發(fā)布時(shí)間：2018-03-04 14:45

  本文選題：女性　切入點(diǎn)：絕經(jīng)　出處：《承德醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:心血管疾病已成為糖尿病患者死亡的主要原因,與同期男性患者相比,女性糖尿病患者特別是絕經(jīng)后女性具有較高的風(fēng)險(xiǎn)發(fā)生心血管疾病,具體發(fā)病機(jī)制尚不明確。諸多臨床研究已證實(shí)糖尿病前期人群同樣具有較高的心血管死亡風(fēng)險(xiǎn)。氧化應(yīng)激與糖尿病前期、糖尿病及其并發(fā)癥的發(fā)生密切相關(guān)。氧化低密度脂蛋白(ox-LDL)是氧化應(yīng)激標(biāo)志物之一,也是動(dòng)脈粥樣硬化斑塊形成的重要始動(dòng)者,被視為發(fā)生冠心病的重要預(yù)測(cè)因子。本實(shí)驗(yàn)旨在比較不同糖耐量絕經(jīng)前后女性血清中ox-LDL水平,分析其與血糖、血脂、血壓、血同型半胱氨酸的相關(guān)性,探討女性糖尿病及糖尿病前期患者發(fā)生心血管疾病的高風(fēng)險(xiǎn)性,為絕經(jīng)前后女性糖尿病心血管并發(fā)癥的預(yù)防及治療提供新的研究方向。方法:選擇我院2013年01月至2014年03月內(nèi)分泌科門診、住院及體檢科年齡45-65歲的女性,通過(guò)行葡萄糖耐量試驗(yàn)及詳細(xì)詢問(wèn)月經(jīng)史,收集入選對(duì)象248例,其中糖耐量正常人群(NGT)80例,絕經(jīng)前40例,絕經(jīng)后40例;糖調(diào)節(jié)受損患者(IGR)82例,絕經(jīng)前40例,絕經(jīng)后42例;2型糖尿病患者(T2DM)86例,絕經(jīng)前44例,絕經(jīng)后42例。采用雙抗夾心酶聯(lián)免疫吸附法(ELISA)測(cè)定人血清氧化低密度脂蛋白(ox-LDL)水平。測(cè)量各組研究對(duì)象的體重指數(shù)(BMI)及血壓,在全自動(dòng)生化分析儀上檢測(cè)血脂(TG、TC、HDL-C、LDL-C),采用葡萄糖氧化酶法測(cè)定血糖(FBG),采用高效液相色譜法測(cè)定同型半胱氨酸(Hcy)。結(jié)果:1不同糖耐量絕經(jīng)前、后女性一般情況、生化指標(biāo)和血清ox-LDL水平比較1.1絕經(jīng)前不同糖耐量女性一般情況、生化指標(biāo)和血清ox-LDL水平比較與NGT組相比,IGR組及T2DM組均具有高的BMI、LDL-C、SBP、DBP、FBG、ox-LDL及低HDL-c(均P0.05),且T2DM組中的TG、Hcy水平明顯高于ngt組,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。與igr組相比,t2dm組具有高的tg、fbg、ox-ldl及低hdl-c(p0.05),而兩組間的hcy水平差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。三組的年齡比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。1.2絕經(jīng)后不同糖耐量女性一般情況、生化指標(biāo)和血清ox-ldl水平比較與ngt組相比,igr組及t2dm組均具有高的ldl-c、sbp、dbp、fbg及ox-ldl(均p0.05),且t2dm組中的tg、hcy水平明顯高于ngt組,hdl-c水平明顯低于ngt組,差異均有統(tǒng)計(jì)學(xué)意義(均p0.05)。與igr組相比,t2dm組具有高的tg、ldl-c、fbg、ox-ldl及低hdl-c(p0.05),而兩組間的hcy、sbp、dbp水平差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。三組的年齡及bmi比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。1.3不同糖耐量女性一般情況、生化指標(biāo)和血清ox-ldl水平絕經(jīng)前與絕經(jīng)后比較ngt組、igr組及t2dm組絕經(jīng)后女性的sbp、dbp、hcy及年齡均高于各組絕經(jīng)前,差異均有統(tǒng)計(jì)學(xué)意義(p0.05),且igr組及t2dm組絕經(jīng)后ldl-c及ox-ldl明顯高于絕經(jīng)前(p0.05)。2不同糖耐量絕經(jīng)前后女性ox-ldl與其相關(guān)指標(biāo)的直線相關(guān)分析及多元線性回歸分析2.1不同糖耐量絕經(jīng)前后女性ox-ldl與其相關(guān)指標(biāo)的pearson直線相關(guān)分析在不同糖耐量組中絕經(jīng)前女性血清ox-ldl與ldl-c、hcy、fbg均呈正相關(guān),與hdl-c呈負(fù)相關(guān)(均p0.05),且在t2dm組中,血清ox-ldl與tg、tch呈正相關(guān)(均p0.05)。在不同糖耐量組中絕經(jīng)后女性血清ox-ldl與sbp、hcy、fbg均呈正相關(guān),與hdl-c呈負(fù)相關(guān)(均p0.05),且在igr、t2dm組中血清ox-ldl與tg、tch、ldl-c均呈正相關(guān)(均p0.05),在igr組組中,血清ox-ldl與dbp呈正相關(guān)(p0.05)。2.2不同糖耐量絕經(jīng)前后女性ox-ldl與其相關(guān)指標(biāo)的多元線性回歸分析以絕經(jīng)前女性的ox-ldl為因變量,以tg、tch、hdl-c、ldl-c、fbg、sbp、dbp、hcy及bmi為自變量得回歸方程ox-ldl=2.786hcy+19.846LDL-C+2.340FBG,可見(jiàn)ox-LDL與Hcy、LDL-C、FBG呈獨(dú)立正相關(guān)(P0.05)。