老年糖尿病前期颈动脉内中膜厚度及血管内皮细胞功能的改变

摘要

Objective To explore the changes of carotid intima-media thickness ( IMT) and function of vascular endothelial cells and explore the risk factors of atherosclerosis in elderly prediabetes. Methods 122 people aged ? 60. Years including 26 normal glucose tolerance ( NGT) , 26 impaired fasting glucose (IFG) , 40 impaired glucose tolerance (IGT) and combined IFG with IGT (IFG + IGT) people were selected. Anthropometric variables, fasting blood glucose (FBG) , postprandial blood glucose (PBG) ,fasting blood insulin (FINS) , postprandial blood insulin (PINS) ,systolic pressure (SBP) , diastolic pressure (DBP) ,blood lipid and other clinic parameters were measured, and carotid IMT were measured by colour ultrasonic, and blood endothelin-1 ( ET-1) were tested by ELJSA , and blood nitric oxide (NO) was tested by nitrate reductase assay. Results There were significant differences in levels of IMT,ET-1 and NO between IFG,IGT, IFG + IGT groups and NGT group ( P < 0. 01). Level of NO in IFG + IGT group was higher than that in IGT group ( P < 0. 05 ). According to linear correlation analysis,IMT showed positive correlation with body mass index(BMI) ,blood NO and triglyceride(TG) (P <0. 01 ). Level of blood NO showed positive correlation with FINS,2 hours PBG.HOMA insulin resistance index (HOMA-IR) , IMT, blood ET-1,blood cholesterol, blood TG(P<0. 01). Level of blood ET-1 showed positive correlation with blood NO, blood TG (respectively,? < 0. 01) and FINS, HOMA-IR, HOMABcell function index (HOMA-B) (respectively,P <0. 05). Risk factors of IMT were SBP,TG and BMI in sequence, ones of blood ET-1 were blood NO and TG, ones of blood NO were SBP,HOMA-IR,blood PBG and TG in sequence. Conclusions IMT, blood ET-1 and NO are increased significantly in elderly prediabetes. Compared with IMT,disorder of vascular endothelial cells function shows closer ties with glycometabolism disorder.%目的 探讨老年糖尿病前期颈动脉内中膜厚度(IMT)及血管内皮功能的变化并探讨其危险因素.方法 研究对象均为≥60岁的老年人,包括26名正常人、单纯空腹血糖受损(IFG)26例、糖耐量受损(IGT) 40例及空腹血糖受损(IFG)合并IGT患者30例,检测血糖、胰岛素、血脂等临床指标,并以彩色多普勒超声测量受试者的颈动脉IMT;检测各组的内皮素-1(ET-1)和一氧化氮(NO)的水平.结果 ①IFG、IGT、IFG+IGT三组的IMT值、ET-1和NO值均高于NGT组(均P＜0.01),IFG+IGT组的NO高于IGT组(P＜0.05).②直线相关分析显示IMT与BMI、NO、TG正相关(P ＜0.01)；NO与FINS、2 h PBG、HOMAIR、IMT、ET-1、TC、TG正相关(P ＜0.01)；ET-1与NO、TG正相关(P＜0.01),与FINS、HOMA-1R、HOMA-β正相关(P＜0.05).③多元回归分析显示IMT影响因子依次为收缩压、TG、BMI;ET-1的影响因子依次为NO、SBP、TG;NO的影响因子依次为SBP、HOMA-IR、PBG、TG.结论 老年糖尿病前期患者的颈动脉内膜中层增厚,其血管内皮细胞功能已发生变化；与IMT相比,血管内皮细胞功能的变化与糖代谢紊乱有更好的相关性.