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目的探讨2型糖尿病(T2DM)早期患者血管内皮功能的变化及其临床意义。方法选择44例新诊断无并发症的T2DM早期患者和40名年龄、性别等匹配的正常对照者。采集空腹静脉血测定FPG、FIns、HbA_1c、TC、TG、HDL-C、LDL-C、UA、NO、内皮素1(ET-1)等,并行75g葡萄糖耐量试验测定2hPG。采用高分辨率血管外彩超测定肱动脉、颈动脉的血管内径及颈动脉内膜中层厚度(IMT),以反应性充血前后血管内径变化百分比反映血管舒张功能。对IMT与各项指标的变化进行相关性分析。结果 T2DM组与对照组之间FPG、FIns、2hPG、HbA_1 c、TG、TC、HDL-C、LDL-C、HOMA-IR、NO、ET-1差异均有统计学意义(P<0.05或P<0.01),而性别、年龄、BMI、收缩压、舒张压、UA差异无统计学意义(P>0.05)。T2DM组基础血管内径、血流介导的内皮依赖性舒张功能和硝酸甘油介导的非内皮依赖性舒张功能与对照组之间差异有统计学意义(P<0.01)。基础血流在两组间差异无统计学意义(P>0.05)。不同部位IMT在不同人群中的密切相关因素是不同的。结论 T2DM早期患者就有血管内皮功能损伤,不仅存在内皮依赖性血管舒张功能障碍,而且存在非内皮依赖性血管舒张功能障碍。
Objective To investigate the changes of vascular endothelial function in early stage of type 2 diabetes mellitus (T2DM) and its clinical significance. Methods Forty-four patients with newly diagnosed T2DM without complications and 40 matched normal controls were selected. Fasting venous blood samples were collected for determination of FPG, FIns, HbA 1c, TC, TG, HDL-C, LDL-C, UA, NO and ET-1. The intravascular diameter and carotid intima-media thickness (IMT) of brachial artery and carotid artery were measured by high-resolution extracorporeal ultrasonography. The percentage of vascular diameter changes before and after reactive hyperemia reflected the vasodilation function. The correlation between IMT and the changes of various indicators was analyzed. Results The differences of FPG, FIns, 2hPG, HbA_1c, TG, TC, HDL-C, LDL-C, HOMA-IR, NO and ET-1 between T2DM group and control group were statistically significant (P <0.05 or P <0.01), while there was no significant difference in gender, age, BMI, systolic blood pressure, diastolic blood pressure and UA (P> 0.05). The difference of basic vascular diameter, blood flow-mediated endothelium-dependent vasodilatation and nitroglycerin-mediated non-endothelium-dependent diastolic function in T2DM group was statistically significant (P <0.01). There was no significant difference between the two groups in basal blood flow (P> 0.05). Closely related factors for different regions of IMT in different populations are different. Conclusion The early stage of T2DM patients have endothelial dysfunction, which not only has endothelium-dependent vasodilatation dysfunction, but also non-endothelium-dependent vasodilatation dysfunction.