同理得出,絕經(jīng)后女性的回歸方程ox-LDL=3.434Hcy+11.465LDL-C-19.123HDL-c+0.893SBP+9.967FBG,可見(jiàn)ox-LDL與Hcy、LDL-C、SBP、FBG呈獨(dú)立正相關(guān),與HDL-c呈獨(dú)立負(fù)相關(guān)(P0.05)。結(jié)論:1隨著糖耐量異常程度的加重,絕經(jīng)前(后)女性的ox-LDL水平逐漸升高。2與絕經(jīng)前女性相比,糖耐量異常的絕經(jīng)后女性ox-LDL、血壓、血同型半胱氨酸升高及明顯的血脂紊亂,可能是絕經(jīng)后女性心血管風(fēng)險(xiǎn)增加的原因之一。3糖尿病前期糖調(diào)節(jié)受損的絕經(jīng)前(后)女性除了血糖升高,機(jī)體已存在明顯血脂紊亂及高血壓,而絕經(jīng)前(后)女性糖尿病患者體內(nèi)上述物質(zhì)代謝紊亂更加明顯及具有高同型半胱氨酸。4不同糖耐量絕經(jīng)前后女性血清ox-LDL水平與血脂、血壓、血糖及血清同型半胱氨酸密切相關(guān)。
[Abstract]:Objective: cardiovascular disease has become a major cause of death in diabetic patients, compared with male patients, female patients with diabetes especially women with higher risk of cardiovascular disease in postmenopausal women, the specific pathogenesis is still not clear. Many clinical studies have confirmed that pre diabetes crowd also has higher risk of cardiovascular death. Oxidative stress and diabetes the early diabetes and its complications are closely related. The oxidation of low density lipoprotein (ox-LDL) is one of the important markers of oxidative stress, and initiating the formation of atherosclerotic plaque, is regarded as an important predictor of coronary heart disease. The aim of this study is to compare the different glucose tolerance in premenopausal and postmenopausal women in the serum ox-LDL level and blood glucose analysis blood pressure, blood lipid, blood relationship, homocysteine, diabetes and pre diabetes on female patients had heart The high risk of tube diseases, provide a new research direction for prevention and treatment of diabetic cardiovascular complications in premenopausal and postmenopausal women. Methods: in our hospital from 2013 01 to 2014 03 months of outpatient department of Endocrinology, hospital and Department of physical examination women aged 45-65 years, through the glucose tolerance test and detailed inquirymenstruation history, collection of selected objects in 248 cases, the population with normal glucose tolerance (NGT) in 80 cases, 40 cases of premenopausal, 40 postmenopausal patients; patients with impaired glucose regulation (IGR) in 82 cases, 40 cases of premenopausal, 42 postmenopausal patients; patients with type 2 diabetes mellitus (T2DM) in 86 cases, 44 cases of premenopausal, 42 postmenopausal cases using double antibody sandwich enzyme-linked immunosorbent assay (ELISA) determination of serum oxidized low density lipoprotein (ox-LDL) level. The research object measured body mass index (BMI) and blood pressure, blood lipid in automatic biochemical analyzer (TG, TC, HDL-C, LDL-C), blood glucose was measured by glucose oxidase method (FBG),閲囩敤楂樻晥娑茬浉鑹茶氨娉曟祴瀹氬悓鍨嬪崐鑳辨皚閰，

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