血管内皮功能检查(FMD值)在2型糖尿病并发症筛查中的应用
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摘要
目的:探讨血管内皮功能检查(FMD值)在2型糖尿病并发症筛查中的应用价值。方法:选取78例糖尿病患者作为研究对象,包括38例老年糖尿病患者(观察A组),40例非老年糖尿病患者(观察B组)。同时另选同期进行健康体检的健康者70例进行研究,包括45例老年健康者(对照A组),35例非老年健康者(对照B组)。采用高分辨率超声测定各组动脉内-中膜厚度(IMT)、肱动脉反应性充血前后及舌下含服硝酸甘油前后内径变化情况。结果:观察A、B组空腹血糖、糖化血红蛋白水平均高于对照A、B组,观察组与对照组比较差异均有统计学意义(P<0.05);观察A组收缩压、舒张压高于观察组B组,两组比较差异有统计学意义(P<0.05)。糖尿病患者动脉IMT值均在正常范围内,但观察A组动脉IMT值与对照A组相比明显增厚,与对照B组比较其颈动脉、股动脉IMT值明显增加,差异均有统计学意义(P<0.05)。观察组与对照组肱动脉基础内径比较,差异无统计学意义(P>0.05);反应性充血时,观察A、B组动脉内径变化率明显低于对照A、B组,差异有统计学意义(P<0.05);含服硝酸甘油后各组动脉内径变化率比较差异无统计学意义(P>0.05)。结论:通过检测糖尿病患者血管内皮功能变化情况,有助于及早发现患者血管内皮功能是否存在受损情况,可作为糖尿病患者大血管并发症的首选检查方法,对糖尿病大血管并发症的早发现、早治疗具有重要临床意义。
Objective:To explore the application value of vascular endothelial function value(FMD) in screening type 2 diabetes complications.Method:78 patients with diabetes were selected as research subjects, which included 38 patients with elderly diabetes mellitus(observation group A) and 40 patients with non-elderly diabetes mellitus(observation group B).Another 70 patients undergoing physical examinations during the same period were studied,which included 45 elderly healthy subjects(control group A) and 35 non-elderly healthy subjects(control group B).High-resolution ultrasonography was used to determine the thicknesses of intima-media thickness(IMT) of arteries and changes in reactive hyperemia of brachial artery inner diameters before and after sublingual nitroglycerin in all groups.Result:The fasting glucose and glycosylated hemoglobin levels of observation group A and B were higher than such indexes of control group A and B,the differences were statistically significant(P<0.05). Systolic pressures and diastolic pressures of subjects in the observation group A were higher than observation group B,the differences were statistically significant(P<0.05).Artery IMT values of diabetes mellitus were within normal range, but artery IMT values of subjects in the observation group obviously thickened when compared to control group A, IMT values of carotid and femoral arteries of patients in the observation group A increased significantly when compared to control group B, the differences were statistically significant(P<0.05).The difference was not statistically significant about basic inner diameters of brachial arteries in the observation group and control group(P>0.05).When reactive hyperemia occurred,the change rate of artery diameters of subjects in the observation group A and B were significantly lower than control group A and B,the differences were statistically significant(P<0.05).After administering with nitroglycerin,the difference were not significantly different about change rates of artery diameters in all groups(P>0.05).Conclusion:The determination on the change in vascular endothelial function of patients with diabetes contributes to early discovering that if there is any damage with vascular endothelial function of patients, and it may be used as preferred examination method for large-size vascular complications of patients with diabetes mellitus.It has great clinical significance in early detection and treatment of large vascular complications of diabetes mellitus.
Objective:To explore the application value of vascular endothelial function value(FMD) in screening type 2 diabetes complications.Method:78 patients with diabetes were selected as research subjects, which included 38 patients with elderly diabetes mellitus(observation group A) and 40 patients with non-elderly diabetes mellitus(observation group B).Another 70 patients undergoing physical examinations during the same period were studied,which included 45 elderly healthy subjects(control group A) and 35 non-elderly healthy subjects(control group B).High-resolution ultrasonography was used to determine the thicknesses of intima-media thickness(IMT) of arteries and changes in reactive hyperemia of brachial artery inner diameters before and after sublingual nitroglycerin in all groups.Result:The fasting glucose and glycosylated hemoglobin levels of observation group A and B were higher than such indexes of control group A and B,the differences were statistically significant(P<0.05). Systolic pressures and diastolic pressures of subjects in the observation group A were higher than observation group B,the differences were statistically significant(P<0.05).Artery IMT values of diabetes mellitus were within normal range, but artery IMT values of subjects in the observation group obviously thickened when compared to control group A, IMT values of carotid and femoral arteries of patients in the observation group A increased significantly when compared to control group B, the differences were statistically significant(P<0.05).The difference was not statistically significant about basic inner diameters of brachial arteries in the observation group and control group(P>0.05).When reactive hyperemia occurred,the change rate of artery diameters of subjects in the observation group A and B were significantly lower than control group A and B,the differences were statistically significant(P<0.05).After administering with nitroglycerin,the difference were not significantly different about change rates of artery diameters in all groups(P>0.05).Conclusion:The determination on the change in vascular endothelial function of patients with diabetes contributes to early discovering that if there is any damage with vascular endothelial function of patients, and it may be used as preferred examination method for large-size vascular complications of patients with diabetes mellitus.It has great clinical significance in early detection and treatment of large vascular complications of diabetes mellitus.
