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目的探讨正常糖耐量2型糖尿病一级亲属(FDR)内皮功能改变和危险因素。方法 FDR(B组)66例分非肥胖亚组(B1)36例和肥胖亚组(B2)30例,与糖耐量正常的非糖尿病亲属(NFDR,A组)76例其中非肥胖亚组(A1)39例和肥胖亚组(A2)37例作比较,作口服葡萄糖耐量试验及胰岛素释放试验,检测0 min、10 min、20 min、30 min、60 min、120 min血糖、免疫活性胰岛素,同时检测空腹血脂、游离脂肪酸(FFA)、脂联素(APN)、超敏C反应蛋白(hs-CRP)、血内皮素(SET),留取晨尿测定尿内皮素(UET)与微量白蛋白(MUA),并观察血压、身高和体重,测定肱动脉休息时、加压及服用硝酸甘油后的内径变化。结果校正性别、年龄后,MUA、hs-CRP、UET、SET、内皮依赖性血管舒张功能(EDD)和内皮非依赖性血管舒张功能(EID)B组与A组比较无差异(P>0.05);UET和SET B2亚组与B1亚组比较有差异(P<0.01);hs-CRP A2亚组与A1亚组以及B2亚组与B1亚组比较有差异(P<0.05或P<0.01);MUA B2亚组与B1亚组及B1亚组与A1亚组比较有差异(P<0.05或P<0.01)。进一步校正性别、年龄和腰围指数后,SET B2亚组与A2亚组比较有差异(P<0.05),MUA B2亚组与B1亚组及B1亚组与A1亚组比较有差异(P<0.05)。多元回归分析显示,以内皮指标为因变量能进入方程的有肥胖、血压、脂代谢、血糖、胰岛素抵抗及胰岛功能等指标。结论 FDR出现了大血管内皮功能改变;糖尿病遗传背景为内皮功能改变的独立因素,合并肥胖和(或)其他代谢性因素不容忽视。
Objective To investigate the changes of endothelial function and risk factors in first-degree relatives (FDR) of normal glucose tolerance type 2 diabetic patients. Methods Sixty-six non-obesity subgroups (B1) and thirty-two obesity subgroups (B group) in 66 cases of FDR (group B) and 76 non-diabetic relatives with normal glucose tolerance (NFDR group A) A1) and 37 obese subgroups (A2) for oral glucose tolerance test and insulin release test. Blood glucose, immunocompetent insulin, insulin and insulin were measured at 0, 10, 20, 30, 60, Fasting blood lipids, free fatty acids (FFA), adiponectin (APN), hs-CRP, SET, urine samples were collected for determination of urinary endothelin (UET) and trace white (MUA). The blood pressure, height and weight of the brachial artery were measured. The brachial artery pressure was measured and the inner diameter of the brachial artery was changed after taking nitroglycerin. Results There was no significant difference between group B and group A (P> 0.05) after adjusting for gender and age. There was no difference between group B and group A (P <0.05) (P <0.05 or P <0.01). There was significant difference between B1 subgroup and B1 subgroup in UET and SET B2 subgroups (P <0.01 or P <0.01) There was significant difference between MUA B2 subgroup and B1 subgroup and B1 subgroup and A1 subgroup (P <0.05 or P <0.01). There was significant difference between SET B2 subgroup and A2 subgroup (P <0.05) after further adjustment for gender, age and waist circumference index (P <0.05) ). Multivariate regression analysis showed that the index of endothelial function as a dependent variable can enter the equation of obesity, blood pressure, lipid metabolism, blood glucose, insulin resistance and islet function and other indicators. Conclusions The vascular endothelial function was changed in FDR. The genetic background of diabetes was an independent factor of endothelial function. The combination of obesity and other metabolic factors should not be neglected.