内皮素no和tnfα在早期糖尿病性心肌病发病中的作用.doc

内皮素、NO和TNFα在早期糖尿病性心肌病发病中的作用 【摘要】 　　目的： 探讨血浆内皮素、氧化亚氮(NO)、肿瘤坏死因子α(TNFα)在早期糖尿病性心肌病发病机制中的作用。方法： 选取57例2型糖尿病患者,根据超声心动图结果将患者分为单纯糖尿病组（DM组）和糖尿病心肌病组（DC组）,另选取健康者30例作为正常对照组（NC组）。分别测定所有患者内皮素、NO和TNFα的水平。结果： 与NC组相比，DC组患者出现E/A比值下降、左心房内径（LAD）增大等左室舒张功能减退的表现。DC组患者血浆中内皮素、NO及TNFα水平明显高于NC组和DM组(Plt;0.01)。直线相关分析显示，血浆内皮素、NO,TNFα水平与射血分数（EF）,E/A均呈负相关。结论: 左室舒张功能减退是糖尿病性心肌病的早期表现，内皮素、NO及TNFα水平的异常表达在早期糖尿病性心肌病的发生、发展中占非常重要的地位。 【关键词】 糖尿病心肌病；氧化亚氮； 内皮素； 肿瘤坏死因子α； 左心室舒张功能 　 　　［Abstract］Objective: To explore the role of endothelin,nitric oxide(NO) and tumor necrosis factorα(TNFα) in the pathogenesis of early diabetic cardiomyopathy.Methods： According to the results of color Doppler ultrasonic cardiogram, 57 cases of type 2 diabetes mellitus were divided into 2 groups:diabetes mellitus group(DM group) and diabetic cardiomyopathy group(DC group),30 cases of healthy people were chosed as normal control group(NC group). The level of blood endothelin,NO and TNFα were detected,respectly. Results: Compared with the NC group, dysfunction of left ventricle diastole function which were manifestated as the decrease of the ratio of E/A and enlargement of left atrium diameter(LAD) were observed in DC group.The level of blood endothelin,NO and TNFα were significantly increased in DC group(Plt;0.01).Linear correlation analysis showed that the level of blood endothelin,NO,TNFα are all negatively correlated with EF,E/A. Conclusion: Left ventricle diastole dysfunction was the early manifestation of diabetic cardiomyopathy.The abnormal expression of endothelin,NO and TNFα occupied significant place in the pathegenesis and development of diabetic cardiomyopathy. 　　［Key words］diabetic cardiomyopathy； nitric oxide； endothelin； tumor necrosis factorα； left ventricle diastole dysfunction 　　糖尿病性心肌病(diabetic cardiomyopathy,DC)是糖尿病心脏病的特异性病变。早期患者可无症状，随着病情的发展，可出现进行性的心功能不全，目前已成为糖尿病患者死亡的重要原因之一［1］,因而早期发现糖尿病性心肌病显得尤为重要。糖尿病性心肌病的发病机制复杂，至今未完全阐明，目前认为与许多细胞因子有关。本研究拟对2型糖尿病患者行心脏多普勒超声检查，并测定患者血浆中血管调节因子内皮素（ET）、氧化亚氮（NO）及肿瘤坏死因子