血清糖化血红蛋白及脂蛋白-(a)水平变化与糖尿病并发冠心病的关系

目的:探讨血清糖化血红蛋白(HbAlc)及脂蛋白-a[Lp(a)]水平变化与糖尿病并发冠心病的关系。方法:单纯2型糖尿病患者54例(糖尿病组)和2型糖尿病并发冠心病患者128例(糖尿病并发冠心病组),测定各组血清HbAlc和Lp(a)水平,通过Logistic回归和ROC曲线分析血清HbAlc和Lp(a)水平变化对糖尿病并发冠心病的相对危险性预测价值。结果:糖尿病合并冠心病组HbAlc(7.5±1.4)%和Lp(a)(0.25±0.19)g/L明显高于单纯糖尿病组[(6.9±1.4)%和(0.19±0.16)g/L,均P<0.05]。Logistic回归分析显示,血清高水平HbAlc和Lp(a)分别是糖尿病并发冠心病的独立危险因素(OR值2.28,95%CI1.12～4.63,P<0.05)及(OR值2.3,95%CI1.11～4.79,P<0.05)。Logistic回归模型的ROC曲线下面积为0.73(P<0.01)。最佳切点0.7对判断糖尿病患者并发冠心病的敏感性和特异性分别为70%和65%。结论:血清HbAlc和Lp-(a)水平是糖尿病患者并发冠心病的独立危险因素,对评估糖尿病并发冠心病的相对危险性具有临床价值。

Association of Serum Level of Hemoglobin A (1c) and lipoprotein-a with Coronary Artery Disease Complicating Diabetes Mellitus

Objective:To investigate the association of serum of hemoglobin A(1c)and Lipoprotein-a with coronary hear disease(CHD)in patients with type 2 diabetes mellitus.Method:Serum levels of hemoglobin A(1c)and Lipoprotein-a were measured in 54 with type 2 diabetes only and 128 patients with diabetes and CHD.Multivariate logistic regression analysis was performed to identify risk factors for CHD in diabetic patients.The predictive value of hemoglobin A(1c)and Lipoprotein-a for presence of CHD in diabetic patients was calculated by constructing receiver-operating characteristic curves(ROC).Results:Serum level of hemoglobin A(1c)(7.5±1.4)% and Lipoprotein-a(0.25±0.19)g/L in diabetic patients with CHD were significantly higher than those in patients with diabetes only(6.9±1.4)% and(0.19±0.16)g/L,P<0.05.Multivariate logistic regression analysis revealed that hemoglobin A(1c)and Lipoprotein-a were independent risk factors for CHD in diabetic patients(OR =2.28,95%CI 1.12～4.63,P<0.05)and(OR=2.3,95%CI 1.11～4.79,P<0.05).Area under the ROC curve for logistic regression model was 0.73,P<0.01.The optimal cut-off point for logistic regression model was 0.7(sensitivity 70%,specificity 65%)in the prediction of CHD in diabetic patients.Conclusion:Serum level of hemoglobin A(1c)and lipoprotein-a are independent risk factors for CHD in diabetic patients and may be useful in predicting the relative risk for CHD in patients with type 2 diabetes.