医堂簦述!Q!Q生§旦箍!!鲞笙!!翅丛型趔墨丝坚i坦丛!:垒鳖垫!Q:y堕:!§:堕!:!§6内皮功能紊乱与AS大量研究证实了血管内皮功能已成为动脉粥样硬化标志,国内外报道在动脉硬化早期血管内皮功能即出现下降,这种功能性的改变明显早于动脉粥样硬化的形态学改变。血管内皮功能的存在为AS的病理生理过程提供了新的诠释,内皮功能异常在糖耐量异常的患者已经存在¨引。IGT人群易发生内皮功能损伤的机制可能如下:(iIGT多伴有餐后高血糖,高血糖状态可造成内皮细胞功能受损。②IGT人群存在明显的IR,使内皮舒血管功能受损,并能促使脂肪组织产生CRP、肿瘤坏死因子ot、IL-6等多种炎性细胞因子。③IGT人群的脂代谢紊乱,可直接损伤血管内皮,是动脉粥样硬化的重要前提之一。总之,IR是导致IGT患者出现早期大血管病变的关键因素,并通过与其相关的肥胖、高血脂、高血压、高炎性反应及内皮细胞功能紊乱等多种危险因素共同导致该人群早期AS的形成,提示对于IGT患者AS的防治应针对上述多种因素加以干预和治疗。参考文献[1]Wang【L,LuJM,PanCY,eta/.A唧ari∞nofurinaryalbuminexcretionrateandmicroalbuminuriainvariousglucosetolerancesubject8[J].DiabetMed,2005,22(3:332-335.[23FujishimaM,KiyoharaY,KatoI,et矗.DiabetesandcardiovasculardiseaseinprospectivepopulationsurveyinJapan:theHisayamastudy[J].Diabetes,1996,45(Suppl3:s14一S16.[3]GrcopL,Ortho—MelanderM.Thedysmetabolicsyndrome[J].InteaMed,2001.250(2:105—120.[4】EganBM,GreeneEL,GoodfriendTL.eta/.Insulinresistanceandcardiovasculardisease[J].AmJHypertens,2001,14(6:Sl16.S125.[5][6][7][8]・2341・FestaA。D,AgestinoRJ。HowardG,eta1.ChronicsubcliIlicalintis-mationaspartoftheinsulintYrsistaneesyndrome:theInsulinRe.sistanceAtherosclerosisStudy(IRAS[J].Circulation。2000,102(1:42-47.SemenkovichCF.Insulinresistanceandatberesderosis[J].JClinInvest。2006。116(7:1831.1822.IsommaB。Alra印enP,TccomiT.eta1.Cardiovascularmorbidityandmbrtalityassociatedwiththemetabolicsyndrome[J].DiabetesCare.2001.24(4:683-689.KhawKT。WarehamN.LubenR,eta1.GIyearedhaemoglobin.dia-betes.andmortalityinmeninNorfolkcohortofEuropeanprospec-liveinvestigationofca/Icerandnutrition(EPIC—Norfolk[J].BMJ。200i,322(7277:15—18.[9]ForbesJM,YccLT,ThallasV,etuetinterventionsreducediabetesa/.Advancedglyeationandprod・accelaeratedatherosclerosis[J].Diabetes,2004,53(7:813-823.[10]张卫茹,候凡凡,刘尚喜,等.晚期糖基化终末产物通过氧化应激加速动脉粥样硬化斑块形成[J].中华医学杂志,2004,84(13:1066—1070.[11][12][13][14][15][163【17][1S]YangM,YangY,ZhangS,eta/.Insulinstimulatedhydrogenper-oxideincreasesguanylateeyelaaeactivityinvascularsmoothmpcle[J].Hypertension,2003,42(4:569-573.TaddeiS,VirdisA,GhiadoniL,eta/.Effectofantihypertensivedrugsoilendothelialdysfunction:Clinicalimphcafions[J].Drugs,2002.62(2:265-284.DhallaNS.temsahRM.NettieadanT.Roleofoxidativestressincardiovasculardisea.ses[J].JHypertens,2000,18(6:655-673.BrandK,PageS,RoglerG,eta/.Activatedtranscriptionfactornu-clearfactor—KappaBispresentintheatherosclemticlesion[J].JClinInvest。1996,97(7:1715.1722.CalaraF,DimayugaP.NiemannA,eta1.AnanimalmodeltostudylocaloxidationofLDLanditsbiologicaleffectinthearterialwall[J1.Arterioscler山tombVascBiol,1998,18(6:884-893.W∞sGF.PlayfordDA.Dyslipoproteinaemiaandhyperoxidative号lTessinthepathogenesisofendothelialdysfunelioninnon—insulindependentdiabetesmallitus:anhypothesis[J].Athercsclerosis,1999。8(4:17-30.徐亚平,肖嘉欣,吕心阳,等.血脂异常与动脉粥样硬化的关系[J].实用临床医学,2000,l(4:3l-37.AndersonTJ.Assessmentandtreatmentofendothelialdysfunctioninhumans[J].JAmCollCardiol,1999,34(3:631.638.收稿日期:...