【作者】 唐芳；

【导师】 蒋铁建；

【作者基本信息】 中南大学 ， 临床医学， 2013， 硕士

【摘要】 目的：本研究拟通过高频彩超检测NC组和DM组西格列汀治疗前后FMD,同时检测其血清PAI-1、3-NT、NO的水平,并分析它们之间的关系,探讨西格列汀能否改善内皮功能及其可能机制。方法：随机收集2012年7月至2013年1月在湘雅医院内分泌科门诊确诊的糖化血红蛋白在6.5%-10.0%的初诊T2DM患者48例为糖尿病组(DM组),分别给予12周西格列汀100mg,1次/天治疗,治疗前后行FMD、 NO、PAI、3-NT测定。同期在我院健康体检中心收年龄、体重指数相匹配的健康体检者20人为正常对照组(NC组)。NO、PAI-1、3-NT均采用酶联免疫吸附法(ELISA法)测定；FMD采用高分辨血管外超声法测定。所有数据处理采用SPSS18.0软件统计分析。结果：1.与NC相比,DM组FMD、NO明显下降,而3-NT、 PAI-1明显上升,差异均有统计学意义(P<0.01)；2.与治疗前相比,DM组治疗后FMD、NO显著上升,PAI-1显著下降,差异均有统计学意义(P<0.01)；3.治疗前后FMD的变化量与相关危险因素的变化量的两两相关分析：△FMD与△NO呈正相关(P<0.01)。4.AFMD与FMD相关因素变化量的多元线性逐步回归方程FMD=0.531+0.041NO-0.096HOMA-IR.结论：1.初诊T2DM患者存在明显的氧化应激、纤溶活性异常及内皮功能障碍,且内皮功能障碍与这些因素密切相关。2.初诊T2DM患者经西格列汀治疗后,FMD、NO显著上升,提示西格列汀治疗可以改善早期糖尿病患者的内皮功能障碍。3.初诊T2DM患者经西格列汀治疗后内皮功能障碍明显改善,与纤溶活性异常、胰岛抵抗、血压的改善有关,但其主要机制可能最后是通过升高NO水平发挥的。图20幅,表9个,参考文献45篇更多还原

【Abstract】 Objective:To identify the effect of sitagliptin therapy on endothelial function in newly diagnosed type2diabetes mellitus (T2DM),and explore the possible mechanism.Methods:48newly diagnosed T2DM patients with HbAlc from6.5%to10.0%were selected randomly in endocrinology department of Xiang Ya hospital during July2012to January2013.All patients were treated with sitagliptin100mg/d for12weeks. The FMD and serum NO,3-NT, PAI-1were inspected at baseline and after12weeks of sitagliptin therapy.20age-and BMI-matched health examination people were selected as NC group during the same time. ELISA was used to detect serum NO, and3-NT PAI-1;High-resolution ultrasound was used to detect FMD. ALL the results were collected and analyzed by SPSS18.0.Results:1.FMD,NO were significantly decreased and3-NT, PAI-lwere significantly increased in DM group compared with control (p<0.01);2.FMD,NO were significantly increased and PAI-1were significantly decreased after sitagliptin therapy in DM group(p<0.01);3. Linear correlation analysis of the change of FMD with the change of3-NT、PAI-1、 NO and other indexes associated:ΔFMD had positive relation with ΔNO (P<0.01).4. Multiple linear regression of ΔFMD and the change of other risk factors associated:ΔFMD=0.531+0.041Δ NO-0.096ΔHOMA-IR.Conclusions:1. There were obvious oxidative stress, abnormal fibrinolytic activity and endothelial dysfunction in newly diagnosed T2DM, and endothelial dysfunction is closely related to these factors.2.vascular endothelial dysfunction of type2diabetes mellitus patients can be improved by the treatment with sitagliptin as evidenced by increase in the FMD, and improvement of the NO levels3. The improvement of abnormal fibrinolytic activity, insulin resistance and blood pressure after sitagliptin therapy can ameliorates endothelial dysfunction of newly diagnosed T2DM, but its possible mechanism is via increasing NO release.更多还原