Objective To explore the relationship between serum lipoprotein A level and cardiovascular disease in patients with type 2 diabetes mellitus.Methods Prospective study method was used to continuously select 1 291 outpatients or inpatients with type 2 diabetes mellitus from January to June in 2010,all of agreed with follow up and were followed up for 6 years.Follow-up results were collected in the Diabetes Center of the People′s Hospital of Lianjiang from January to June in 2016.Baseline information of the above patients was recorded before follow up,including gender,age,BMI,smoking status,course of diabetes,past medical history(including hypertension and diabetic nephropathy),drugs usage and laboratory examination results.Baseline information was compared in patients with or without cardiovascular disease,in patients with different serum lipoprotein A level,and influencing factors of cardiovascular disease in patients with type 2 diabetes mellitus were analyzed by multiple Cox regression analysis.Results (1)Of the 1 291 patients,872 cases completed the 6-year follow-up,thereinto 214 cases were newly diagnosed as cardiovascular disease.No statistically significant differences of female ratio,BMI,smoking rate,proportion of patients using statins,baseline FPG,baseline HbA1c,baseline TG,baseline HDL-C,baseline LDL-C,lipoprotein A revised TC,lipoprotein A revised LDL-C or baseline UAER was found in patients with or without cardiovascular disease(P>0.05),while there were statistically significant differences of age,course of diabetes,incidence of hypertension and diabetic nephropathy,proportion of patients using insulin,using ACEI/ARB and using acetylsalicylic acid,baseline GFR,baseline TC and baseline lipoprotein A in patients with or without cardiovascular disease(P<0.05).(2)According to serum lipoprotein A level,patients completed the follow-up were divided into Q1 group(with serum lipoprotein A level equal or less than 11.70 mg/L,n=203),Q2 group(with serum lipoprotein A level over 11.70 mg/L but equal or less than 18.03 mg/L,n=247),Q3 group(with serum lipoprotein A level over 18.03 mg/L but equal or less than 23.91 mg/L,n=233)and Q4 group(with serum lipoprotein A level over 23.91 mg/L,n=189).No statistically significant differences of BMI,incidence of hypertension or diabetic nephropathy,proportion of patients using insulin,using ACEI/ARB,using statins or acetylsalicylic acid,or baseline HDL-C was found in patients with different serum lipoprotein A level(P>0.05),while there were statistically significantly differences of female ratio,age,smoking rate,course of diabetes,baseline FPG,baseline HbA1c,baseline GFR,baseline TC,baseline TG,baseline LDL-C,lipoprotein A revised TC,lipoprotein A revised LDL-C and UAER in patients with different serum lipoprotein A level(P<0.05).(3)Multiple Cox regression analysis results showed that,compared with Q1 baseline serum lipoprotein A level,Q3 baseline serum lipoprotein A level〔RR=1.72,95%CI(1.11,2.62)〕and Q4 baseline serum lipoprotein A level〔RR=2.33,95%CI(1.56,3.51)〕were independent risk factors of cardiovascular disease in patients with type 2 diabetes mellitus(P<0.05).After corrections of gender,age,BMI,smoking,course of diabetes,hypertension,diabetic nephropathy,baseline HbA1c,baseline GFR,using insulin,ACEI/ARB,statins and acetylsalicylic acid,multiple Cox regression analysis results showed that,compared with Q1 baseline serum lipoprotein A level,Q4 baseline serum lipoprotein A level was independent risk factor of cardiovascular disease in patients with type 2 diabetes mellitus〔RR=1.95,95%CI(1.23,2.98)〕.Conclusion Risk of cardiovascular disease significantly increased in type 2 diabetes mellitus patients with elevated serum lipoprotein A level,serum lipoprotein A level may be reference index for predicting cardiovascular disease in patients with type 2 diabetes mellitus.%目的 探讨血清脂蛋白A水平与2型糖尿病患者心血管疾病的关系.方法 采用前瞻性研究方法,选取2010年1-6月陆续来广东省廉江市人民医院就诊并同意接受随访的门诊或住院2型糖尿病患者1 291例,所有患者随访6年,于2016年1-6月陆续到广东省廉江市人民医院糖尿病中心反馈随访结果.随访前记录所有患者基线资料,包括性别、年龄、体质指数(BMI)、吸烟情况、糖尿病病程、既往史(包括高血压和糖尿病肾病)、药物使用情况及实验室检查指标.比较有无罹患心血管疾病及不同血清脂蛋白A水平患者基线资料,2型糖尿病患者心血管疾病影响因素分析采用多元Cox回归分析.结果 (1)1 291例患者随访6年,其中完成随访者872例;随访期间被新诊断为心血管疾病214例.有无罹患心血管疾病患者女性比例、BMI、吸烟率、使用他汀类药物者所占比例、基线空腹血糖(FPG)、基线糖化血红蛋白(HbA1c)、基线三酰甘油(TG)、基线高密度脂蛋白胆固醇(HDL-C)、基线低密度脂蛋白胆固醇(LDL-C)、脂蛋白A修正的TC、脂蛋白A修正的LDL-C及基线尿白蛋白排泄率(UAER)比较,差异均无统计学意义(P>0.05);有无罹患心血管疾病患者年龄、糖尿病病程、高血压发生率、糖尿病肾病发生率、使用胰岛素者所占比例、使用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)者所占比例、使用乙酰水杨酸者所占比例、基线肾小球滤过率(GFR)、基线总胆固醇(TC)、基线脂蛋白A比较,差异均有统计学意义(P<0.05).(2)根据血清脂蛋白A水平将完成随访的患者分为脂蛋白A≤11.70 mg/L者203例(Q1组)、11.70 mg/L<脂蛋白A≤18.03 mg/L者247例(Q2组),18.03 mg/L<脂蛋白A≤23.91 mg/L者233例(Q3组),脂蛋白A>23.91 mg/L者189例(Q4组).不同血清脂蛋白A水平患者BMI、高血压发生率、糖尿病肾病发生率、使用胰岛素者所占比例、使用ACEI/ARB者所占比例、使用他汀类药物者所占比例、使用乙酰水杨酸者所占比例及基线HDL-C比较,差异无统计学意义(P>0.05);不同脂蛋白A水平患者女性比例、年龄、吸烟率、糖尿病病程、基线FPG、基线HbA1c、基线GFR、基线TC、基线TG、基线LDL-C、脂蛋白A修正的TC、脂蛋白A修正的LDL-C及UAER比较,差异均有统计学意义(P<0.05).(3)多元Cox回归分析结果显示,与第一四分位数基线血清脂蛋白A水平相比,第三四分位数基线血清脂蛋白A水平〔RR=1.72,95%CI(1.11,2.62)〕和第四四分位数基线血清脂蛋白A水平〔RR=2.33,95%CI(1.56,3.51)〕是2型糖尿病患者心血管疾病的独立危险因素(P<0.05).调整性别、年龄、BMI、吸烟、糖尿病病程、高血压、糖尿病肾病、基线HbA1c、基线GFR、使用胰岛素、使用ACEI/ARB、使用他汀类药物、使用乙酰水杨酸后,多元Cox回归分析结果显示,与第一四分位数基线血清脂蛋白A水平相比,第四四分位数基线血清脂蛋白A水平是2型糖尿病患者心血管疾病的独立危险因素〔RR=1.95,95%CI(1.23,2.98)〕.结论 血清脂蛋白A水平升高的2型糖尿病患者心血管疾病发生风险明显升高,血清脂蛋白A水平升高可作为预测2型糖尿病患者心血管疾病的参考指标.
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