老年DM患者脂餐后脂蛋白(a)水平变化及其对血管内皮功能的影响

目的：探讨老年2型糖尿病（2-DM）患者脂肪餐负荷后脂蛋白a[LP（a）]水平变化及其对血管内皮功能的影响。方法：选取25例老年2-DM患者（DM组）及24例健康志愿者（对照组）,均给与脂肪餐试验,分别于空腹和餐后2、4、6h抽血化验LP（a）,采用B超检测空腹颈动脉内中膜厚度（IMTc）和血管内皮依赖性舒张功能（FMD0）及餐后4hFMD4。结果：与空腹时比较,脂餐后各时段2组自身LP（a）的水平比较差异不明显,与对照组比较,DM组空腹及餐后LP（a）的水平、IMTc、FMD0均明显增高（P〈0.05）;LP（a）水平与IMTc、FMD呈正相关（r=0.36、0.45,均P〈0.05）。结论：老年DM患者有明显的LP（a）血症,LP（a）血症可以一过性损伤血管内皮功能,是动脉粥样硬化的独立危险因素。

The Change of Postprandial Lipoprotein(a) and Its Effect on Endothelial Function in Elderly Patients with Type 2 Diabetes Melletus

Objective: To explore the change of postprandial lipoprotein(a) and its effect on endothelial function in elderly patients with type 2 diabetes melletus(DM). Methods: The subjects were assigned to two groups: the elderly type 2-DM group and the healthy control group. Lipoprotein(a) was measured before and 2, 4 and 6 h after a fatty meal (600 kcal, 60% fat, 14% protein, 26% carbohydrate). Carotid IMT, FMD fasting and 4 h after the meal were measured by ultrasonography. Results: Compared with the healthy control group, a slight increase of LPa, IMTc and FMD and a slight decrease of FMD0 and FMD4 were found in type 2 DM group (P<0.05); FMD4 was significantly declined after the meal in both groups. The level of lipoprotein(a) was positively correlated with IMTc (r=0.11, P<0.05) and FMD (r=0.02, P<0.05). Conclusion: The increased lipoprotein(a) level in the elderly type 2 DM induced endothelial dysfunction and was one independent risk factor of atherosclerosis.