Correlations of three serological indexes with diabetic peripheral vascular disease
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摘要:目的
探讨同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)、脂蛋白相关磷脂酶(Lp-PLA2)水平与糖尿病周围血管病变的相关性。
方法选择206例诊断为2型糖尿病(T2DM)的患者为研究对象, 根据检查结果不同, 将其分为正常组(颈动脉正常患者, 116例)和粥样斑块组(糖尿病伴颈动脉粥样斑块患者, 90例)。分析T2DM患者各项指标与颈动脉内膜中层厚度(IMT)的相关性, 记录血清学指标(HbA1c、Lp-PLA2、Hcy)及不良事件发生情况, 探讨T2DM患者血管并发症的影响因素。探讨冠状动脉微循环阻力指数(IMR)与Lp-PLA2、Hcy的相关性, 采用多因素Logistic回归分析探讨IMR升高的危险因素。
结果粥样斑块组与正常组的超敏C反应蛋白(hs-CRP)和尿酸水平比较, 差异有统计学意义(P < 0.05);随访第6、12个月时, 2组HbA1c、Lp-PLA2、Hcy指标比较, 差异有统计学意义(P < 0.05);粥样斑块组第6、12个月时不良事件发生率均高于正常组, 差异有统计学意义(P < 0.05)。T2DM患者血浆Lp-PLA2与总动脉、外动脉及双侧颈内动脉IMT呈显著正相关(P < 0.01);尿酸与右颈总动脉、外动脉、内动脉IMT呈显著正相关(P < 0.05);餐后2 h C肽水平与左颈外动脉、内动脉、右颈外动脉IMT呈显著正相关(P < 0.05)。Lp-PLA2、hs-CRP是糖尿病血管并发症的主要影响因素。Hcy、Lp-PLA2与IMR呈显著正相关(P < 0.01), 冠状动脉血流储备(CFR)与IMR呈显著负相关(P < 0.01)。IMR升高的危险因素为Hcy和年龄, 保护因素为HDL-C、CFR (P < 0.05)。
结论HbA1c、Lp-PLA2、Hcy是糖尿病周围血管病变的独立影响因素。
Abstract:ObjectiveTo explore the correlations of levels of homocysteine (Hcy), glycosylated hemoglobin (HbA1c) and lipoprotein associated phospholipase (Lp-PLA2) with diabetic peripheral vascular disease.
MethodsA total of 206 patients diagnosed as type 2 diabetes (T2DM) were selected as research subjects.According to different results of the examination, they were divided into normal group (normal carotid artery patients, 116 cases) and atherosclerotic plaque group (diabetes mellitus combined with atherosclerotic plaque patients, 90 cases).The correlations between various indicators and carotid intima media thickness (IMT) in T2DM patients, the serological indicators (HbA1c, Lp-PLA2, Hcy) and the occurrence of adverse events were compared, and the influencing factors of vascular complications in T2DM patients were explored.The correlations of coronary artery microcirculation resistance index (IMR) with Lp-PLA2 and Hcy, and the risk factors of IMR elevation by multivariate Logistic regression analysis were explored.
ResultsThere were significant differences in hypersensitive C-reactive protein (hs-CRP) and uric acid levels between the atheromatous plaque group and the normal group (P < 0.05).There were statistically significant differences in HbA1c, Lp-PLA2 and Hcy between the two groups at the 6 and 12 month of follow-up (P < 0.05).The incidence of adverse events at 6 and 12 months in the atheromatous plaque group was higher than that in the normal group (P < 0.05).Plasma Lp-PLA2 was positively correlated with IMT of common artery, external artery and bilateral internal carotid artery in T2DM patients (P < 0.01).There was significant positive correlation between uric acid and IMT of right common carotid artery, external artery and internal artery (P < 0.05).The level of 2 h postprandial C peptide was significantly positively correlated with IMT of left external carotid artery, internal carotid artery and right external carotid artery (P < 0.05).Lp-PLA2 and hs-CRP were the main influencing factors of diabetic vascular complications.Hcy, Lp-PLA2 were significantly positively correlated with IMR (P < 0.01), there was a significant negative correlation between coronary blood flow reserve (CFR) and IMR (P < 0.01).The risk factors for increase of IMR were Hcy and age, and the protective factors were HDL-C and CFR (P < 0.05).
ConclusionHbA1c, Lp-PLA2 and Hcy are independent risk factors of diabetic peripheral vascular disease.
