血管内皮功能和颈动脉内膜中膜厚度变化在糖尿病肢动脉闭塞症中的表达意义

目的:研究血管内皮功能与颈动脉内膜中膜厚度在监测和评估糖尿病肢动脉闭塞症病情变化中的作用及临床意义。方法:将2012年10月至2013年10月入院的75例糖尿病肢体动脉闭塞症患者为研究对象,按照病程分为一、二和三期组,各25例,并纳入25例健康者为对照组。测定其体内一氧化氮、内皮素1、6-酮-前列腺素F1a和血栓素B2水平变化,并运用高分辨率超声对患者及对照组颈动脉内膜中膜厚度(IMT)、内皮依赖性舒张功能(EDD)及非内皮依赖性舒张功能(EID)进行检测,分析比较各组间差异性。结果:随着病程变化,健康对照组与三组糖尿病肢体动脉闭塞症患者相比较高,一、二和三期患者的EDD逐渐降低,且差异有统计学意义(P0.01)。三期患者的EID值较健康组、一期及二期患者低,差异有统计学意义(P0.01)。二期与三期患者IMT与对照组相比逐渐升高,差异有统计学意义(P0.01)。各病程糖尿病肢体动脉闭塞症患者的总胆固醇水平、空腹血糖水平、收缩压及舒张压均高于健康对照组(P0.05),而各组间差异无统计学意义。结论:血管内皮功能及颈动脉内膜中膜厚度的变化可反映糖尿病肢体动脉闭塞症的病程发展,可作为这临床诊断与监测的参考指标。

The Significance of the Changes of Vascular Endothelial Function and Carotid Artery Intima-Media Thickness in Patients with Diabetic Arterial Occlusion of Lower Extremities

Objective:To investigate the changes of vascular endothelial function and carotid artery intima-media thickness and their relationship with the course of diabetic limb arterial obliteration (DLAO).Methods:75 patients with Diabetic Arterial Occlusion of Lower Extremities who were treated in our hospital fromOctober 2012 to October 2013 were chosen and divided into three groups on the basis of different disease stagese. 25 healthy people were observed as the control group. The changes of vascular tension factors such as nitric oxide, endothelin-1, 6-keto-prostaglandin and thromboxane B2 were observed. Endothelium-dependent dilation (EDD), endothelium-independent dilation (EID) and IMT were measured with high resolution ultrasound.Results:In different stages , EDD has significantly characteristic changes, and it was reduced significantly in patients with DAO compared with those healthy control. EID of the branchial arteryin patients of 3rd stage was also lower than that of the 1st, 2nd stage and the control group (P<0.01). IMT of healthy control group were significantly lower than that of the 2nd and 3rd stage. The levels of total cholesterol, fasting blood glucose, systolic and diastolic blood pressure were significantly higher than those of healthy control group (P<0.05).Conclusion:The changes of vascular endothelial function and carotid artery intima-media thickness can indicates the different stages of disease and can be used to monitor the condition of the patients.