發(fā)布時間：2018-06-27 21:38

  本文選題：2型糖尿病 + 糖尿病血管并發(fā)癥　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:內(nèi)皮祖細(xì)胞(EPCs)是血管內(nèi)皮修復(fù)的重要物質(zhì),EPCs數(shù)量和功能的下降是2型糖尿病并發(fā)癥的主要原因之一,本研究旨在探討α-硫辛酸(ALA)對糖尿病周圍神經(jīng)病變患者循環(huán)EPCs數(shù)量的影響,并探討其機(jī)制,為糖尿病慢性并發(fā)癥的預(yù)防及治療提供依據(jù)。方法:1選擇2014年8月至2015年1月收入院的50例2型糖尿病合并糖尿病周圍神經(jīng)病變患者,其中男性31例,女性19例,均符合2009年中國糖尿病周圍神經(jīng)病變診療規(guī)范提出的糖尿病周圍神經(jīng)病變的診斷標(biāo)準(zhǔn),詳細(xì)記錄患者性別、年齡、病程、身高及體重。患者降糖藥物均為胰島素,口服他汀類藥物保護(hù)血管內(nèi)皮治療,待患者空腹血糖7.0mmol/L、餐后2h血糖10.0mmol/L,血壓控制在140/80mm Hg左右,將入選對象隨機(jī)分為兩組:1)對照組(Control Group):應(yīng)用丹參酮IIA磺酸鈉、甲鈷胺、前列地爾組(Con,n=20);2)硫辛酸組(ALA Group):在對照組基礎(chǔ)上聯(lián)合α-硫辛酸(ALA,n=30),治療時間均為2周。觀察治療前后兩組患者EPCs數(shù)量及氧化應(yīng)激指標(biāo)的變化,并探討他們之間的關(guān)系。2采用流式細(xì)胞儀檢測EPCs(CD34+/VEGFR2+)數(shù)量;3采用酶法測甘油三酯(TG)、總膽固醇(T-CHO)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C),測定超氧化物歧化酶(SOD)、谷胱甘肽過氧化物酶(GSH-PX)的活性,采用硫代巴比妥酸法測定丙二醛(MDA),采用ELISA酶聯(lián)免疫吸附試驗(yàn)法檢測8-羥基脫氧鳥苷(8-OHd G)的變化情況。4所有數(shù)據(jù)處理均應(yīng)用SPSS17.0軟件分析,計(jì)量資料采用t檢驗(yàn)及非參數(shù)檢驗(yàn),相關(guān)分析采用多元線性回歸分析。結(jié)果:1兩組治療前比較兩組間年齡(Age)、性別(Sex)、糖尿病病程、收縮壓(SBP)、舒張壓(DBP)、體重指數(shù)(BMI)、空腹血糖(FBG)、糖化血紅蛋白(Hb A1c)、TG、T-CHO、LDL-C、HDL-C、EPCs數(shù)量、SOD、GSH-PX、MDA、8-OHd G相比無差異(P0.05)。2對照組(Con)EPCs數(shù)量治療前后相比無差異(P0.05);SOD、GSH-PX、MDA、8-OHd G治療前后相比無差異(P0.05);TG、T-CHO、LDL-C治療后較治療前明顯下降,HDL-C治療后較治療前顯著升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3硫辛酸組(ALA)EPCs數(shù)量治療后較治療前明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05);SOD、GSH-PX治療后較治療前活性明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05);MDA、8-OHd G水平治療后較治療前含量明顯減低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);TG、T-CHO、LDL-C治療后較治療前明顯下降,HDL-C治療后較治療前明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4兩組治療后比較治療后EPCs數(shù)量硫辛酸組較對照組明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05);SOD、GSH-PX硫辛酸組較對照組活力明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05);MDA、8-OHd G水平硫辛酸組較對照組含量明顯減低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);TG、T-CHO、LDL-C、HDL-C兩組相比無差異(P0.05)。5兩組治療前后相關(guān)指標(biāo)差值的比較兩組EPCs數(shù)量治療前后差值相比,硫辛酸組較對照組明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05);SOD、GSH-PX硫辛酸組較對照組活性明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05);MDA、8-OHd G水平硫辛酸組較對照組含量明顯減低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);TG、T-CHO、LDL-C、HDL-C相比無差異(P0.05)。6 EPCs數(shù)量與相關(guān)參數(shù)的相關(guān)性以硫辛酸組EPCs治療前后數(shù)量的差值作為因變量,硫辛酸組SOD、GSH-PX、MDA、8-OHd G、TG、T-CHO、LDL-C、HDL-C、FBG治療前后的差值作為自變量進(jìn)行多元線性回歸分析,經(jīng)逐步擬合,最優(yōu)回歸方程為:Y=6.349+0.195X2-3.335X3,X2代表GSH-PX的差值(P=0.01),X3代表MDA的差值(P=0.041),內(nèi)皮祖細(xì)胞數(shù)目與GSH-PX、MDA有相關(guān)性。結(jié)論:1糖尿病周圍神經(jīng)病變患者經(jīng)ALA治療后,EPCs數(shù)量明顯增加;2 ALA可以改善糖尿病周圍神經(jīng)病變患者氧化應(yīng)激水平,恢復(fù)抗氧化酶SOD、GSH-PX活性,減低MDA、8-OHd G的含量;3 ALA增加EPCs的數(shù)量與氧化應(yīng)激相關(guān)。
[Abstract]:Objective: endothelial progenitor cells (EPCs) is an important substance in vascular endothelial repair. The decrease of EPCs number and function is one of the main causes of complications of type 2 diabetes. This study aims to explore the effect of alpha lipoic acid (ALA) on the number of circulatory EPCs in patients with diabetic peripheral neuropathy, and to explore its mechanism for the prevention and prevention of chronic diabetic complications. Methods: 1 to select 50 patients with type 2 diabetes with diabetic peripheral neuropathy from August 2014 to January 2015, including 31 male and 19 female, which were all in line with the diagnostic criteria of the diabetic peripheral neuropathy around the diabetic peripheral neuropathy in 2009, and the patient's sex was recorded in detail. Age, course of disease, height and weight. The patients with hypoglycemic drugs were insulin, oral administration of statins to protect vascular endothelium, pending fasting blood glucose 7.0mmol/L, postprandial 2H blood glucose 10.0mmol/L, blood pressure control at 140/80mm Hg, and randomly divided into two groups: 1) group (Control Group): the application of tanshinone IIA sulfonic acid sodium, Mecobalamin, pre Mecobalamin, The group (Con, n=20); 2) sulfur