糖耐量减低者血浆同型半胱氨酸、内皮素的变化及二甲双胍的干预作用研究

摘要

Objective To investigate the differenc:e of plasma homocystein ( Hcy ) and endothelin ( ET ) concentrations between subjects with impaired glucose tolerance ( IGT ) and subjects with other levels of glucose tolerance.and to investigate the changes of Hcy and ET concentrations in IGT patients after intervention with metformin.Methods A total of 166 subjects, according to their levels of oral 75 g glucose tolerance test, were assigned into groups of normal glucose tolerance ( NGT )( n =51 ), IGT ( n =70 ) and type 2 diabetes mellitus ( T2DM ) ( n =45 ).And 70 IGT patients were randomly divided into two sub - groups, with 35 in each.The IGT subjects received either l.5 g metformin daily or placeho for half year.Then Hcy and ET levels of each group pre - and post - treatment were detected.Results ( 1 ) The serum Hcy and ET levels concentration increased from NGT group to IGT and T2DM groups ( P ＜ 0.05 ).The Hcy concentration was positively correlated with the age , triglyceride ( TG ), 2 - hour postprandial blood glucose ( 2 hPG ) and glycosylated hemoglobin ( HbA1c ), and the ET concentration with fasting blood glucose ( FBG ), 2 hBG, HbA1c , total cholesterol ( TC ) and TG ( P ＜ 0.05 ).( 2 ) The Hcy and ET concentrations in IGT subjects treated with metformin decreased ( P ＜0.01 ), while the changes in the placebo group were of no significant difference ( P ＞0.05 ).and the differences pre - and post - treatment between the two groups were statistically significant ( P ＜0.05 ).Conclusion The Hcy and ET concentrations are gradually increased with the worsening of glucose tolerance.The Hcy and ET concentrations in IGT subjects treated with metformin decrease following the improvement of glucose and lipid metabolism.%目的 了解糖耐量减低(IGT)与其他糖耐量水平者血浆同型半胱氨酸(Hcy)、内皮素(ET)的差别,比较IGT患者二甲双胍干预治疗后Hcy、ET的变化.方法 166例受试者行口服75 g葡萄糖耐量试验(OGTT),按糖耐量水平分为正常糖耐量(NGT)组51例,IGT组70例,2型糖尿病(T2DM)组45例.将IGT患者分为两组,分别予二甲双胍(二甲双胍组)及安慰剂(安慰剂组)进行干预治疗,测定各组及干预治疗前后的Hcy、ET水平.结果 (1)NGT、IGT、T2DM患者中,Hcy及ET水平逐渐升高,差异有统计学意义(P＜0.05);Hcy水平与年龄、三酰甘油(TG)、OGTT 120 min血糖(2 hPBG)、糖化血红蛋白(HbA1c)呈正相关,ET水平与空腹血糖(FBG)、OGTT 2 hPBG、HbA1c、总胆固醇(TC)、TG呈正相关(P＜0.05).(2)二甲双胍组血浆Hcy、ET水平治疗后显著降低,与治疗前比较差异有统计学意义(P＜0.01),安慰剂组干预前后无明显变化,差异无统计学意义(P＞0.05);两组干预前后差值比较,差异亦有统计学意义(P＜0.05).结论 血浆Hcy、ET水平随着糖耐量受损的加重逐渐升高;IGT患者应用二甲双胍干预治疗后,随着糖脂代谢的改善,血浆Hcy、ET水平也下降.