蔡晓盛　杨立善　陶凯　余玉慧　陈景海　陈颖　周乐

[摘要] 目的 探討ω-3多不饱和脂肪酸（ω-3 PUFA）对吸烟男性2型糖尿病（T2DM）患者内皮功能影响。 方法 将60例吸烟男性T2DM患者按随机原则分为A、B两组，每组30例。采取2个阶段交叉实验设计，每阶段3个月。第1阶段A组口服ω-3 PUFA片，B组口服安慰剂，两组剂型相同，每天早晚各1片，第1阶段实验开始和结束时间为T1和T2；经1个月药物洗脱期后，第2阶段两组治疗措施互换，B组服用ω-3 PUFA，A组服用安慰剂，第2阶段实验开始和结束时间为T3和T4。于每个阶段开始和结束时间检测患者内皮依赖性血流介导的舒张功能（FMD）、空腹血糖、GHB、TC、LDL-C、HDL、TG、IL-6、纤溶酶原激活物抑制剂-1（PAI-1）。 结果 第1阶段A组治疗后T2时间FMD较T1时间显著升高，TG、LDL-C、IL-6、PAI-1较T1显著降低，差异有统计学意义（P<0.05）。第2阶段B组治疗后T4时间FMD较T3时间显著升高，TG、LDL-C、IL-6、PAI-1较T3显著降低，差异有统计学意义（P<0.05）。 结论 ω-3 PUFA可改善吸烟男性T2DM患者内皮功能，对心脑血管预防保护有重要作用。

[关键词] ω-3多不饱和脂肪酸；2型糖尿病；吸烟；男性；内皮功能

[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-9701（2017）36-0010-05

[Abstract] Objective To investigate the effect of ω-3 polyunsaturated fatty acids（ω-3 PUFA） on endothelial function in smoking men with type 2 diabetes mellitus（T2DM）. Methods 60 male smokers with T2DM were randomly divided into A and B groups， with 30 cases in each group. The patients underwent two-stage cross-experimental design， with 3 months in each stage. In the first phase， the group A was given omega-3 PUFA tablets orally， and the group B was given placebo. The dosage in the two groups was the same， with 1 tablet in daily morning and evening. The experiment start and end time in the first stage was T1 and T2. After one month of drug-eluting phase， the treatment measurements in the two groups were reversed in phase 2. The group B received omega-3 PUFA， and the group A received placebo. The experiment start and end time in the second stage was T3 and T4. Patients were monitored for endothelium-dependent blood flow-mediated diastolic function （FMD）， fasting plasma glucose， GHB， TC， LDL-C， HDL， TG， IL-6， plasminogen activator inhibition-1（PAI-1） at the beginning and end of each phase. Results In the first stage， FMD in the group A at T2 after treatment was significantly higher than that at T1 after treatment， and the TG， LDL-C， IL-6 and PAI-1 at T2 after treatment were significantly lower than those at T1 after treatment（P<0.05）. In the second stage， the FMD in group B at T4 after treatment was significantly higher than that at T3 after treatment（P<0.05）， and the levels of TG， LDL-C， IL-6 and PAI-1 in T3 at T4 after treatment were significantly lower than those at T3， and the difference was significant （P<0.05）. Conclusion ω-3 PUFA can improve endothelial function in smoking men with T2DM and play an important role in the prevention and protection of cardiovascular and cerebrovascular diseases.

[Key words] ω-3 Polyunsaturated fatty acid； Type 2 diabetes； Smoking； Men； Endothelial function

2型糖尿病已经成为威胁人类健康安全的慢性疾病之一，我国目前糖尿病患者人数已居世界首位，达1.4亿。T2DM的主要慢性并发症是血管病变，由此引发的心脑血管疾病也是T2DM致死、致残的主要原因。近年来国内外大量研究发现[1，2]，T2DM患者的血管内皮功能已存在比较明显改变，提示T2DM早期患者已经存在血管内皮损伤和内皮依赖性血管舒张功能受损。国外研究显示[3]，凡是可引起心血管疾病的危险因素（血脂异常、高血压、高血糖和糖尿病、吸烟）均可以引起血管内皮功能障碍。吸烟可升高血糖，是糖尿病的独立危险因素[4]。此外大量临床研究表明，吸烟还是动脉粥样硬化相关疾病的独立危险因素，吸烟不仅增加心脑血管事件发生，还可以对外周动脉及外周静脉均有影响[5，6]。……