Comparative study of endothelial function in different course of diabetic patients

目的了解不同病程状态下2型糖尿病患者血管内皮功能损害的差异，并探讨其与各危险因素间的关系。方法选择有或无血管并发症的2型糖尿病患者各49例，年龄、体质量指数相匹配的健康对照44例。采用高分辨血管超声仪测定肱动脉血流介导的内皮依赖性血管舒张功能（FMD）和硝酸甘油介导的非内皮依赖性血管舒张功能（GTN）。同时测定受试者的血压、血糖、糖化血红蛋白、血脂及血尿酸。结果①糖尿病组与对照组比较，收缩压、舒张压、空腹血糖、糖化血红蛋白（HbA1 c）、胆固醇（TC）、三酰甘油、低密度脂蛋白胆固醇、血尿酸均明显升高（P ＜0．01或 P ＜0．05），高密度脂蛋白胆固醇明显降低（P ＜0．01）。但收缩压、舒张压、TC 及血尿酸，仅显示糖尿病有并发症组高于对照组（P ＜0．05或 P ＜0．01），而无并发症组与对照组差异无统计学意义（P ＞0．05）。在糖尿病两组之间，收缩压、舒张压、HbA1 c 及病程，有并发症组明显高于无并发症组（P ＜0．01）。②糖尿病组的 FMD 和 GTN 明显低于对照组（P ＜0．05或 P ＜0．01），有血管并发症组更显著低于无并发症组（P ＜0．01）。糖尿病两组的内膜中层厚度与健康对照组相比均增厚（P ＜0．05），而糖尿病有无并发症组之间比较差异无统计学意义。基础血管内径三组间差异无统计学意义（P ＞0．05）。结论2型糖尿病患者血管内皮功能明显降低，病程长、有血管并发症者降低更显著。Objective To understand the damage variance of vascular endothelial function in type 2 diabetes mellitus damage with different courses,and the relationship between damage of vascular endothelial function and each risk factor.Methods Forty nine type 2 diabetes with or without vascular complications were collected,and 44 cases of healthy were chosen as control group.Carotid flow-mediated vasodilation (FMD),and glyceryl trinitrate dilatation (GTN)were assessed by highresolution B-mode color vascular Doppler instrument.Blood pressure,glucose,HbA1 c, blood lipid and blood uric acid were measured.Results (1)Compared with control group,the systolic pressure,di-astolic blood pressure,fasting plasma glucose,HbA1 c,TC,TG,LDL-C,blood uric acid were significantly increased (P <0.01 or P <0.05),while HDL-C significantly decreased (P <0.01)in diabetes group.But the systolic pres-sure,diastolic blood pressure,TC and blood uric acid,were higher than that in control group in diabetes with compli-cations (P <0.05 or P <0.01),while there was no significant difference between no complications group and control group (P >0.05).Compared with no-complications group,the systolic pressure,diastolic pressure,HbA1 c,and course of the disease were significantly higher in complications group (P <0.01).FMD and GTN were obviously lower in di-abetes group (P <0.05 or P <0.01),and much lower in complications group (P <0.01).Intima-media thickness of diabetes was thicker than that in healthy controls (P <0.05 ),and there was no difference between complications group and no-complications group.Basis of blood vessel diameter among three groups had no significant difference (P >0.05).Conclusion Vascular endothelial function was significantly reduced in patients with type 2 diabetes,re-duced more significantly in patients with long duration and vascular complications.首都医学科研发展基金中国科技核心期刊(ISTIC)3228-23