糖耐量异常与动脉粥样硬化发病的相关性

背景糖耐量异常是动脉粥样硬化潜在的危险因子,但糖耐量异常与动脉粥样硬化的确切关系尚未阐明.目的探讨糖耐量异常患者糖耐量的异常变化与动脉粥样硬化发病的关系.设计观察对比实验.单位解放军总医院心内科.对象选择2001-01/2002-02在解放军总医院就诊的血糖异常升高患者221例,均自愿参加观察.男135例,女86例,年龄(52±10)岁.方法①受试者于空腹过夜10～14 h后食用含至少150 g碳水化合物的食物3 d,口服溶于250 mL水内的无水葡萄糖粉75 g.分别取空腹及服糖后2 h静脉血标本,立即离心分离血浆.②按照预先设计的调查表格记录患者的病史,空腹过夜12 h后测量空腹胰岛素、总胆固醇、三酰甘油及高、低密度脂蛋白胆固醇水平.③使用高频B型超声检查颈动脉,用频率10 MHz的线阵探头扫描双侧颈总动脉,测量内膜内侧缘至中膜外侧缘之间的距离,即为内中膜厚度.④按照1999年世界卫生组织的诊断标准进行糖耐量分型.糖尿病为空腹血糖≥7.0 mmol/L或服糖后2 h血糖≥11.1 mmol/L;糖耐量异常为空腹血糖＜7.0 mmol/L和7.8 mmol/L≤服糖后2 h血糖＜11.1 mmol/L;正常糖耐量为空腹血糖＜6.1mmol/L和服糖后2 h血糖＜7.8 mmol/L.高血压标准为收缩压≥160 mm Hg(1 mm Hg=0.133 kP),舒张压≥95 mm Hg.以颈动脉内中膜厚度≥1.2 mm定为斑块.颈动脉内膜光滑性分级光滑性及连续性好,内膜无粗糙区为0;光滑性较差为1;明显差为2.主要观察指标各组观察对象的一般情况、血脂水平及颈动脉颈动脉内中膜厚度.结果221例血糖异常升高者全部进入结果分析,无脱落.①血糖异常升高患者分为3组,正常糖耐量组97例,糖耐量异常组51例,糖尿病组73例.②各组观察对象动脉粥样硬化一般情况的比较糖耐量异常组三酰甘油、低密度脂蛋白胆固醇、空腹胰岛素水平及胰岛素抵抗指数显著高于正常糖耐量组[(1.79±0.89,3.31±0.52)mmol/L,(5.90±3.02)mU/L,1.52±0.86;(1.49±0.83,3.07±0.66)mmol/L,(3.91±2.08)mU/L,(0.93±0.54)(t=2.038～5.113,P＜0.05～0.01)],高密度脂蛋白胆固醇水平显著低于正常糖耐量组[(1.17±0.28,1.39±0.32)mmol/L,(t=4.145,P＜0.01)].除胰岛素抵抗指数外,以上指标糖尿病组与糖耐量异常组之间的差异无显著意义(P＞0.05).③各组观察对象颈动脉粥样硬化的相关指标比较糖耐量异常组的平均内中膜厚度、内膜光滑性评分均显著高于正常糖耐最组[(0.80±0.20,0.73±0.15)mm;2.10±1.37,1.55±1.23(t=2.398,2.485,P＜0.05)].④Logistic回归分析年龄、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平与糖耐量异常相关(P＜0.05～0.01).结论糖耐量异常患者存在明显的动脉粥样硬化表现,其程度与糖尿病患者接近.

Correlation between abnormal glucose tolerance and the incidence of atherosclerosis

BACKGROUND: Impaired glucose tolerance (IGT) is a potential risk factor of atherosclerosis. But the precise correlation between IGT and atherosclerosis is still unknown.OBJECTIVE: To investigate the relationship between IGT and atherosclerosis in patients with IGTDESIGN: An observational comparative experiment.SETTING: The Department of Cardiology of the General Hospital of Chinese PLA.PARTICIPANTS: Totally 221 cases who received the treatment of increased glucose at the General Hospital of Chinese PLA were recruited between January 2001 and February 2002. They participated in the observation voluntarily. There were 135 male and 86 female patients aged (52±10)years.Recipients took meals including more than 150 g of carbohydrates for 3days. 75 g of anhydrous glucose diluted in 250 mL of solution was administered orally and blood sample was drawn before glucose loading and 2hours after that. The blood sample was centrifuged immediately to separate tus of the subjects. The biochemical parameters were obtained after an overnight fast for 12 hours. Venous blood was sampled for the measurement of fasting insulin (FINS), total cholesterol (CH), triglyceride (TG), high-denwas detected by high-resolution B-mode ultrasound. Bilateral common carotid arteries were scanned with a 10-MHz linear transducer. The intimal medial thickness(IMT) was measured as the distance between the characteristic echoes from the lumen-intima and the media-adventitia interfaces.WHO criteria [2]. Subjects were subdivided into diabetes [fasting plasma glucose (FPG) ≥ 7.0 mmol/L or 2-hour PG ≥ 11.1mmol/L), impaired glucose tolerance (FPG＜7.0 mmol/L and 7.8 mmol/L≤ 2-hour PG＜1 1.1mmol/L= and normal glucose tolerance (FPG＜6.1 mmol/L and 2-hour PG ＜7.8mmol/L). Hypertension was defined as a systolic blood pressure ≥160mmHg (1 mm Hg=0.133 kP)or diastolic blood pressure≥95mmHg. A plaque was defined as any wall thickness greater than 1.2 mm. The intima smoothness was graded as follows: good smoothness and continuity, no coarse area, valued as 0; relatively poor smoothness as 1; apparently poor smoothness as 2.MAIN OUTCOME MEASURES: General conditions, blood lipid level as well as carotid artery intima-media thickness of the subjects in each groupRESULTS: Totally 221 patients with increased glucose tolerance all entients with increased glucose tolerance were divided into 3 groups: Normal glucose tolerance (n=97), abnormal glucose tolerance (n=51), and diabetic atherosclerotic patients in each group: triacylglycerol, Low-density lipoprotein, fasting insulin and insulin resistance index in the abnormal glucose tolerance group were significantly higher than those of the normal glucose tolerance group [(1.79±0.89,3.31 ±0.52)mmol/L, (5.90 ±3.02)mU/L,1.52±0.86; ( 1.49±0.83,3.07±0.66)mmol/L, (3.91 ±2.08)mU/L, (0.93±0.54)(t=2.038-5.113,P ＜ 0.05-0.01)]. High-density lipoprotein level in the abnormal glucose tolerance group was significantly lower than that in the normal glucose tolerance group [(1.17±0.28, 1.39±0.32) mmol/L,(t=4.145,P ＜ 0.01)]. There was no significant difference of above indexes except for insulin index between diabetic mellitus group and abnormal glucose tolatherosclerosis: the scores of average intima-media thickness and intima-media smoothness in the abnormal glucose tolerance group were significantly higher than those of the normal glucose tolerance group [(0.80±0.20,0.73±0.15)mm;2.10±1.37,1.55±1.23 (t=2.398,2.485, P ＜ 0.05 )].density lipoprotein cholesterol level were related to abnormal glucose tolerance (P ＜ 0.05-0.01).CONCLUSION: Patients of abnormal glucose tolerance had significant atherosclerotic manifestations compared with those of normal glucose tolerance, which is similar to DM subjects.