引文
[1]唐冰霜.替米沙坦对老年糖尿病合并高血压患者胰岛素敏感性及血管内皮功能的影响[J].蚌埠医学院学报,2013,38(7):854-855.
[2]路文盛,师布朵,黄群,等.不同血糖情况下的血管内皮功能与PGC-1α对糖尿病大血管的保护作用[J].中华内分泌代谢杂志,2013,29(6):479-483.
[3]刘悦,沈建国.老年糖尿病患者脂肪餐后甘油三酯的变化及其对血管内皮功能的影响[J].中国老年学杂志,2014,25(17):4775-4777.
[4]范文.糖尿病患者脂肪餐后三酰甘油的变化及其对血管内皮功能的影响[J].医学综述,2015,25(17):3230-3232.
[5]张子新,余陆娇,张立敏,等.法舒地尔对糖尿病合并动脉粥样硬化大鼠心脏结构和功能的影响[J].中国循环杂志,2013,28(5):384-387.
[6]高梅.内皮素和一氧化氮检测对糖尿病血管内皮功能的评价作用[J].齐齐哈尔医学院学报,2015,14(29):4422-4423.
[7]陆再英,钟南山.内科学[M].7版.北京:人民卫生出版社,2012:60-62.
[8]张征,郭发金,韩栋,等.高分辨率超声在检测糖尿病患者早期血管内皮功能中的应用[J].中华老年医学杂志,2006,25(8):574-576.
[9]孙连庆,孙扬,郑伟,等.糖尿病肢体动脉闭塞症患者血管内皮功能和颈动脉内膜中膜厚度的变化[J].中国动脉硬化杂志,2008,16(2):145-148.
[10]宋福展,郝清智.糖尿病足患者肱动脉血管内皮功能、股动脉IMT变化及意义[J].山东医药,2012,52(2):97-98.
[11]陈章强,洪浪,王洪,等.通心络胶囊对原发性高血压伴糖尿病患者血小板活化因子和炎症因子及内皮功能的影响[J].中国中西医结合杂志,2010,30(4):376-379.
[12]陈德友,曹剑,朱冰坡,等.老年冠心病合并糖尿病患者血管内皮功能的变化[J].中华老年心脑血管病杂志,2006,8(1):22-24.
[13]张东升,史清平,高玲,等.二维血流显像技术及多普勒超声对2型糖尿病早期下肢血管内皮功能状况研究[J].山西医药杂志,2012,41(21):1090-1092.
[14]姜彤伟,张文风.糖尿病大鼠血液流变学与血管内皮功能的相关性及益气活血通络方药的干预作用[J].中国老年学杂志,2010,30(23):3513-3514.
[15]刘静,王桂山.血管内皮功能检测在冠心病合并2型糖尿病的应用价值[J].中国民康医学,2013,25(3):21-23.
[16]陈健儿,吴文斌,郭健,等.MMP-9、TIMP-1的表达与糖尿病合并肺结核发病的关系探讨[J].中国医学创新,2015,36(24):5-7.
[17]王丽佳,程瑞迎,柳洁,等.Chemerin与糖尿病大血管病变的相关性分析[J].中国医学创新,2015,25(12):139-142.
[18]武晓莉.糖尿病状态血糖、胰岛素的时间生物学特征的研究[J].中国医学创新,2015,12(29):145-147.
[19]邵坤银.糖化血红蛋白对糖尿病诊断及监测的临床意义[J].中国医学创新,2011,8(2):122-123.
[20]Soleimanpour S A,Gupta A,Bakay M,et al.The diabetes susceptibility gene clec16a regulates mitophagy[J].Cell,2014,157(7):1577-1590.
[21]Deschamps K,Matricali G A,Roosen P,et al.Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes[J].Clinical Biomechanics,2013,28(7):813-819.
[22]Liu L,Li Y,Guan C,et al.Free fatty acid metabolic profile and biomarkers of isolated post-challenge diabetes and type 2 diabetes mellitus based on GC-MS and multivariate statistical analysis[J].Journal of Chromatography,B.Analytical Technologies in the Biomedical and Life Sciences,2010,878(28):2817-2825.
[23]Yi C,Lee J H,Kwak B S,et al.Diagnosis of diabetes mellitus using sialic acid expression of erythrocyte and a microfluidic resistive temperature detector(micro-RTD)[J].Sensors and Actuators B Chemical,2014,191(2):305-312.
