老年糖代谢异常患者血浆NT—proBNP与血管内皮功能早期监测意义

通过检测老年糖代谢异常患者的血浆N末端血清脑钠肽前体（NT—proBNP）水平与肱动脉血管内皮依赖性舒张功能（FMD），探讨其早期监测意义。共77例观察对象，其中12例血糖正常的健康老人为对照组，65例老年糖代谢异常组患者根据空腹血糖（FBG）和糖耐量2小时（0GTT2h）血糖水平分为空腹血糖受损组（IFG）14例、糖耐量受损组（IGT）23例和2型糖尿病组（DM）28例。各组均检测血浆NT—proBNP水平和无创超声监测FMD。随着血糖代谢异常程度加重，比较正常组，糖代谢异常组的血浆NT—proBNP水平升高（P〈0．01），FMD调节下降（P〈0．01）；糖代谢异常发展过程中，IFG阶段FMD即出现舒张失调（P〈0．05）；IGT阶段血浆NT-proBNP水平升高有意义并达到无症状心衰诊断标准（P〈0．01），且FMD出现舒张过度调节，提示收缩和舒张功能双向调节不良。空腹血糖升高增加血管内皮依赖性舒张功能损害，当FBG合并（或）餐后血糖升高，血浆NT—proBNP水平升高可以成为早期预测慢性无症状心功能不全的危险因素。因此，关注老年糖代谢异常早期阶段进程，并联合血浆NT—proBNP水平和血管内皮依赖性舒张功能监测，不仅对靶器官保护具有早期预警意义，而且是临床控制血糖管理的重要而简易的方法之一。

Plasma NT--proBNP Level and Vessel Endothelium Function In Elderly With Sugar Metabolism Disorders In Early Stage

To investigate the clinical significance of plasma N--terminal pro--B--type natriuretic peptide （NT--proBNP） and brachial artery flow-mediated dilation（FMD） in early prevention stage in elderly with sugar metabolism disorder. According to plasma fasting glucose level and OGTT2h, 77 cases are divided into two groups which include 12 cases as control group and 65 cases as sugar metabolism disorder group. However 65 cases in the sugar metabolism group has three subgroups including 14 cases in IFG group,23 cases in IGT group and 28 cases in DM group. Based on clinical profiles,there is difference between control group and sugar metabolism group in BMI, cholesterol, plasma NT--proBNP（P〈 0. 01） and FMD（P〈0.01）. FMD is impaired earlier in IFG stage（P〈0.05）. Plasma NT--proBNP level is significantly higher（ P〈 0.01） and can serve as risk factor for chronic heart failure. Paying more great attention on IFG is significant in clinic treatment. To protect target organ in elderly with glucose disorder,NT--proBNP combined with FMD can be taken as one of pre-warning detection methods.