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目的 观察伴或不伴微量白蛋白尿的 2型糖尿病 (DM )患者胰岛素抵抗 (IR)状态及内皮细胞功能 ,探讨 2型DM大血管病变危险性增加的发病机制。方法 伴微量白蛋白尿的 2型DM组 (DM MA)、尿白蛋白正常的 2型DM组 (DM NA)及正常对照组 (NC)各 12例。 3组研究对象均采用正常血糖高胰岛素钳夹试验评价其外周组织葡萄糖利用率 (GDR) ,采用彩色多普勒超声技术测定其内皮细胞依赖性血管舒张功能 (EDV)以及非内皮细胞性血管舒张功能 (EIV)。结果 DM组GDR明显低于正常对照组 ,且DM MA组GDR较DM NA组更低〔对照组 (13 .0 6± 1.98)mg·kg-1·min-1,DM MA和DM NA组分别为 (7.90± 1.79)、(9.46± 1.5 2 )mg·kg-1·min-1,P <0 .0 5或P <0 .0 1〕。两组DM患者的EDV较正常对照组降低 (均P <0 .0 5 ) ,且DM MA组EDV受损程度重于DM NA组 (P <0 .0 5 )。 3组间的EIV差异无显著性。DM组的血游离脂肪酸 (FFA)水平明显高于正常对照组 (P <0 .0 5 ) ,其中DM MA组FFA水平最高。偏相关分析显示 :GDR与EDV呈显著正相关 (r=0 .47,P <0 .0 1,n =3 6)。结论 与尿白蛋白正常的 2型DM患者相比 ,伴有微量白蛋白尿的 2型DM患者具有更严重的IR ,EDV明显受损和较高的血FFA水平。提示伴微量白蛋白尿的 2型DM患者大血管病变危险性增高的机?
Objective To observe the insulin resistance (IR) status and endothelial cell function in patients with type 2 diabetes mellitus (DM) with or without microalbuminuria and to explore the pathogenesis of increased risk of type 2 DM macroangiopathy. Methods DMEM (DM MA), urine albumin normal type 2 DM group (DM NA) and normal control group (NC) were included in this study. The glucose-uptake rate (GDR) in peripheral tissues of the three groups were evaluated by the hyperinsulinemic insulin clamp test. The endothelial cell-dependent vasodilation (EDV) and non-endothelial cell vasodilation were measured by color Doppler sonography. Function (EIV). Results The GDR of DM group was significantly lower than that of normal control group, and the GDR of DM group was lower than that of DMNA group [(13.06 ± 1.98) mg · kg-1 · min-1, DMMA group and DM NA group (7.90 ± 1.79), (9.46 ± 1.5 2) mg · kg-1 · min-1, P <0.05 or P <0.01). The EDV of DM patients in both groups was lower than that in normal controls (all P <0.05), and the EDV in DM group was more severe than that in DM NA group (P <0.05). There was no significant difference in EIV between the three groups. The levels of free fatty acids (FFA) in DM group were significantly higher than those in normal control group (P <0.05), in which DMFA group had the highest FFA level. Partial correlation analysis showed that there was a significant positive correlation between GDR and EDV (r = 0.47, P <0.01, n = 36). Conclusions Type 2 DM patients with microalbuminuria have more severe IR, significant impairment of EDV and higher blood FFA levels than type 2 DM patients with normal urinary albumin. Prompted with microalbuminuria type 2 DM patients with increased risk of macrovascular disease machine?