脂肪细胞型脂肪酸结合蛋白与老年人2型糖尿病下肢血管病变的关系

摘要

目的 探讨血浆脂肪细胞型脂肪酸结合蛋白(A FABP)与老年2型糖尿病(T2DM)患者下肢血管病变程度的关系. 方法 选择老年T2DM患者1 26例进行双下肢高分辨彩色多普勒检查,根据其下肢血管病变程度分为单纯T2DM组42例,合并轻度下肢动脉粥样硬化组(轻度硬化组)40例,合并重度下肢动脉粥样硬化组(重度硬化组)44例;并选择同期健康体检者40例为对照组.采用ELISA方法测定空腹血浆A-FABP水平,检测血糖、血脂、胰岛素抵抗指数(HOMR-IR)、超敏C反应蛋白(hs CRP)、肾小球滤过率等代谢指标. 结果 血浆A-FABP水平比较,对照组(4.5±1.7)μg/L＜单纯T2DM组(6.1±2.1)μg/L＜轻度硬化组(7.2±2.3)μg/L＜重度硬化组(8.4±3.2)μg/L,差异有统计学意义(P＜0.01).而且随着踝肱指数的降低和下肢血管内膜中层厚度的升高,血浆A FABP也随之升高.多因素Logistic回归分析结果显示,血浆A-FABP水平是老年T2DM患者发生下肢血管病变的主要影响因素之一(P＜0.01).多元逐步回归分析显示,低密度脂蛋白、糖化血红蛋白、H()MR-IR、hs CRP是老年T2DM患者血浆A-FABP的独立预测因子. 结论 血浆A-FABP与老年T2DM患者下肢血管病变程度相关,在老年T2DM患者下肢血管病变的发生中起重要作用.%Objective To explore the relationship between adipocyte fatty acid binding protein (A-FABP) and lower limb vascular disease (LLVD) in the elderly with type 2 diabetes(T2DM).Methods Bilateral lower limb vessels were checked by the High Resolution Color Doppler in all the subjects,including 40 healthy subjects as control (group A),126 T2DM patients.42 T2DM patients had no LLVD (group B),40 had mild LLVD (group C),and 44 had severe LLVD (group D).The levels of plasma A-FABP,blood glucose,lipid profiles,HOMA-IR,hypersensitive C reactive protein (hs CRP),and e-glomerular filtration rate were determined.Results The levels of plasma A-FABP were in the following ascending order of group A(4.5± 1.7)μg/L＜group B(6.1±2.1)μg/L＜group C (7.2 ± 2.3)μg/L ＜ group D (8.4 ± 3.2)μg/L (P＜ 0.01).A-FABP levels elevated along with the decrease of ABI and the increase of L IMT.Multiple logistic regression analysis showed that A FABP levels was main influencing factor of lower limb vascular disease (LLVD) in the elderly with type 2 diabetes.LDL C,HbA1c,HOMR-IR,hs-CRP were the predictive factors for the plasma A-FABP levels in the elderly with T2DM after multiple stepwise regression analysis.Conclusions For elder T2DM patients,the level of plasma A FABP is correlated with the degree of LLVD,and plays an important role in the progress of LLVD.