (DM-MA) and 12 type 2 diabetic patients without microalbuminuria (DM-NA) matched for sex, age, body mass index, duration of illness and antidiabetic therapy were recruited. Twelve healthy volunteers were enrolled as control (NC). Hyperinsulinemic euglycemic clamp assay was performed to assess the peripheral glucose disposal rate (GDR) and high-resolution ultrasonography was applied to measure the vasodilation in brachial artery diameter for endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV). Results The GDR was (13.06±1.98)mg·kg -1 ·min -1 (NC group), (9.46±1.59)mg·kg -1 ·min -1 (DM-NA group) (vs NC group, P<0.05) and (7.90±1.79)mg·kg -1 ·min -1 (DM-MA group) (vs NC group, P<0.01). EDV was impaired in DM-MA group (8.3±4.0)%andDM-NA group (9.7±4.7)%compared with NC group 〔(14.1±5.2)%, both P<0.05〕, and EDV in DM-MA group was lower than that in DM-NA group (P<0.05). There was no significant difference in EIV among three groups. Plasma free fatty acid (FFA) concentration was (364±169)μmol/L (NC group), (675±201)μmol/L (DM-NA group) (vs NC group P<0.01) and (1008±229)μmol/L (DM-MA group) (vs NC group and DM-NA group both P<0.01). In addition, partial correlation analysis revealed a significant positive correlation between GDR and EDV (r=0.47, P<0.01, n=36). Conclusion Compared with normoalbuminuric type 2 diabetic patients, microalbuminuric type 2 diabetic patients show more severe IR, impaired endothelial function and higher plasma FFA level, suggesting that IR and endothelial dysfunction may be involved in the pathogenesis of increasing cardiovasular risk in this subset of patients.

关 键 词：2型糖尿病 胰岛素抵抗 血管内皮细胞功能 微量白蛋白尿 

分 类 号：R587.1[医药卫生—内分泌]