本文選題：糖尿病　切入點(diǎn)：糖尿病大血管病變　出處：《山西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:近年來,隨著人們生活與飲食結(jié)構(gòu)顯著改變,肥胖、糖尿病等威脅人類健康的非傳染疾病越來越多。2型糖尿病(T2DM)患者常伴有高血糖、肥胖等多種心血管疾病的危險(xiǎn)要素,這些因素綜合作用加速動(dòng)脈粥樣硬化進(jìn)程,嚴(yán)重影響患者身心健康。在T2DM患者中,絕大多數(shù)屬于超重或者肥胖[1]。其中脂肪細(xì)胞分泌的脂肪細(xì)胞因子有可能是肥胖與糖尿病兩者潛在聯(lián)系的分子基礎(chǔ)。脂聯(lián)素(adiponectin,ADP),趨化因子Chemerin等脂肪細(xì)胞因子參與糖類和脂質(zhì)代謝途徑,促進(jìn)糖尿病大血管病變的發(fā)生、發(fā)展。本文探討新診斷T2DM患者頸動(dòng)脈內(nèi)中膜厚度與內(nèi)臟型肥胖及脂肪細(xì)胞因子ADP,Chemerin和同型半胱氨酸(homocysteine,hcy)的關(guān)系。方法:收集2013年3月至2014年10月于山西省人民醫(yī)院內(nèi)分泌科住院及門診就診的60例新診斷T2DM患者,并選擇20例體檢正常者作對照組。依據(jù)頸動(dòng)脈超聲測得的頸動(dòng)脈內(nèi)中膜厚度(Carotid artery intima media thickness,CIMT)值將入選的新診斷T2DM患者分2組,CIMT增厚組(CIMT0.9mm)28例及CIMT正常組(CIMT≤0.9mm)32例,采集空腹靜脈血,測定Chemerin、ADP、hcy、TG、TC、LDL-C、Hb A1c和空腹胰島素(fasting insulin,Flns)等相關(guān)指標(biāo)。分析新診斷2型糖尿病患者CIMT與BMI,腰圍,腰臀比(waist-hip ratio,WHR),血清Chemerin,ADP,hcy等的關(guān)系。結(jié)果:1.新診斷T2DM患者的腰圍,WHR,Chemerin及hcy水平高于對照組,ADP低于對照組;CIMT增厚組腰圍,腰臀比,Chemerin,hcy水平高于CIMT正常組,而ADP水平低于CIMT正常組。2.血清Chemerin與腰圍,腰臀比,糖化血紅蛋白,胰島素抵抗指數(shù)(homeostasis model of assessment-insulin resistence,HOMA-IR)呈正相關(guān)。3.血清hcy水平與BMI,腰圍,WHR,Hb A1c,HOMA-IR呈正相關(guān)。4.血清ADP水平與體質(zhì)指數(shù),腰圍,WHR,糖化血紅蛋白,胰島素抵抗指數(shù)呈負(fù)相關(guān)。5.新診斷T2DM組CIMT影響因素的多元逐步回歸分析。以CIMT為因變量,BMI,腰圍,腰臀比,TC,TG,LDL,HDL,Hb A1c,FPG,HOMA-IR,Chemerin,hcy,ADP為自變量,在校正年齡、性別后,用多元逐步回歸分析篩選變量,發(fā)現(xiàn)CIMT與ADP呈負(fù)相關(guān),與腰圍,TG,LDL,Hb A1c,FPG,Chemerin,hcy呈正相關(guān),與其余指標(biāo)無顯著相關(guān)。結(jié)論:T2DM合并糖尿病大血管病變的患者血清趨化素Chemerin及hcy水平明顯升高,ADP水平下降。腹型肥胖時(shí),Chemerin水平升高,ADP水平下降可能通過不同途徑參與T2DM大血管病變的發(fā)生和發(fā)展,聯(lián)合測定Chemerin及脂聯(lián)素水平可能對糖尿病大血管病變的預(yù)測有重要價(jià)值。
[Abstract]:Objective: in recent years, with the significant changes in people's life and diet structure, obesity, diabetes and other non-communicable diseases threatening human health, more and more type 2 diabetes mellitus T2DM) patients are often accompanied by hyperglycemia, obesity and other cardiovascular disease risk factors. The combined effects of these factors accelerate the progression of atherosclerosis and seriously affect the physical and mental health of patients with T2DM. Most of them are overweight or obese [1] .Adipose cytokines secreted by adipocytes may be the molecular basis of the potential link between obesity and diabetes. Adiponectin, Chemerin and other adipocytokines are involved in carbohydrates. And lipid metabolism pathways, Promote the development of diabetic macroangiopathy, The relationship between carotid intima-media thickness (IMT) and visceral obesity, adipocyte factor (ADP- Chemerin) and homocysteine homocysteine (homocysteine) in newly diagnosed T2DM patients was investigated. Methods: from March 2013 to October 2014, the patients were collected in Shanxi Provincial people's Hospital. 60 newly diagnosed T2DM patients in secretory department and outpatient department, Twenty normal subjects were selected as control group. The newly diagnosed T2DM patients were divided into 2 groups according to carotid artery artery intima media thicknessCIMT, 28 patients with CIMT thickening group and 32 patients with CIMT normal group with CIMT 鈮，

本文編號(hào)：1577201