初发2型糖尿病患者血管内皮功能与颈动脉病变的相关性研究

摘要

Objective To investigate the changes in vascular endothelial function ,carotid artery morphology and hemodynam -ics in patients with type 2 diabetes mellitus(T2DM)at early stage,and analyze the correlation between vascular endothelial function and intimal-media thickness(IMT).Methods By using a Doppler ultrasound,changes of morphology and hemodynamics of carotid artery in 50 patients with early type 2 diabetes and 50 normal controls were measured.Changes of brachial artery inner -diameter in reactive hy-peremia test and sublingual nitroglycerin were also evaluated .Correlation between vascular endothelial function and carotid artery in T2DM patients was analyzed.Results Compared to the normal controls ,the carotid IMT was significantly increased while pulsatility in -dex(PI),early diastolic reverse flow velocity ( PRV) and end diastolic velocity (EDV) were significantly decreased in early stage of T2DM(P <0.05).However,no significant difference in peak systolic velocity (PSV)was found between the two groups .After sublingual nitroglycerin,the percentage of changes in brachial artery inside was significantly decreased in the early -stage T2DM group under reac-tive hyperemia situation when compared to the normal controls (P <0.05).In the early-stage T2DM group,the carotid IMT was posi-tively correlated with the percentage of changes in the diameter of brachial artery under reactive hyperemia situation (r =-0.583,P <0.05).Conclusion The carotid artery lesions and endothelial function damage in early -stage T2DM patients can be detected by ultra-sonic examination.%目的：探讨初发2型糖尿病（T2DM）患者颈动脉形态学和血流动力学的改变，分析颈动脉内皮功能与内－中膜厚度（IMT）之间的相关性。方法选取我院门诊初发 T2DM 患者（初发 T2DM 组）和正常对照人群（正常对照组）各50例，应用多普勒超声检测颈动脉形态和血流动力指数变化，测量反应性充血试验和舌下含服硝酸甘油前后肱动脉内径变化，评估血管内皮功能，分析颈动脉内皮功能与内－中膜厚度的相关性。结果与正常对照组相比较，初发 T2DM 组患者颈动脉 IMT 增加，动脉搏动指数（PI）、舒张早期反向血流峰值速度（PRV）、舒张末期血流速度（EDV）均降低，差异均有统计学意义（P ＜0．05）。两组收缩期峰值流速（SPV）差异无统计学意义。反应性充血试验前后，初发 T2DM 组肱动脉内径变化百分率均低于正常组，差异有统计学意义（P ＜0．05）。初发 T2DM 颈动脉 IMT 与反应充血时肱动脉内径变化百分率呈负相关（r＝－0．583，P＜0．05）。结论血管超声检测可以评估初发 T2DM 患者颈动脉血管病变的严重程度和血管内皮功能改变的情况，为早期诊断动脉粥样硬化治疗提供新的评价标准。