摘要
目的采用超声技术评价糖代谢异常者血管内皮功能，并探讨其相关影响因素。方法选取2011年10月至2013年6月北京医院内分泌科门诊就诊者109例，行75g口服葡萄糖耐量试验（OGTT），检测空腹血糖（FPG）、OGTT 2 h的血糖（PPG）以及空腹及OGTT 2 h胰岛素、C肽、糖化血红蛋白（HbA1c）、糖化血清白蛋白（GA）、血脂、肝肾功能、血尿酸（UA）等；同时在空腹和葡萄糖负荷后2 h采用高分辨率超声进行肱动脉血流介导的内皮依赖性血管舒张功能（FMEDD）检测及测定血清一氧化氮（NO）、内皮素1（ET-1）和丙二醛（MDA）、超氧化物歧化酶（SOD）。采用受试者工作特征性曲线（ROC曲线）获得血管内皮功能的最佳临界点。结果（1）糖代谢异常时FMEDD的临界点：空腹FMEDD为13.37%，约登指数为0.467，曲线下面积为0.786（95%CI：0.697～0.876）。OGTT 2 h FMEDD为10.67%，约登指数为0.458，曲线下面积为0.774（95%CI：0.687～0.861）。（2）空腹FMEDD异常组体质指数（BMI）、FPG、HbA1c、GA、甘油三酯（TG）、MDA显著高于正常组（t=-3.013、-4.567、-3.487、-4.611、-2.309、-2.909，均P〈0.05），稳态模型β细胞功能指数（HOMA-β）、NO、SOD显著低于正常组（t=2.765、2.472、5.937，均P〈0.05）。葡萄糖负荷后FMEDD异常组PPG、HbA1c、GA显著高于正常组（t=-4.907、-4.236、-3.896，均P〈0.05），HOMA-β、NO、SOD显著低于正常组（t=2.704、4.675、4.633，均P〈0.05）。（3）空腹FMEDD与FPG、HbA1c、GA呈负相关（r=-0.460、-0.390、-0.391，均P〈0.05），与空腹NO、SOD、HOMA-β呈正相关（r=0.301、0.321、0.310，均P〈0.05）。葡萄糖负荷后FMEDD与PPG、HbA1c、GA呈负相关（r=-0.460、-0.450、-0.389，均P〈0.05），与NO、SOD、HOMA-β呈正相关（r=0.196、0.360、0.257，均P〈0.05）。结论不同糖代谢状态下，血糖水平、HOMA-β、血管舒张因子、抗氧化应激等会影响血管内皮功能。
Objective To evaluate the vascular endothelial function and explore the related influencing factors in patients with abnormal glucose metabolism by use of ultrasound technology. Methods A total of 109 participants selected from endocrinology outpatients of Beijing Hospital from October 2011 to June 2013 were enrolled in this study. Oral glucose tolerance test（OGTT） was carried out, including fasting plasma glucose（FPG） and postprandial glucose（PPG）, fasting and 2 hours after glucose load testing insulin, C-peptide, glycated hemoglobin A1c（HbA1c）, glycated albumin（GA）, lipids, liver and kidney function, blood uric acid,flow-mediated endothelium-dependent vasodilation （FMEDD）, serum nitric oxide （NO）, endothelin-1（ET-1）, serum malondialdehyde（MDA） and superoxide dismutase（SOD）.With the receiver operating characteristic （ROC）curve, the best critical points of fasting and glucose loading vascular endothelial function were obtained. Results （1）The critical points of FMEDD in the state of abnormal glucose metabolism： fasting FMEDD was 13.37%, Youden index was 0.467, and the area under the curve＆amp;nbsp;was 0.786 （95%CI：0.697-0.876）;FMEDD of OGTT 2 h was 10.67%,Youden index was 0.458, and the area under the curve was 0.774（95% CI：0.687-0.861）. （2）Body mass index（BMI）, FPG, HbA1c, GA, triglyceride （TG）, MDA in the patients withabnormal fasting FMEDD were significantly higher than those in the normalgroup（t=-3.013,-4.567,-3.487,-4.611,-2.309,-2.909, all P〈0.05）; and the homeostasis model assessment-β（HOMA-β）, NO, SOD were significantly lower than those in the normal group（t=2.765,2.472, 5.937, all P〈0.05）. PPG, HbA1c, GA in the patients with abnormal FMEDD after glucose load were significantly higher than those in the normal group（t=-4.907,-4.236,-3.896, all P〈0.05）;and the HOMA-β, NO, SOD were all significantly lower than those in the normal group（t=2.704,4.675,4.633, all P〈0.05）.（3） FPG,HbA1c,GA were negatively correlated with fasting FMEDD（r=-0.460,-0.390,-0.391, all P〈0.05）, whereas fasting NO, SOD, HOMA- β were positively correlated with fasting FMEDD（r=0.301,0.321, 0.310, all P〈0.05）. PPG, HbA1c, GA were negatively correlated with FMEDD after glucose load （r=-0.460,-0.450,-0.389, all P〈0.05）, whereas NO, SOD, HOMA- β were positively correlated with FMEDD after glucose load（r=0.196,0.360,0.257, all P〈0.05）. Conclusions Blood sugar levels, islet β-cell function index, vasodilators, and the indicators of antioxidative stress can affect vascular endothelial functions in different state of glucose metabolism.
出处
《中华糖尿病杂志》
CAS
CSCD
2015年第6期350-354,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
国家自然科学基金（81471050、81270917）
首都市民健康教育项目培育项目（BJ-2012-011）
北京市自然科学基金（7122158）
关键词
葡萄糖代谢障碍
血管内皮功能
氧化应激
Glucose metabolism disorders
Vascular endothelial function
Oxidative stress
