血浆脂联素水平下降与2型糖尿病合并慢性稳定性心绞痛患者冠状动脉病变的严重性相关

摘要

Objective To investigate the relationship between plasma adiponectin level and the severity of coronary artery lesions in patients with type -2 DM and chronic stahle angina pectoris( DM - SAP). Methods 236 DM - SAP patients were diagnosed by coronary angiography,and the severity of coronary artery lesions was measured by Gensini score, then the DM - SAP patients were assigned into 4 groups according to the quartile of Gensini score , and a healthy control group( n = 138 ) was established. Plasma adiponectin concentrations in all subjects were measured by ELISA.and serum Hs - CRP levels were measured by immunoturbidimetry. Results Adiponectin level in DM - SAP group was lower than that in control group (6. 51 ± 1. 97 μg/ml vs 7. 55 ± 1. 63 μg/ml,P ＜ 0. 001 ) . Adiponectin levels in the higher Gensini scores quartile groups ( group 4, group 3 and group 2) were significantly lower than those in the lowest quartile group ( group 1 ) ( P ＜ 0.001 ) . There was significant negative correlation between plasma adiponectin level and current smoking or HbA1c ( P ＜ 0. 05 ) . Multivariate logistic regression analysis demonstrated that decreased adiponectin level was the significant independent risk factor of the severity of coronary artery lesions in patients with DM - SAP( OR = 17. 78 , 95 ％ CI 6. 453 to 49. 01 ,P ＜ 0. 001 ) . Conclrision Plasma adiponectin level decreased markedly with the severity of coronary artery lesions in patients with type - 2 DM and chronic stable angina pectoris, which suggested that decreased plasma adiponectin may be involved in the pathogenesis of atherosclerosis.%目的 研究血浆脂联素水平与2型糖尿病合并慢性稳定性心绞痛(DM-SAP)患者冠状动脉病变严重程度的关系.方法 236例DM-SAP患者的诊断依靠冠状动脉造影确诊,采用Gensini积分计算方法评价冠脉病变的严重程度,并根据Gensini积分四分位数分成4组,另外选取138例健康体检者作为阴性对照组.所有研究对象均采用ELISA法测定血浆脂联素水平,以免疫比浊法测定血清hs-CRP水平.结果 DM-SAP组血浆脂联素水平较阴性对照组明显降低(6.51±1.97μg/ml∶ 7.55±1.63μg/ml,P<0.001).较高Gensini积分四分位组(组4、3和2)的DM-SAP患者其血浆脂联素水平明显低于最低四分位组(组1)(P<0.001).DM-SAP患者脂联素水平与当前吸烟、HbA1c水平呈显著负相关(P<0.05).多因素Logistic回归分析显示,低脂联素水平是DM-SAP患者冠脉病变严重程度的独立危险因素(OR=17.78,95%CI 6.453～49.01,P<0.001).结论 血浆脂联素水平随着2型糖尿病合并慢性稳定性心绞痛冠脉病变的严重性显著下降,表明血浆脂联素水平下降可能参与了动脉粥样硬化的病理过程.