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目的观察空腹血糖受损并糖耐量受损(IFG+IGT)患者血管内皮功能及代谢功能情况。方法选择IFG+IGT者72例(E组),其中非肥胖30例(E1组),肥胖42例(E2组);另选择糖耐量正常的健康人群142例(N组),其中非肥胖75例(N1组)、肥胖67例(N2组)。做口服葡萄糖耐量试验及胰岛素释放试验检测血糖、免疫活性胰岛素,同时检测空腹血脂、游离脂肪酸、脂联素。采用免疫比浊法检测超敏C反应蛋白(hs-CRP),RIA法检测血清内皮素(SET)。留取晨尿,采用未抽提法测定内皮素(UET),散射比浊法检测尿微量白蛋白(MUA)。观察血压和腰围。彩超测定肱动脉休息时、加压及服用硝酸甘油后的内径变化,计算内皮依赖性血管舒张功能(EDD)及内皮非依赖性血管舒张功能(EID)指标(ΔD%、ΔD1%)。结果校正性别、年龄后,E和N组比较、E2与N2组比较及E1与N1组比较,MUA、hs-CRP、UET、SET、ΔD%、ΔD1%差异有统计学意义(P均<0.05);N2与N1组比较hsCRP、UET和SET差异有统计学意义(P均<0.05);E2与E1组比较MUA、hs-CRP、UET和SET差异有统计学意义(P均<0.05)。结论 IFG+IGT患者大血管和微血管内皮功能均出现异常,尤以肥胖者为著;患者的代谢功能亦出现异常,主要表现为高血压、高血糖、脂代谢紊乱、胰岛素抵抗及胰岛分泌功能下降。
Objective To observe the vascular endothelial function and metabolic function in patients with impaired fasting glucose and impaired glucose tolerance (IFG + IGT). Methods 72 patients (group E) with IFG + IGT were selected, including 30 cases of non-obesity (group E1) and 42 cases of obesity (group E2). Another 142 healthy people (n = Cases (N1 group), obesity 67 cases (N2 group). To do oral glucose tolerance test and insulin release test for blood glucose, immune active insulin, fasting blood lipids, free fatty acids, adiponectin. The hs-CRP was detected by immunoturbidimetry and the serum endothelin (SET) was detected by RIA. Morning urine was collected, UET was measured by non-extraction method, and urine microalbumin (MUA) was measured by nephelometry. Observe blood pressure and waist circumference. The endothelium-dependent vasodilatation (EDD) and endothelium-independent vasodilation (EID) indices (ΔD%, ΔD1%) were measured by color Doppler ultrasonography after brachial artery resting, pressure and the change of the inner diameter after taking nitroglycerin. Results There was significant difference in gender, age, E and N between E2 and N2 group and between E1 and N1 group, MUA, hs-CRP, UET, SET, ΔD% and ΔD1% (P <0.05). The difference of hsCRP, UET and SET between N2 and N1 group was statistically significant (all P <0.05). The difference of MUA, hs-CRP, UET and SET between E2 and E1 group was statistically significant (all P <0.05). Conclusions Abnormalities of macrovascular and microvascular endothelium in patients with IFG + IGT are abnormal, especially in obese patients. Metabolic dysfunction is also abnormal in patients with IFG + IGT, mainly including hypertension, hyperglycemia, disorders of lipid metabolism, insulin resistance and decreased pancreatic secretion .