Objective To explore the correlation between the level of lipoprotein associated phospholipase A2(Lp-PLA2) and cervical vascular disease in patients with type 2 diabetes mellitus (T2DM).Methods Totally 76 patients with T2DM from July 2014 to March 2015 underwent carotid artery color Doppler ultrasound to measure the intima-media thickness (IMT) and were divided into simple T2DM group and T2DM with cervical vascular complication group according to the results of ultrasound.Meanwhile, 40 cases of healthy people who received physical examination were selected as control group.The level of fasting blood-glucose (FBG) , hemoglobin A1c (HbA1 c), triacylglycerol, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), apolipoprotein (Apo) A1, ApoB, homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) and Lp-PLA2 were detected and compared among groups.Results There were 36 cases in simple T2DM group and 40 cases in T2DM with cervical vascular complication group.There were no statistical differences regarding gender, age, triacylglycerol, total cholesterol, LDL-C, HDL-C, ApoA1 , ApoB were found among groups (P ＞ 0.05).The levels of FBG, HbA1 c, Hcy, Lp-PLA2 in simple T2DM group and T2DM with cervical vascular complication group were significantly higher than those in control group [(8.5 ± 2.9), (8.1 ± 3.1) mmol/L vs (5.2±0.4) mmol/L;(8.4±2.7), (9.3±2.9)％ vs (5.3±0.5)％;(9±4), (14±5) μmol/L vs (6± 3) μmol/L;(131 ± 32), (283 ± 66) μg/L vs (69 ± 16) μg/L];the duration of diabetes was significantly longer, the levels of Hcy, hs-CRP, Lp-PLA2 were significantly higher in T2DM with cervical vascular complication group compared with those in simple T2DM group [(9 ± 6) years vs (4 ± 3) years, (14 ± 5)μmol/L vs (9 ±4) μmol/L, (5.2 ± 2.5) mg/L vs (3.5 ± 2.1) mg/L, (283 ± 66) μg/L vs (69 ± 16) μg/L];the IMT and ApoB/ApoA1 T2DM with cervical vascular complication group were significantly higher than those in control group and simple T2DM group [(1.08 ±0.16) mmvs (0.69 ±0.06), (0.73 ±0.10) mm;(0.78 ±0.22) vs (0.54 ± 0.18), (0.60 ± 0.24)] (P ＜ 0.05).The level of Lp-PLA2 was positively correlated with IMT, Hcy, hs-CRP and ApoB/ApoA1 ratio (r =0.402, 0.335, 0.226, 0.214, P ＜ 0.05) , and it was negatively correlated with ApoA1 (r =-0.205, P ＜ 0.05).Multiple stepwise regression analysis showed that IMT and Hcy were risk factors of Lp-PLA2 [Y =2.312 + 0.724X1 + 0.163X2 (X1 =IMT, X2 =Hcy)].Logistic regression analysis showed that IMT and plasma Lp-PLA2 were the risk factors of neck vascular lesions in T2DM (P =0.003, 0.011).Conclusion Lp-PLA2 is one of the independent risk factors of cervical vascular complication in T2DM patients.%目的 探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与2型糖尿病患者颈部大血管病变的相关性.方法 选择2014年7月至2015年3月于常熟市第二人民医院住院的2型糖尿病患者76例,应用颈动脉彩色多普勒超声检查患者颈动脉内膜中层厚度(IMT),根据是否有颈部血管病变分为单纯糖尿病组和糖尿病颈部血管病变组.另选取同期在我院体检的40名健康者作为正常对照组.检测并比较3组空腹血糖、糖化血红蛋白(HbA1c)、三酰甘油、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白(Apo)A1、ApoB、同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)及血浆Lp-PLA2水平.结果 单纯糖尿病组患者36例,糖尿病颈部血管病变组40例.3组性别、年龄、三酰甘油、总胆固醇、LDL-C、HDL-C、ApoA1、ApoB比较,差异均无统计学意义(均P＞0.05);单纯糖尿病组和糖尿病颈部血管病变组空腹血糖、HbA1c、Hcy及Lp-PLA2水平均高于正常对照组[(8.5±2.9)、(8.1 ±3.1)mmol/L比(5.2±0.4)mmol/L, (8.4 ±2.7)、(9.3±2.9)％比(5.3±0.5)％,(9±4)、(14±5)μmoL/L比(6±3)μmol/L,(131±32)、(283 ±66)μg/L比(69±16) μg/L],且糖尿病颈部血管病变组糖尿病病程、Hcy、hs-CRP、Lp-PLA2水平明显高于单纯糖尿病组[(9±6)年比(4±3)年,(14±5)μmol/L比(9±4)μmol/L,(5.2±2.5) mg/L比(3.5 ±2.1)mg/L,(283±66) μg/L比(69±16) μg/L],IMT及ApoB/ApoA1比值明显高于正常对照组及单纯糖尿病组[(1.08 ±0.16)mm比(0.69±0.06)、(0.73±0.10) mm,(0.78 ±0.22)比(0.54 ±0.18)、(0.60±0.24)],差异均有统计学意义(均P＜ 0.05).2型糖尿病患者血浆Lp-PLA2水平与IMT、Hcy、hs-CRP及ApoB/ApoA1比值呈正相关(r=0.402、0.335、0.226、0.214),与ApoA1呈负相关(r=-0.205),均P＜0.05;多元逐步回归分析显示,IMT、Hcy为影响血浆Lp-PLA2水平的相关因素[Y=2.312 +0.724X1+0.163X2(X1为IMT,X2为Hcy)];Logistic回归分析表明IMT和血浆Lp-PLA2水平是2型糖尿病患者颈部大血管病变的危险因素(P =0.003,P=0.叭1).结论 Lp-PLA2是2型糖尿病患者颈部血管病变的危险因素.
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