高胰岛素血症对冠心病患者血浆视黄醇结合蛋白4水平的影响及其临床意义

目的 观察视黄醇结合蛋白4(RBP4)在合并高胰岛素血症的冠心病患者血浆中的水平,探讨高胰岛素血症对冠心病患者RBP4的影响及其临床意义.方法 收集2009年9月～2010年5月在湘雅医院心血管内科住院并行冠状动脉造影( CAG)检查证实为冠心病患者59例,根据其胰岛素水平分为:单纯冠心病组(CHD)30例、冠心病合并高胰岛素组患者(CHD+HIn )29例；另选同期来我院行健康体检者作为正常对照组( NC )30例.酶联免疫吸附法(ELISA)检测上述人群血浆RBP4水平；测身高、体重,计算体重指数(BMI),测腰围、臀围,计算腰/臀,测收缩压与舒张压；测空腹血糖、胰岛素、餐后2h胰岛素,计算胰岛素抵抗指数(HOMA-IR),测血脂水平以及高敏C反应蛋白、尿酸、游离脂肪酸等生化指标.结果 CHD+HIn组患者血浆RBP4水平显著高于CHD组和NC组(P＜0.01),CHD与NC组间差异无统计学意义；相关分析显示RBP4与BMI、FPG、FIn、2bPIn、HOMA-IR、TG、HDL-C、UA、hsCRP有显著相关性；多元回归分析显示BMI、2hPIn、HOMA-IR是RBP4的独立相关因素.结论 合并高胰岛素血症的冠心病患者血浆RBP4水平显著升高,提示高胰岛素血症是影响RBP4的重要因素,RBP4可作为识别冠心病患者是否存在胰岛素抵抗的血清学指标；血浆RBP4与BMI、血脂、尿酸、等心血管危险因素相关,提示RBP4参与AS的发生、发展过程；BMI、2hPIn、HOMA-IR是RBP4的独立相关因素.

The impact and clinical significance of hyperinsulinemia on plasma retinol binding protein 4 level in coronary heart disease patients

【Objective】 To evaluate the plasma Retinol Binding Protein 4(RBP4) level in coronary heart disease(CHD) patients and the CHD combined with hyperinsulinemia,and investigate the impact and the possible clinical significance of hyperinsulinemia on plasma RBP4 level in coronary heart disease patients.【Methods】 This study was carried out at Xiangya Hospital of Central South University,China,from September 2009～May 2010.59 hospitalized coronary heart disease(CHD) patients confirmed by coronary angiography were divided into two groups according to the plasma insulin level: 30 patients were treated as simple CHD group and 29 patients were treated as CHD plus hyperinsulinemia group(CHD+HIn).Another 30 healthy subjects who got health checkup at the same time were enrolled as a normal control group(NC).The peripheral blood samples aseptically from the anti-cubital vein from all the study subjects were measured by ELISA technique for RBP4.Meanwhile,the height and weight,the waistline and hip were checked;the body mass index(BMI) and the waist-to-hip ratio(WHR) were calculated.The blood pressure,the fasting blood glucose,insulin,2 h postprandial insulin were all checked and the insulin resistance index(HOMA-IR) was calculated.The lipids,high-sensitivity C-reactive protein(hs-CRP),uric acid(UA),free fatty acids were all checked.【Results】 Plasma RBP4 level in CHD+HIn group is higher than CHD and NC group(P <0.01),while there is no significant difference between CHD and NC group.Correlation Analysis showed that plasma RBP4 level significantly related with BMI,FPG,Fin,2hPIn,HOMA-IR,TG,HDL-C,UA and hsCRP.Multiple regression analysis showed that BMI,2hPIn and HOMA-IR were the factors independently associated with RBP4.【Conclusion】 Plasma RBP4 level does not increase in CHD patients while it is higher in CHD patients combine with hyperinsulinemia.Implied that hyperinsulinemia is an important factor which affects RBP4,and RBP4 might be a factor which can distinguish the coronary heart disease patients whether combined with or without insulin resistance.RBP4 level is related with BMI,lipids,UA and other cardiovascular risk factors.Suggested that RBP4 might participate the process of atherosclerosis.BMI,2hPIn and HOMA-IR are the factors independently associated with RBP4.