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表 1 2组患者一般资料比较(x±s)[n(%)]
一般资料 正常组(n=116) 粥样斑块组(n=90) t/χ 2 P 年龄/岁 50.58±9.36 54.24±11.67 -1.541 0.141 性别 男 68(58.62) 52(57.78) 0.008 0.989 女 48(41.38) 38(42.22) 高血压 32(27.59) 28(31.11) 0.164 0.687 体质量指数/(kg/m2) 24.90±3.44 25.54±3.45 -1.411 0.176 糖化血红蛋白/% 10.39±1.74 10.17±1.90 -0.389 0.701 空腹血糖/(mmol/L) 11.89±2.76 11.32±3.28 -0.216 0.849 空腹C肽/(ng/mL) 1.90±0.97 1.89±0.72 -1.026 0.324 餐后2 h血糖/(mmol/L) 22.19±4.48 21.38±5.54 0.388 0.687 餐后2 h C肽/(ng/mL) 3.86±1.83 4.12±1.89 -0.714 0.495 总胆固醇/(mmol/L) 5.17±1.18 5.43±1.27 -0.285 0.796 甘油三酯/(mmol/L) 2.75±2.57 3.01±3.82 1.091 0.295 高密度脂蛋白胆固醇/(mmol/L) 1.18±0.43 1.25±0.76 -0.424 0.692 低密度脂蛋白胆固醇/(mmol/L) 2.78±0.97 2.90±1.19 -1.135 0.276 超敏C反应蛋白/(ng/mL) 1 870.82±1 506.42 3 989.10±4 808.24 -2.977 0.008 尿酸/(μmol/L) 267.84±84.41 300.80±82.75 -2.057 0.045 
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表 2 T2DM患者各指标与IMT的相关性分析(r值)
指标 左颈外动脉 左颈内动脉 左颈总动脉 右颈外动脉 右颈内动脉 右颈总动脉 体质量指数/(kg/m2) 0.062 0.072 0.067 0.074 0.067 0.096 糖化血红蛋白/% -0.197 -0.166 -0.077 -0.145 -0.157 -0.069 餐后2 h血糖/(mmol/L) -0.097 -0.094 0.101 -0.071 -0.019 0.125 空腹血糖/(mmol/L) -0.138 -0.135 -0.088 -0.189 -0.079 -0.060 餐后2 h C肽/(ng/mL) 0.243** 0.264** 0.153 0.305** 0.175 0.088 空腹C肽/(ng/mL) 0.063 0.141 0.068 0.159 0.120 0.108 总胆固醇/(mmol/L) 0.004 0.035 0.101 0.047 -0.055 0.097 甘油三酯/(mmol/L) -0.135 -0.064 0.033 0.009 -0.057 0.067 高密度脂蛋白胆固醇/(mmol/L) 0.102 0.191 0.121 0.153 0.120 0.026 低密度脂蛋白胆固醇/(mmol/L) 0.110 0.111 0.092 0.045 -0.006 0.066 超敏C反应蛋白/(ng/mL) 0.167 0.136 0.103 0.155 0.137 0.074 尿酸/(μmol/L) 0.183 0.195* 0.160 0.242* 0.131 0.214* 脂蛋白相关磷脂酶/(ng/mL) 0.434** 0.391** 0.508** 0.322** 0.408** 0.494** *P < 0.05, **P < 0.01。
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表 3 T2DM患者各指标与IMT的相关性
变量 SE(B) B OR P 95%CI 超敏C反应蛋白 0.000 15 0.000 46 1.000 56 0.002 1.000 28~1.000 83 脂蛋白相关磷脂酶 0.007 58 0.024 97 1.025 28 0.001 1.010 37~1.010 30
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表 4 单因素Logistic回归分析
因素 Sb B P Wald χ2 RR 95%CI 男性 0.594 0.640 0.283 1.159 1.895 0.593~6.061 年龄 0.037 0.107 0.004 8.760 1.113 1.038~1.194 吸烟 0.536 0.192 0.723 0.128 1.211 0.425~3.455 体质量指数 0.121 0.127 0.293 1.112 1.136 0.898~1.436 门静脉高压 0.711 1.810 0.232 6.498 2.106 1.520~4.541 总胆固醇 0.193 0.103 0.597 0.282 1.108 0.761~1.613 甘油三酯 0.200 0.119 0.554 0.353 1.126 0.763~1.663 空腹血糖 0.187 0.091 0.630 0.234 1.095 0.761~1.575 高密度脂蛋白胆固醇 0.877 -2.685 0.003 9.394 0.069 0.013~0.381 低密度脂蛋白胆固醇 0.358 0.624 0.082 3.049 1.866 0.927~3.756 脂蛋白相关磷脂酶 0.008 0.004 0.707 0.143 1.004 0.990~1.018 糖化血红蛋白 0.446 0.473 0.126 1.123 1.604 0.671~3.839 冠状动脉血流储备 0.649 -1.872 0.005 8.366 0.155 0.044~0.548 同型半胱氨酸 0.067 0.156 0.020 5.461 1.169 1.026~1.332
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表 5 多因素Logistic回归分析
因素 Sb B P Wald χ2 RR 95%CI 年龄 0.039 0.087 0.024 5.174 1.091 1.013~1.174 高密度脂蛋白胆固醇 0.956 -2.358 0.014 6.107 0.096 0.016~0.615 同型半胱氨酸 0.872 0.017 0.028 5.434 1.017 0.842~1.229 冠状动脉血流储备 0.735 -1.602 0.03 4.773 0.202 0.049~0.849 常量 3.486 1.802 0.651 0.268 — —
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