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目的研究2型糖尿病患者血清可溶性血管细胞黏附分子-1(sVCAM-1)、可溶性细胞间黏附分子-1(sICAM-1)水平和颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)的关系以及吡格列酮治疗对其的影响。方法将150例2型糖尿病患者随机分为治疗组和对照组。治疗组在原治疗基础上给予吡格列酮15mg/d,治疗6个月,观察吡格列酮治疗前后血糖、血脂、sVCAM-1、sICAM-1和CIMT水平变化及与对照组之间的差别。结果与治疗前比较,两组治疗后血糖均下降,差异有统计学意义(P<0.05),治疗组治疗后sVCAM-1、sICAM-1和CIMT较治疗前显著降低,差异有统计学意义(P<0.05)。对照组治疗前后sVCAM-1、sICAM-1和CIMT差异无统计学意义(P<0.05)。多元线性逐步回归分析显示,CIMT变化与体质指数(BMI)餐后2h血糖(2hPG)、糖化血红蛋白(HbA1C)、甘油三酯(TG)、sVCAM-1和sICAM-1有关,相关系数分别为0.298、0.358、0.381、0.368、0.580、0.572(均P<0.05)。结论血清sVCAM-1和sICAM-1水平与2型糖尿病早期大血管病变关系密切,吡格列酮能显著降低2型糖尿病患者血清sVCAM-1和sICAM-1水平,这可能是吡格列酮血管保护的作用机制之一。
Objective To investigate the changes of serum soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1) and carotid intima-media thickness (CIMT) in type 2 diabetic patients Relationship and the effect of pioglitazone on it. Methods 150 patients with type 2 diabetes were randomly divided into treatment group and control group. The treatment group was given pioglitazone 15mg / d on the basis of the original treatment for 6 months. The changes of blood glucose, blood lipid, sVCAM-1, sICAM-1 and CIMT before and after pioglitazone treatment were observed and compared with the control group. Results Compared with those before treatment, the blood glucose of the two groups decreased after treatment, the difference was statistically significant (P <0.05). The levels of sVCAM-1, sICAM-1 and CIMT in the treatment group were significantly lower than those before treatment, the difference was statistically significant P <0.05). There was no significant difference in sVCAM-1, sICAM-1 and CIMT before and after treatment in the control group (P <0.05). Multivariate linear stepwise regression analysis showed that the changes of CIMT were correlated with 2hPG, HbA1C, triglyceride (TG), sVCAM-1 and sICAM-1 after mealtime with a body mass index (BMI) of 0.298 , 0.358,0.381,0.368,0.580,0.572 (all P <0.05). Conclusions Serum levels of sVCAM-1 and sICAM-1 are closely related to early macrovascular disease in type 2 diabetes. Pioglitazone can significantly reduce the serum levels of sVCAM-1 and sICAM-1 in type 2 diabetic patients, which may be one of the mechanisms of pioglitazone’s vascular protection .