冠心病患者血浆视黄醇结合蛋白4水平变化及高胰岛素血症对其的影响

摘要

目的:探讨冠心病患者血浆视黄醇结合蛋白4 (retinol binding protein4,RBP4)水平变化情况,以及高胰岛素血症对其影响.方法:收集2009年9月至2010年5月在中南大学湘雅医院经冠状动脉造影(coronary angiography, CAG)检查证实为冠心病的患者30例(CAD组),冠心病合并高胰岛素血症患者29例(CAD+HIns组)；另设正常对照30例(对照组).采用酶联免疫吸附法检测血浆RBP4水平；同时测患者身高、体质量,计算体质量指数(body mass index,BMI),测腰围、臀围,计算腰/臀比(waist-to-hip ratio,WHR),测收缩压(systolic pressure,SBP)与舒张压(diastolic pressure,DBP)；测空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,Fins)、餐后2h胰岛素(2-hour postprandial inslulin,2hPIns),计算胰岛素抵抗指数(homeostasis model assessment-insulin resistance index,HOMA-IR),测血脂水平以及高敏c反应蛋白 (high sensitivity C reactive protein,hsCRP)、尿酸(uric acid,UA)、游离脂肪酸(free fatty acids,FFA)等生物化学指标.结果:CAD+HIns组血浆RBP4水平较CAD组及对照组显著升高(P＜0.01),而CAD组和正常对照组问差异无统计学意义(P＞0.05)；相关分析显示RBP4与BMI,FPG,Fins,2hPIns,HOMA-IR,三酰甘油,高密度脂蛋白胆固醇,UA和hsCRP有显著相关性(分别r=0.259,0.331,0.582,0.452,0.600,0.236,-0.290,0.243,0.231;均P＜0.05)；多元回归分析显示 BMI,2hPIns和HOMA-IR是RBP4的独立相关因素.结论:冠心病患者血浆RBP4水平不高,合并高胰岛素的冠心病患者血浆RBP4水平显著升高,且血浆RBP4与BMI、血脂、UA等心血管危险因素相关；BMI,2hPIns和HOMA-IR是RBP4的独立相关因素.%Objective: To evaluate the change of plasma level of retinol binding protein 4 (RBP4) in patients with coronary heart disease, and to explore the effect of hyperinsulinemia.Methods: This study was carried out at Xiangya Hospital of Central South University, China, from September 2009 to May 2010. Thirty patients with coronary artery disease (the CAD group) were confirmed by coronary angiography, 29 patients with CAD plus hyperinsulinemia (the CAD+Hins group), and 30 healthy subjects were enrolled as controls (the control group). The peripheral blood sample from the anticubital vein was collected aseptically in all the subjects to measure the RBP4 by enzyme linked immunosorbent-assay (ELISA). The height, weight, body mass index (BMI) the waist-to-hip ratio (WHR), the blood pressure, the fasting plasma glucose (FPG), the fasting insulin (Fins), the 2-hour postprandial inslulin (2hPIns), and the homeostasis model assessment-insulin resistance index (HOMA-IR) was measured. The lipids, high sensitivity C reactive rotein (hsCRP), uric acid(UA), free fatty acids (FFA) were all examined.Results: The level of plasma RBP4 in the CAD+Hins group was higher than that in the CAD group and the control group (both P<0.01), with no significant difference of plasma RBP4 between the CAD group and the control group (P>0.05). Correlation analysis showed that the plasma RBP4 level was significantly correlated with BMI, FPG, Fins, 2hPIns, HOMA-IR, TG, HDL-C, UA, and hsCRP (r=0.2S9, 0.331, 0.582, 0.452, 0.600, 0.236, -0.290, 0.243, 0.231, respectively; all P <0.05). Multiple regression analysis showed that BMI, 2hPIns, and HOMA-IR were the independent factors related to RBP4.Conclusion: The plasma level of RBP4 does not increase in the CAD group, but it is high in the CAD +Hins group. RBP4 level is related to BMI, lipids, UA, and other cardiovascular risk factors. BMI, 2hPIns, and HOMA-IR are the independent factors associated with RBP4.