2 型糖尿病炎症、氧化应激与颈动脉粥样硬化的 关系及中医证型分布特征

Correlation Between Inflammation, Oxidative Stress and Carotid Atherosclerosis in Type 2 Diabetes and Distribution Characteristics of TCM Syndrome Types

摘要:

〔摘 要〕 目的：探究 2 型糖尿病（T2DM）合并颈动脉粥样硬化患者体内氧化应激水平及中医证型的分布特征。 方法：选取 2022 年 2 月至 2022 年 6 月德驭医疗马鞍山总医院收治的 T2DM 患者 60 例，按照颈动脉超声检查结果有无颈动脉粥样 硬化分为颈动脉粥样硬化组（28 例）与无颈动脉粥样硬化组（32 例），进行 72 h 动态血糖监测，同时检测血清炎症因子和 氧化应激因子水平，比较两组血糖波动情况、炎症因子及氧化应激因子水平，观察中医证候分布特征。分析入组患者体内 氧化应激水平以及中医证型分布与颈动脉粥样硬化形成的相关性。 结果：颈动脉粥样硬化组患者血糖值标准差（SDBG）、 平均血糖波动幅度（MAGE）、最大血糖漂移幅度（LAGE）、日间血糖平均绝对值差（MODD）和餐后血糖波动幅度（PPGE） 均高于无颈动脉粥样硬化组，差异具有统计学意义（P ＜ 0.05）。颈动脉粥样硬化组血清白细胞介素 –6（IL–6）、IL–18、 超敏 C 反应蛋白（hs–CRP）水平均高于无颈动脉粥样硬化组，差异具有统计学意义（P ＜ 0.05）。颈动脉粥样硬化组尿 8– 羟基脱氧鸟苷（U8–OHdG）水平高于无颈动脉粥样硬化组，谷胱甘肽还原酶（GR）水平低于无颈动脉粥样硬化组， 差异具有统计学意义（P ＜ 0.05）。两组患者血清超氧化物歧化酶（SOD）水平比较，差异无统计学意义（P ＞ 0.05）。 在 T2DM 的中医证型中，痰浊中阻证相较与肺胃津伤证、肾阴亏虚证、气阴两虚证，更容易发生颈动脉粥样硬化。 结论：T2DM 患者中，血糖波动、炎症因子水平、氧化应激反应与颈动脉粥样硬化的形成有关，痰浊中阻证的 T2DM 患者合并颈 动脉粥样硬化的概率更高。

Abstract:

〔Abstract〕 Objective To explore the influence of oxidative stress level in type 2 diabetes mellitus (T2DM) patients with carotid atherosclerosis and the distribution of TCM syndromes. Methods A total of 60 T2DM patients admitted to the Ma’anshan General Hospital of from February 2022 to June 2022 were selected and divided into a carotid atherosclerosis group (n = 28) and a non-carotid atherosclerosis group (n = 32) according to the results of carotid artery ultrasound. Dynamic blood glucose monitoring was conducted for 72 h, and serum inflammatory cytokines and oxidation factors were detected.The blood glucose pulsation, inflammatory cytokines and oxidation factors were compared between the two groups, and the distribution characteristics of TCM syndromes were observed. The correlation between the level of oxidative stress and the distribution of TCM syndrome and the formation of carotid atherosclerosis in enrolled patients was analyzed. Results Standard deviation of blood glucose (SDBG), mean amplitude glycemicexcursi (MAGE), largest amplitude of glycemic excursion (LAGE), mean of daily differences (MODD) and postprandial glucose excursion (PPGE) in the carotid atherosclerosis group were higher than those in the non-carotid atherosclerosis group, with statistical significance (P < 0.05). The levels of interleukin-6 (IL-6), IL-18 and hypersensitive C-reactive protein (HS-CRP) in the carotid atherosclerosis group were higher than those in the non-carotid atherosclerosis group, and the differences were statistically significant (P < 0.05). Urine 8-hydroxy-2’-deoxyguanosine (U8-OHdG) in the carotid plaque group was higher than that in the no carotid plaque group, and glutathione reductase (GR) was lower than that in the no carotid plaque group, the differences were statistically significant (P < 0.05). There was no significant difference in the level of superoxide dismutase (SOD) between the two groups (P > 0.05). In the traditional Chinese medicine syndrome of diabetes, the syndrome of phlegm turbidity and obstruction is more likely to cause carotid atherosclerosis than the syndrome of lung, stomach and fluid injury, kidney Yin deficiency and Qi Yin deficiency. Conclusion In T2DM patients, blood glucose fluctuation, inflammatory factor level and oxidative stress reaction are related to the formation of carotid atherosclerosis, and the incidence of carotid atherosclerosis is higher in T2DM patients with phlegm-turbidity obstruction syndrome.