octanic acid group (ALA Group): Based on the control group, combined with alpha lipoic acid (ALA, n=30), the treatment time was 2 weeks. The changes in the number of EPCs and oxidative stress in two groups of patients were observed before and after treatment, and the relationship between them and the number of EPCs (CD34+/VEGFR2+) detected by the flow cytometry was explored; 3 by enzyme method. Oil three ester (TG), total cholesterol (T-CHO), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), the activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), the determination of malonaldehyde (MDA) by thiobarbituric acid method, and the determination of 8- hydroxy deoxy guanosine (8-OH) by the enzyme linked immunosorbent assay (8-OH). The changes in D G) all data processing in.4 were analyzed by SPSS17.0 software. The measurement data were examined by t test and nonparametric test, and multivariate linear regression analysis was used. Results 1 groups of two groups were compared with two groups of age (Age), sex (Sex), diabetes course, systolic pressure (SBP), diastolic pressure (DBP), body mass index (BMI), and fasting blood glucose (FBG). Glycosylated hemoglobin (Hb A1c), TG, T-CHO, LDL-C, HDL-C, EPCs quantity, SOD, GSH-PX, MDA, 8-OHd G before and after treatment. The difference has statistical significance (P0.05).3 sulphate octanic acid group (ALA) EPCs number after treatment significantly increased compared with before treatment, the difference was statistically significant (P0.05); SOD, GSH-PX after treatment significantly increased before treatment, the difference was statistically significant (P0.05); MDA, 8-OHd G level after treatment was significantly lower than before treatment, the difference was statistically significant. (P0.05); TG, T-CHO, LDL-C after treatment was significantly lower than before treatment, HDL-C treatment was significantly higher than before treatment, the difference was statistically significant (P0.05).4 two group after treatment, the number of EPCs in the group of lipoic acid was significantly increased compared with the control group, the difference was statistically significant (P0.05); SOD, GSH-PX sulphate octanic acid group than the control group activity significantly increased, the difference was Statistical significance (P0.05); MDA, 8-OHd G level of lipoic acid group was significantly lower than the control group, the difference was statistically significant (P0.05); TG, T-CHO, LDL-C, HDL-C two groups compared with the difference (P0.05).5 two groups before and after treatment of the difference between the two groups before and after the difference between the number of EPCs, the group of sulphur octanic acid was significantly higher than the control group, the difference was Statistical significance (P0.05); SOD, GSH-PX lipoic acid group activity significantly increased compared with the control group, the difference was statistically significant (P0.05); MDA, 8-OHd G level of sulphur octanoic acid group content was significantly lower than the control group, the difference was statistically significant (P0.05); TG, T-CHO, LDL-C, HDL-C phase and relative parameters of the correlation with the related parameters of sulphur octanoic acid group The difference value of the number of Cs before and after treatment was used as the dependent variable. The difference values of SOD, GSH-PX, MDA, 8-OHd G, TG, T-CHO, LDL-C, HDL-C, and FBG were used as multivariate linear regression analysis before and after the treatment. The number of progenitor cells was associated with GSH-PX and MDA. Conclusion: 1 patients with diabetic peripheral neuropathy were treated with ALA, and the number of EPCs increased significantly. 2 ALA could improve the level of oxidative stress in diabetic peripheral neuropathy, restore antioxidant enzyme SOD, GSH-PX activity, reduce the content of MDA, 8-OHd G; 3 ALA increase the number of EPCs and oxidative stress. Close.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2

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