不同糖耐量人群早期动脉硬化指标检测及临床意义探讨

摘要

Objective To explore the detection and clinical significance of early arteriosclerosis indexes in humans with different degrees of carbohydrate tolerance. Methods The subjects were divided into normal glucose tolerance group (n, =56) , impaired glucose tolerance group (n =58) and firstly diagnosed type 2 diabetes mellitus group (re =56). Body mass index, waist circumference, waist-hip ratio, total cholesterin, triglyceride, high density lipoprotein cholesferol (HDL-C), low density lipoprotein cholesterol (LDL-C) , fasting plasma glucose, fasting insulin and insulin resistance index (HOMA-IR) were detected, and carotid-femoral pulse wave velocity (cf-PWV) , cardio-ankle vascular index (CAVI), ankle-brachial index (ABI) and flow-mediated endo-thelium-dependent dilatation (EDD) were also measured. Results Body mass index, waist circumference, waist-hip ratio, blood pressure, blood fat, fasting plasma glucose, fasting insulin and HOMA-IR were significantly higher in impaired glucose tolerance group and type 2 diabetes mellitus group than those in normal glucose tolerance group (P <0.05 or P <0.01) , and the above indexes in type 2 diabetes mellitus group were higher than those in impaired glucose tolerance group (P <0.05 or P < 0. 01). Compared with those in normal glucose tolerance group, the cf-PWV and CAVI were significantly increased, while ABI and EDD were significantly reduced in impaired glucose tolerance group and type 2 diabetes mellitus group (P < 0. 05 or P < 0. 01) , the differences were statistically significant between type 2 diabetes mellilus group and impaired glucose tolerance group ( P < 0. 05 or P < 0. 01). Multi-factor Logistic analysis showed that there were close relationships between cf-PWV and age, waist circumference, blood pressure, LDL-C, fasting plasma glucose, HOMA-IR; CVAI and age, waist circumference, blood pressure, fasting plasma glucose and HOMA-IR were closely related; ABI and LDL-C, fasting plasma glucose and HOMA-IR were closely related, and EDD was closely related with waist circumference, blood pressure, fasting plasma glucose, HOMA-IR. Conclusion The early arteriosclerosis is significantly correlated not only with impaired glucose tolerance, but also with central obesity, hypertension, hyperlipemia and insulin resistance. The measurement of early arteriosclerosis and the intervention of metabolic risk factors are very important in preventing cardiovascular and cerebrovascular diseases.%目的 对不同糖耐量人群进行早期动脉硬化指标检测,并探讨其临床意义.方法 将研究对象分为正常糖耐量组56例、糖耐量异常组58例和初诊2型糖尿病组56例,均测定体重指数、腰围、腰臀比、总胆固醇、甘油三脂、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、空腹胰岛素及胰岛素抵抗指数(HOMA-IR),并检测脉搏波传导速度(cf-PWV)、心踝血管指数(CAVI)、踝臂指数(ABI)及依赖性血管内皮舒张功能(EDD).结果 糖耐量异常组和2型糖尿病组的体重指数、腰围、腰臀比、血压、血脂、空腹血糖、空腹胰岛素及HOMA-IR均显著高于正常糖耐量组,2型糖尿病组显著高于糖耐量异常组,差异均有统计学意义(P ＜0.05或P＜0.01).糖耐量异常组和2型糖尿病组与正常糖耐量组比较,cf-PWV、CAVI显著升高,ABI和EDD明显降低,差异有统计学意义(P＜0.05或P＜0.01),2型糖尿病组与糖耐量异常组比较,差异亦有统计学意义(P＜0.05或P＜0.01).多因素Logistic分析显示,cf-PWV与年龄、腰围、血压、LDL-C、空腹血糖和HOMA-IR密切相关,CAVI与年龄、腰围、血压、空腹血糖和HOMA-IR密切相关,ABI与LDL-C、空腹血糖和HOMA-IR密切相关,EDD与腰围、血压、空腹血糖和HOMA-IR密切相关.结论 早期动脉粥样硬化发生不仅与糖耐量异常有关,也与腹型肥胖、高血压、高血脂和胰岛素抵抗密切相关,早期检测并进行各项代谢危险因素干预,对预防心脑血管疾病具有重要意义.