【作者】 唐学杰；

【导师】 陈淑敏；

【作者基本信息】 大连医科大学 ， 内科学， 2004， 硕士

【摘要】 心血管疾病是威胁人类健康的主要疾病,动脉结构与功能异常是其重要的病理学基础。动脉结构与功能变化的直接表现之一是动脉弹性(顺应性)异常。动脉弹性的异常不仅反映动脉结构与功能的变化,而且还进一步通过影响某些血流动力学参数如脉压等而影响心血管病的发生发展。因此,研究动脉弹性的变化已成为目前研究心血管病的重要焦点。糖尿病是重要的心血管危险因素,其10年内发生心血管事件的风险大于20%,被认为是冠心病的等危症(equivalent)。新近国外的研究发现,2型糖尿病患者动脉弹性功能下降[1。2] ,但对其异常的表现形式及机制尚不清楚。因此,有必要对糖尿病患者的动脉弹性功能作进一步的深入研究。动脉内皮功能是影响动脉结构与功能的重要因素。内皮细胞通过多种机制如释放NO等维护动脉结构与功能的完整。NO能通过舒张动脉平滑肌等机制,快速改善动脉的结构与功能特性。因此,目前常通过外源性 NO探讨动脉内皮功能及动脉弹性变化。无创性动脉弹性功能检测方法中的C1(大动脉弹性指数)、C2(小动脉弹性指数)值测定是具有有良好的重复性和可靠性,被认为能较好地反映动脉弹性功能的改变,尤其是C2下降所揭示的小动脉弹性功能损害要早于大动脉弹性功能损害,具有重要的研究价值。本研究以美国<WP=5>HDI公司生产的CVProfilerDO-2020无创动脉功能检测仪、采用PWA(脉搏波形分析)技术测定2型糖尿病患者和健康人的C1和C2、并观察舌下含服硝酸甘油前后C1和C2的变化,以探讨2型糖尿病患者动脉弹性功能的变化及其机制。 目的: 观察大动脉弹性指数(C1)与小动脉弹性指数(C2)在2型糖尿病患者中的变化及硝酸甘油对它们影响,并探讨其改变的可能机理。方法: 采用美国HDI公司生产的CVProfilerDO-2020无创动脉功能检测仪测定65例2型糖尿病患者和62名健康人的C1、C2,并观察舌下含服硝酸甘油后C1和C2的变化。结果:在健康对照组,C1和C2均随着年龄的增加逐渐降低,这一现象在糖尿病组不明显。糖尿病组总的C1、C2均显著低于对照组,但在去除年龄和血压这两大影响因素后,糖尿病组只有C2显著低于健康人(3.68±2.03 Vs 6.30±2.68,P<0.05),而C1的降低无显著性(14.4±4.5 Vs 15.3±3.7,P>0.05);含服硝酸甘油后糖尿病患者的C2明显升高(6.25±1.99 Vs 3.87±2.11,P<0.05),其增幅不低于对照组,但C1无明显变化(17.0±5.4 Vs 15.0±4.5,P>0.05)。结论:1)、2型糖尿病患者的小动脉弹性功能(C2)显著降低,硝酸甘油可有效逆转这一变化。2)、动脉内皮功能障碍可能是2型糖尿病患者小动脉弹性功能下降的主要原因。3)、因为小动脉弹性指数(C2)的变化相对独立于年龄和血压,故小动脉弹性指数(C2)比大动脉弹性指数(C1)更能敏感地反映早期血管功能的损伤。4)、原发性高血压的存在对动脉弹性功能减退有叠加作用。5)、C1、C2与脉压(PP)显著负相关。更多还原

【Abstract】 Cardiovascular diseases have been become the primary dangerous of our health.Abnormity of structure and function of arterial wall is the pathology-base of it,and change on arterial elasticity(compliance) is one primary behave of this abnormity.Furthermore, changes on arterial elasticity(compliance) play a very important role in occur and development of cardiovascular disease by working on some parameters such as pulse pressure(PP). So, study on arterial elasticity(compliance) become one of the focus of corrent reserching.Diabetes mellitus is a very important risk factor of coronary heart disease,its risk of occur cardiovascular event in 10 years exceed 20% ,therefore diabetes mellitus being regarded as a equivalent of coronary heart disease. Some studies showed that arterial elasticity(compliance) reduced in patients with with type 2 diabetes mellitus.But the mechanism of it hasn’t been revealed clearly yet. So it’s worthy doing more researches on arterial elasticity (compliance) of patients with with type 2 diabetes mellitus.Endothelium function is the most important factor which working on arterial wall structure and funtion.NO can improve the function of arterial wall rapidly by stretch smooth muscle of artery,so we usually estimate the <WP=7>change on arterial elasticity(compliance) by taking nitroglycerin orally. Recent studies revealed that the reduced arterial elasticity(compliance) is a sensitive marker of Cardiovascular diseases. A reduced systemic arterial elasticity(compliance) that can be derived from analysis of the pulse contour is regarded as the best clinical index of impaired pulsatile auterial function and may mark the presence of early vascular damage. In other words,we can measure and find the changes on arterial elasticity(compliance) before symptom become obvious.Thus we may prognosticate the risk before disease outbreak.(Symptom usually is the later character of the function-changes of organ). So,studies on arterial elasticity(compliance) has great theory and clinic significance.As a non-invasive examination of arterial elasticity (compliance),C1 (large arterial compliance) and C2 (oscillatory compliance ) have been considerd the best parameter to reflect those changes on arterial compliance,especially C2 .Objective:To observe the changes of C1 (large arterial elasticity index) and C2 (small arterial elasticity index) in patients with type 2 diabetes mellitus and healthy subjects and the effect of nitroglycerin on them .Discuss the mechanism of it.Methods:By using CVProfilerDO-2020, C1 and C2 of 65 patients with type 2 diabetes mellitus and 62 healthy subjects were measured .Still ,C1 and C2 of some healthy subjects and diabetes patients were measured after taking nitroglycerin orally. Results: C2 of type 2 diabetes mellitus were significantly lower than the one of the healthy subjects (3.68±2.03 Vs 6.30±2.68,P<0.05), but C1 not(14.4±4.5 Vs 15.3±3.7,P>0.05). After taking nitroglycerin orally , C2 of diabetes patients was obviously increased(6.25±1.99 Vs 3.87±2.11,P<0.05),but C1 not(17.0±5.4 Vs 15.0±4.5,P>0.05). Conclusion: The small arterial elasticity (C2) of patients with type 2 diabetes mellitus was significantly decreased ,which could be reversed by <WP=8>taking nitroglycerin.The endothelial dysfunction might plays an important role during the injuring process of small arterial elasticity in diabetes patients. A reduced C2 (small arterial elasticity index) is more sensitive than C1 (large arterial compliance) to mark the presence of early vascular damage. C2 (small arterial elasticity index) and C1 (large arterial compliance) correlated negatively with pulse pressure(PP).更多还原