超声评价无大血管并发症的2型糖尿病患者血管内皮舒张功能及其影响因素分析

摘要

目的 超声评价无大血管并发症的2型糖尿病患者血管内皮舒张功能并分析其影响因素.方法 选择无大血管并发症的2型糖尿病患者50例(糖尿病组),以34名年龄、性别相匹配健康志愿者作对照(健康对照组).超声检测、计算肱动脉血流介导的内皮依赖性血管舒张功能(FMD)和硝酸甘油介导的内皮非依赖性血管舒张功能(NMD),同时检测血糖(FBG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白α(Lpα)、血清铁蛋白(SF)和氧化低密度脂蛋白(ox-LDL)水平.采用多元线性回归分析分析FMD、NMD与实验室检测指标之间的关系.结果 (1)糖尿病组FBG、HbA1c、TC、TG、LDL-C、ApoB、Lpα、SF和ox-LDL水平分别为(8.58±1.90)mmol/L、(8.66±2.60)%、(5.43±0.79)mmol/L、(1.96±0.94)mmol/L、(3.22±0.73)mmol/L、(0.87±0.23)g/L、(215.69±81.9 )mg/L、(279.19±92.68)ng/ml、(24.95±7.2)μg/dl,均明显高于健康对照组的(5.31±0.42)mmol/L、(5.16±0.41)% 、(4.64±0.54)mmol/L、(1.45±0.62)mmol/L、(2.32±0.55)mmol/L、(0.69±0.16)g/L、(178.26±20.2 )mg/L、(151.21±84.37)ng/ml、(10.62±8.46)μg/dl,且差异均有统计学意义(t值分别为2.653、2.986、2.252、2.224、2.321、2.096、2.786、2.965、2.996,P均＜0.05).糖尿病组HDL-C水平为(1.02±0.23)mmol/L,明显低于健康对照组的(1.27±0.25)mmol/L,差异也有统计学意义(t=2.320,P均＜0.05).(2)糖尿病组FMD、NMD分别为(7.10±2.23)%、(20.22±4.68)%,均高于健康对照组的(4.11±1.13)% 、(13.02±4.25)%,且差异有统计学意义(t=2.217、2.121,P均＜0.05).(3)多元线性回归分析提示,FMD和TC、ApoB、SF和ox-LDL水平显著相关(r=0.681,P＜0.05),而NMD只与TC和ApoB水平显著相关(r=0.642,P＜0.05).结论 2型糖尿病早期患者血管内皮舒张功能降低,TC、ApoB、SF和ox-LDL水平可能与糖尿病患者血管内皮舒张功能障碍有关.%Objective To investigate the changes of endothelium-dependent flow-nediated vasodilation (FMD) and endothelium independent nitroglycein -mediated vasodilation (NMD) of brachial artery in patients with the early stage of type 2 diabetes mellitus. Methods Fifty type 2 diabetic patients without large vascular complications (DM) and 34 healthy controls ( NC) were included in the study. High resolution ultrasound was performed to measure FMD and NMD , and laboratory data such as fasting blood glucose (FBG) ,hemoglobin Alc ( HbAlc), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) , high density lipoprotein cholesterol ( HDL-C) , apolipoprotein Al (ApoAl) , apolipoprotein B ( ApoB) , lipoprotein a (Lpα) , serum ferritin (SF) and oxidized low density lipoprotein ( ox-LDL) were also analyzed. Results The FBG,HbAlc,TC,TG,LDL-C,HDL-C,ApoB,Lpα,SF and ox-LDLwere(8.58 + 1. 90)mmol/L, (8.66+2.60)%, (5.43 + 0. 79) mmol/L, (1. 96 + 0. 94) mmol/L, (3. 22 + 0. 73 ) mmol/L, (1. 02 + 0.23)mmol/L,(0.87+0.23)g/L,(215.69+81.9 )mg/L,(279. 19 +92. 68) ng/ml, (24. 95 +7.2)μg/dl in DM group,(5.31 +0. 42) mmol/L, (5. 16 +0. 41)% , (4. 64 +0. 54)mmol/L, (1. 45 +0. 62) mmol/L, (2.32±0.55)mmol/L,(1.27±0.25 )mmol/L, (0. 69 ±0. 16)g/L, (178. 26 ±20. 2 ) mg/L, (151. 21 ± 84. 37 ng/ml, (10. 62 ± 8. 46) μg/dl in NC group , there were significant difference between the two groups (t=2.653 ,2. 986,2. 252,2.224,2. 321,2. 320,2.096,2.786,2.965 ,2. 996,all P <0. 05). Compared with NC group, FMD and NMD in DM group were significantly lower [ (7. 10±2.23)% vs (4. 11 ± 1. 13) % ,t = 2.217,P<0.01]and[ (20.22 ±4.68)% vs (13.02 ±4.25)% ,t =2. 121,P <0. 05 ],whereas laboratory parameters including FBG , TC, TG, LDL-C, ApoB , Lpα, HbAlc, SF and ox -LDL were significantly higher. Taking FMD and NMD as the dependent variables , multi-variable regression analysis indicated that FMD was significantly related with TC , ApoB, SF, and ox-LDL level ( r = 0. 681, P < 0. 05 ) , whereas NMD was significantly related with Tc and ApoB ( r = 0. 642, P < 0. 05 ). Conclusion FMD was impaired in patients with type 2 diabetes mellitus possibly related with the increased levels of TC , ApoB, SF and ox-LDL.