[24]Hu Y,Chen Y,Ding L,et al.Pathogenic role of diabetesinduced PPAR-αdown-regulation in microvascular dysfunction[J].Proceedings of the National Academy of Sciences of the United States of America,2013,110(38):15401-15406.
[25]Diabetes Control and Complications Trial Research Group.The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus[J].New England Journal of Medicine,1993,329(14):977-986.
[2]路文盛,师布朵,黄群,等.不同血糖情况下的血管内皮功能与PGC-1α对糖尿病大血管的保护作用[J].中华内分泌代谢杂志,2013,29(6):479-483.
[3]刘悦,沈建国.老年糖尿病患者脂肪餐后甘油三酯的变化及其对血管内皮功能的影响[J].中国老年学杂志,2014,25(17):4775-4777.
[4]范文.糖尿病患者脂肪餐后三酰甘油的变化及其对血管内皮功能的影响[J].医学综述,2015,25(17):3230-3232.
[5]张子新,余陆娇,张立敏,等.法舒地尔对糖尿病合并动脉粥样硬化大鼠心脏结构和功能的影响[J].中国循环杂志,2013,28(5):384-387.
[6]高梅.内皮素和一氧化氮检测对糖尿病血管内皮功能的评价作用[J].齐齐哈尔医学院学报,2015,14(29):4422-4423.
[7]陆再英,钟南山.内科学[M].7版.北京:人民卫生出版社,2012:60-62.
[8]张征,郭发金,韩栋,等.高分辨率超声在检测糖尿病患者早期血管内皮功能中的应用[J].中华老年医学杂志,2006,25(8):574-576.
[9]孙连庆,孙扬,郑伟,等.糖尿病肢体动脉闭塞症患者血管内皮功能和颈动脉内膜中膜厚度的变化[J].中国动脉硬化杂志,2008,16(2):145-148.
[10]宋福展,郝清智.糖尿病足患者肱动脉血管内皮功能、股动脉IMT变化及意义[J].山东医药,2012,52(2):97-98.
[11]陈章强,洪浪,王洪,等.通心络胶囊对原发性高血压伴糖尿病患者血小板活化因子和炎症因子及内皮功能的影响[J].中国中西医结合杂志,2010,30(4):376-379.
[12]陈德友,曹剑,朱冰坡,等.老年冠心病合并糖尿病患者血管内皮功能的变化[J].中华老年心脑血管病杂志,2006,8(1):22-24.
[13]张东升,史清平,高玲,等.二维血流显像技术及多普勒超声对2型糖尿病早期下肢血管内皮功能状况研究[J].山西医药杂志,2012,41(21):1090-1092.
[14]姜彤伟,张文风.糖尿病大鼠血液流变学与血管内皮功能的相关性及益气活血通络方药的干预作用[J].中国老年学杂志,2010,30(23):3513-3514.
[15]刘静,王桂山.血管内皮功能检测在冠心病合并2型糖尿病的应用价值[J].中国民康医学,2013,25(3):21-23.
[16]陈健儿,吴文斌,郭健,等.MMP-9、TIMP-1的表达与糖尿病合并肺结核发病的关系探讨[J].中国医学创新,2015,36(24):5-7.
[17]王丽佳,程瑞迎,柳洁,等.Chemerin与糖尿病大血管病变的相关性分析[J].中国医学创新,2015,25(12):139-142.
[18]武晓莉.糖尿病状态血糖、胰岛素的时间生物学特征的研究[J].中国医学创新,2015,12(29):145-147.
[19]邵坤银.糖化血红蛋白对糖尿病诊断及监测的临床意义[J].中国医学创新,2011,8(2):122-123.
[20]Soleimanpour S A,Gupta A,Bakay M,et al.The diabetes susceptibility gene clec16a regulates mitophagy[J].Cell,2014,157(7):1577-1590.
[21]Deschamps K,Matricali G A,Roosen P,et al.Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes[J].Clinical Biomechanics,2013,28(7):813-819.
[22]Liu L,Li Y,Guan C,et al.Free fatty acid metabolic profile and biomarkers of isolated post-challenge diabetes and type 2 diabetes mellitus based on GC-MS and multivariate statistical analysis[J].Journal of Chromatography,B.Analytical Technologies in the Biomedical and Life Sciences,2010,878(28):2817-2825.
[23]Yi C,Lee J H,Kwak B S,et al.Diagnosis of diabetes mellitus using sialic acid expression of erythrocyte and a microfluidic resistive temperature detector(micro-RTD)[J].Sensors and Actuators B Chemical,2014,191(2):305-312.
[24]Hu Y,Chen Y,Ding L,et al.Pathogenic role of diabetesinduced PPAR-αdown-regulation in microvascular dysfunction[J].Proceedings of the National Academy of Sciences of the United States of America,2013,110(38):15401-15406.
[25]Diabetes Control and Complications Trial Research Group.The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus[J].New England Journal of Medicine,1993,329(14):977-986.