Study On The Relationship Between Postprandial Hyperlipidemia And Carotid Ultrasonography Detection In Type 2 Diabetic Patients

BACK GROUND AND OBJECTIVE: Diabetes mellitus does sever harm to human health ,The Vascular complication is the important reason of death ,about 70~ 80% diabetic patients died of vascular complications, Not only abnormal blood glucose but also abnormal blood lipids can lead to Vascular complications .Not only abnormal blood glucose but also abnormal blood lipids can lead to diabetic vascular complication. In recent years, many scholars have studied postprandial yperlipidemia . most of time , people live postprandial state , therefore postprandial hyperlipidemia is very important for diabetic vascular complication . Cardial color Doppler sonarography is the useful way of studying atherosclerosis . we detected type 2 diabetes patients' carotid arteries with color Doppler sonarography , these diabetes patients have postprandial hypertriglyceridemia or not. We studied the influence of postprandial hypertriglyceridemia to atherosclerosis in order to provide the theory of preventing and controlling the diabetic vascular complication .METHODS: Ninety type 2 diabetic patients were enrolled , they were screened in our hospital from February , 2003 to February ,2004 . Their diagnosis conformed to the diagnostic standard of diabetes mellitus proposed by WHO in 1999 , 56 type 2 diabetic patients had normal blood triglyceride level (fasting blood triglyceride ≤1.7mmol/l). 30 males and 26 females aged 40-75years , their disease time was2~ 20 years . The 56 patients' total triglyceride were measured 4 hours after a fatty test meal (600kcal ,45% carbohydrate ,35% fat and 20% protein),the 56 patients were assigned to two groups, group I (TG4h ≤ 2.0mmol/l) and group II (TG4h>2.0mmol/l) ,group I had 19 males and 16 females .group II had 16 males and 15 females .24 type 2 diabetic patients who had fasting hypertriglyceride level (fasting blood triglyceride level ≥ 1.7mmol/l) was group III, group III had 13 males and 11 females ,aged 42-76 years ,their disease's time was 3-19 years , All patients' fasting blood glucose -. postprandial two hours blood glucose (PBG2hX fasting blood insulin ^ HbAlc^ total cholesterol (TC)> total triglyceride(TG) -> HDL -cholesterol were measured . In same time ,we measured all patients' BMI> WHR> systolic blood pressure (SBP) and diastolic blood pressure (DBP)o We counted insulin activity index (IAI) and LDL-cholesterol (LDL-C ) . All patients were detected by carotid color Doppler sonarography . The bilateral common carotid artery > internal carotid artery > external carotid artery were screened . The intima-media thickness (IMT)> carotid artery plaque and the vessel diameter ^ the maximal systolic velocity (max) ^ the diastolic velocity (MIN)n the pulsatility index(PI)^ the resistive index(PJ)were all measured .RESULTS: 1. Three groups' course of diabetes ^ age ^ gender porption ^ fasting blood glucose (FBG^ PBG2h> HbAlc, fasting total cholesterol ^ HDL-cholesterol ^ LDL-cholesterol were similar , They were comparable , BMI, WHR and fasting total triglyceride in three groups were different (P<0.01), BMI > WHR and TG in group III were significantly higher than those in group II ,BMI ^ WHR and TG in group II were significantly higher than those in group I .2. carotid artery intima-media thickness(IMT) in group II , and group III were significantly higher than those in group I (P<0.01). carotid artery intima-media thickness (IMT) in group II and group III were similar (p>0.05).3. Three groups carotid artery plaque were 40%^ 80.9%> 85.7%,carotid artery plague in group II and group III were significantly higher than those in group I(p<0.00227),carotid artery plaque in group II and group III were similar (P>0.0125).4. Three groups carotid artery plaque score were 2.60±0.25mm, 3.50±0.4mm, 3.52± 0.52mm,Carotid artery plaque score in group II III Were significantly than those in group I (P<0.001), carotid artery plaque score in group II and III were similar (P>0.05).5. Three groups macro vascular complications were 20% -< 57.1% ^ 64.2%.Macrovascular complication in group II > III were significantly higher than those in group I , but there was no significantly difference between group II and group III.6. TheVmax> Vmin, Vmku PI and RI have no difference for the three groups.7. Three groups' insulin activity index(IAI) were:-2.34±0.1K -2.35 + 0.12, -3.64 ±0.13? The insulin activity index of group II and group I had no difference, but group II'sIAI was significantly higher than these of group III.8. Through multiple correlation analying ,we found carotid artery's IMT was significantly positively correlated with TG4h ,BMI .WHR which stated that TG4h ,BMI WHR were dangerous factors of arteriosclerosis .CONCLUSIONS: Postprandial hyperlipidemia have same danger of causing atherosclerosis with fasting hyperlipidemia . Postprandial hyperlipidemia can cause diabetic macrovascular complications, having the same danger as fasting hyperlipidemia .Insulin resistance and fasting TG is connective .Carotid artery's IMT was significantly correlated with TG4h> BMK WHR, that showed that TG41k BMK WHR were dangerous factors of arteriosclerosis (AS).Diabetes mellitus not only have abnormal blood glucose but also have abnormalblood lipids. Diabetes mellitus have postprandial hyperlipidemia, postprandial hyperlipidemia lead to arteriosclerosis and diabetic vascular complication. Postprandial hyperlipidemia was earlier than fasting hyperlipidemia. We found that postprandial hyperlipidemia and fasting hyperlipidemia had same danger of causing atherosclerosis. It was important that measuring the postprandial hyperlipidemia of the Diabetes mellitus patients whose fasting blood lipids were normal. We can find and treatpostprandial hyperlipidemia in time, so that we can prevent and delay that macrovasular complications of diabetes mellitus. Carotial ultrasonogrphy detection can find interima—media thickness and gruel type mottling. The research indicated the carotid artery supersonic inspection, may take observation atherosclerosis the window , some scholars study the confirmation, obtains IMT through the uhrasonoscopy with the dissectionresult is consistent, the internal membrane tunica media vasorum accumulation is atherosclerosis early time refers drafts, but the mottling forms is the arteriosclerosis obvious characteristic, it may reflect atherosclerosis the degree , thus in on clinical positively carries on the carotid artery color ultra examination to diabetes patient, regarding discovered early diabetes atherosclerosis also has the vital significance, this topic also studied diabetes patient to have atherosclerosis, concurrent macrovascular complications high danger factor, Regarding prevents and delays diabetes big blood vessel pathological change the occurrence, he instruction clinical treatment to have the vital significance, and or on clinical prevents and delays diabetes big blood vessel athological change the occurrence to provide the theory basis.