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目的:探讨褪黑素对2型糖尿病患者血管内皮功能的影响。方法:选择早期无大血管并发症的2型糖尿病患者60例,随机分为试药组和对照组各30例,对照组采用饮食、运动、胰岛素治疗,试药组加用褪黑素(MLT)胶囊6 mg,每晚口服,共治疗6个月。同期选择28例健康个体为正常对照组。治疗前后检测血压、空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),计算体质量指数(BMI)。用高分辨率超声检测、计算肱动脉血流介导的内皮依赖性血管舒张功能(FMD)和硝酸甘油介导的内皮非依赖性血管舒张功能(NMD)。结果:①与正常对照组比较,糖尿病组治疗前FPG、2hPG、HbA1c、TG、LDL-C明显增高(均P<0.01),HDL-C明显降低(P<0.05)。治疗半年后糖尿病组TG、LDL-C略下降,BMI、HDL-C略升高但均无统计学差异,FBG、2hPG、HbA1c无明显变化。②与正常对照组比较,糖尿病组治疗前肱动脉基础内径、NMD无显著差异,FMD明显降低(均P<0.01)。治疗半年后糖尿病各组肱动脉基础内径、NMD无明显变化;FMD明显升高(P<0.05或P<0.01),试药组FMD明显高于对照组(P<0.05)。结论:2型糖尿病患者早期出现血管内皮舒张功能降低,褪黑素明显改善2型糖尿病早期患者受损血管内皮功能。
Objective: To investigate the effect of melatonin on vascular endothelial function in type 2 diabetic patients. Methods: Sixty patients with type 2 diabetes mellitus without early-stage macrovascular complications were randomly divided into control group (30 cases) and control group (30 cases). The control group was treated with diet, exercise and insulin. MLT ) Capsule 6 mg, orally every night for a total of 6 months. In the same period, 28 healthy individuals were selected as normal control group. Before and after treatment, blood pressure, fasting blood glucose (FPG), postprandial 2h blood glucose (2hPG), HbA1c, triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol HDL-C), body mass index (BMI) was calculated. Brachial artery-mediated endothelium-dependent vasodilation (FMD) and nitroglycerin-mediated endothelium-independent vasodilation (NMD) were calculated using high-resolution ultrasound. Results: ① Compared with the normal control group, the levels of FPG, 2hPG, HbA1c, TG and LDL-C in diabetic group were significantly increased (all P <0.01) and HDL-C significantly decreased (P <0.05). Six months after treatment, the levels of TG and LDL-C in diabetes mellitus decreased slightly, BMI and HDL-C slightly increased, but there was no statistical difference. There was no significant change in FBG, 2hPG and HbA1c. ② Compared with the normal control group, there was no significant difference in the basic diameter and NMD of brachial artery before treatment in diabetic group, and the FMD was significantly lower (all P <0.01). After 6 months of treatment, the basal diameter of brachial artery and NMD had no significant change in each group. The FMD was significantly increased (P <0.05 or P <0.01). The FMD in test group was significantly higher than that in control group (P <0.05). CONCLUSION: In the early stage of type 2 diabetes, the vasodilatation function of blood vessels is decreased. Melatonin significantly improves the endothelial dysfunction in patients with type 2 diabetes in early stage.