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目的研究糖尿病早期肾病患者的血管内皮功能。方法糖尿病早期肾病组20例、糖尿病正常白蛋白尿组25例及正常对照组21例,应用高分辨率彩色超声诊断仪,在基础状态、反应性充血及含服硝酸甘油后测定肱动脉血管内径,计算反应性充血后、含服硝酸甘油后的血管内径变化率,测定肱动脉基础血流量,计算反应性充血后、含服硝酸甘油后的血流量及其变化率,以评定肱动脉血流介导的血管舒张功能。结果与正常对照组相比,糖尿病早期肾病组和糖尿病正常白蛋白尿组的内皮依赖性舒张功能和非内皮依赖性舒张功能均显著降低(P<0.05)。同糖尿病正常白蛋白尿组相比,糖尿病早期肾病组患者的内皮依赖性舒张功能显著降低(P<0.05),非内皮依赖性舒张功能也显著降低(P<0.05)。糖尿病早期肾病组患者内皮依赖性舒张功能与患者的血糖、血压、甘油三酯、病程和体重指数水平呈负相关。结论糖尿病早期肾病组患者比糖尿病正常白蛋白尿组患者血管内皮功能损害更明显,提示血管内皮功能损害可能是糖尿病肾损害的机制之一。糖尿病早期肾病患者的血管内皮依赖性舒张功能与患者的血糖、血压、血脂尤其是甘油三酯、病程及体重指数呈负相关。作为一种无创性检测血管内皮功能的方法,血管彩色超声检查具有简单方便、重复性好、准确度高等优点。
Objective To study the endothelial function of patients with early diabetic nephropathy. Methods 20 patients with early diabetic nephropathy, 25 patients with normal urine albuminuria, and 21 normal controls were enrolled in this study. High-resolution color sonography was used to measure the intravascular diameter of brachial artery after basal state, reactive hyperemia and nitroglycerin , Calculated after reactive hyperemia, with nitroglycerin after the rate of change of vascular diameter, determination of brachial artery basal blood flow, reactive hyperemia, the blood flow and its rate of change after containing nitroglycerin to assess the brachial artery blood flow Mediated vasodilation. Results Compared with the normal control group, the endothelium-dependent and non-endothelium-dependent diastolic function of diabetic nephropathy group and normal albuminuria group were significantly decreased (P <0.05). Compared with normal albuminuria group, endothelium-dependent diastolic function was significantly decreased (P <0.05) and non-endothelium-dependent diastolic function was significantly lower in diabetic nephropathy group (P <0.05). Endothelium-dependent diastolic function in patients with early diabetic nephropathy was negatively correlated with patients’ blood glucose, blood pressure, triglycerides, duration of disease and body mass index. Conclusions Patients with early diabetic nephropathy may have more significant endothelial dysfunction than diabetic patients with normal albuminuria, suggesting that vascular endothelial dysfunction may be one of the mechanisms of diabetic nephropathy. Endothelium-dependent vasodilation in patients with early diabetic nephropathy was negatively correlated with the patient’s blood glucose, blood pressure, blood lipids, especially triglycerides, duration of disease and body mass index. As a non-invasive method of detecting vascular endothelial function, vascular color ultrasound has the advantages of simple and convenient, good repeatability and high accuracy.