不同糖耐量绝经前后女性氧化低密度脂蛋白的相关研究

发布时间：2018-03-04 14:45

  本文选题：女性　切入点：绝经　出处：《承德医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:心血管疾病已成为糖尿病患者死亡的主要原因,与同期男性患者相比,女性糖尿病患者特别是绝经后女性具有较高的风险发生心血管疾病,具体发病机制尚不明确。诸多临床研究已证实糖尿病前期人群同样具有较高的心血管死亡风险。氧化应激与糖尿病前期、糖尿病及其并发症的发生密切相关。氧化低密度脂蛋白(ox-LDL)是氧化应激标志物之一,也是动脉粥样硬化斑块形成的重要始动者,被视为发生冠心病的重要预测因子。本实验旨在比较不同糖耐量绝经前后女性血清中ox-LDL水平,分析其与血糖、血脂、血压、血同型半胱氨酸的相关性,探讨女性糖尿病及糖尿病前期患者发生心血管疾病的高风险性,为绝经前后女性糖尿病心血管并发症的预防及治疗提供新的研究方向。方法:选择我院2013年01月至2014年03月内分泌科门诊、住院及体检科年龄45-65岁的女性,通过行葡萄糖耐量试验及详细询问月经史,收集入选对象248例,其中糖耐量正常人群(NGT)80例,绝经前40例,绝经后40例;糖调节受损患者(IGR)82例,绝经前40例,绝经后42例;2型糖尿病患者(T2DM)86例,绝经前44例,绝经后42例。采用双抗夹心酶联免疫吸附法(ELISA)测定人血清氧化低密度脂蛋白(ox-LDL)水平。测量各组研究对象的体重指数(BMI)及血压,在全自动生化分析仪上检测血脂(TG、TC、HDL-C、LDL-C),采用葡萄糖氧化酶法测定血糖(FBG),采用高效液相色谱法测定同型半胱氨酸(Hcy)。结果:1不同糖耐量绝经前、后女性一般情况、生化指标和血清ox-LDL水平比较1.1绝经前不同糖耐量女性一般情况、生化指标和血清ox-LDL水平比较与NGT组相比,IGR组及T2DM组均具有高的BMI、LDL-C、SBP、DBP、FBG、ox-LDL及低HDL-c(均P0.05),且T2DM组中的TG、Hcy水平明显高于ngt组,差异均有统计学意义(p0.05)。与igr组相比,t2dm组具有高的tg、fbg、ox-ldl及低hdl-c(p0.05),而两组间的hcy水平差异无统计学意义(p0.05)。三组的年龄比较,差异均无统计学意义(p0.05)。1.2绝经后不同糖耐量女性一般情况、生化指标和血清ox-ldl水平比较与ngt组相比,igr组及t2dm组均具有高的ldl-c、sbp、dbp、fbg及ox-ldl(均p0.05),且t2dm组中的tg、hcy水平明显高于ngt组,hdl-c水平明显低于ngt组,差异均有统计学意义(均p0.05)。与igr组相比,t2dm组具有高的tg、ldl-c、fbg、ox-ldl及低hdl-c(p0.05),而两组间的hcy、sbp、dbp水平差异无统计学意义(p0.05)。三组的年龄及bmi比较,差异均无统计学意义(p0.05)。1.3不同糖耐量女性一般情况、生化指标和血清ox-ldl水平绝经前与绝经后比较ngt组、igr组及t2dm组绝经后女性的sbp、dbp、hcy及年龄均高于各组绝经前,差异均有统计学意义(p0.05),且igr组及t2dm组绝经后ldl-c及ox-ldl明显高于绝经前(p0.05)。2不同糖耐量绝经前后女性ox-ldl与其相关指标的直线相关分析及多元线性回归分析2.1不同糖耐量绝经前后女性ox-ldl与其相关指标的pearson直线相关分析在不同糖耐量组中绝经前女性血清ox-ldl与ldl-c、hcy、fbg均呈正相关,与hdl-c呈负相关(均p0.05),且在t2dm组中,血清ox-ldl与tg、tch呈正相关(均p0.05)。在不同糖耐量组中绝经后女性血清ox-ldl与sbp、hcy、fbg均呈正相关,与hdl-c呈负相关(均p0.05),且在igr、t2dm组中血清ox-ldl与tg、tch、ldl-c均呈正相关(均p0.05),在igr组组中,血清ox-ldl与dbp呈正相关(p0.05)。2.2不同糖耐量绝经前后女性ox-ldl与其相关指标的多元线性回归分析以绝经前女性的ox-ldl为因变量,以tg、tch、hdl-c、ldl-c、fbg、sbp、dbp、hcy及bmi为自变量得回归方程ox-ldl=2.786hcy+19.846LDL-C+2.340FBG,可见ox-LDL与Hcy、LDL-C、FBG呈独立正相关(P0.05)。同理得出,绝经后女性的回归方程ox-LDL=3.434Hcy+11.465LDL-C-19.123HDL-c+0.893SBP+9.967FBG,可见ox-LDL与Hcy、LDL-C、SBP、FBG呈独立正相关,与HDL-c呈独立负相关(P0.05)。结论:1随着糖耐量异常程度的加重,绝经前(后)女性的ox-LDL水平逐渐升高。2与绝经前女性相比,糖耐量异常的绝经后女性ox-LDL、血压、血同型半胱氨酸升高及明显的血脂紊乱,可能是绝经后女性心血管风险增加的原因之一。3糖尿病前期糖调节受损的绝经前(后)女性除了血糖升高,机体已存在明显血脂紊乱及高血压,而绝经前(后)女性糖尿病患者体内上述物质代谢紊乱更加明显及具有高同型半胱氨酸。4不同糖耐量绝经前后女性血清ox-LDL水平与血脂、血压、血糖及血清同型半胱氨酸密切相关。
[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皑閰，

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