2型糖尿病HDL2b的变化特点及对预测冠心病风险的意义

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清高密度脂蛋白(high-density lipoprotein,HDL)亚组分HDL2b的变化特点及对预测冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)风险的意义。方法采用病例对照研究的方法观察41例T2DM患者及41例空腹血糖正常(normal fasting glucose,NFG)对照者,病例均来自于北京市顺义区南法信镇35～74岁自然人群,2组研究对象的年龄、性别、体质量指数(body mass index,BMI)、腰围、臀围、血压均匹配,采用微流芯片(microfluidic chip)技术测定空腹血清HDL、HDL2b、HDL2b/HDL比率,并对10年CHD发生风险(10-year CHD risk)进行评估。结果 T2DM组患者空腹血糖(fasting plasma glucose,FPG)、稳态模型胰岛素敏感指数(homeostasis model for insulin resistance,HOMA-IS)、胰岛素抵抗指数(homeostasis model assessment-insulin resistant index,HOMA-IR)、三酰甘油(triglycerides,TG)、血清总胆固醇(total cholesterol,TC)、10年CHD发生风险均显著高于对照组(P<0.05),HDL、HDL2b、HDL2b/HDL比率显著低于对照组(P<0.01),HDL2b与FBG、空腹胰岛素(fasting insulin,FINS)、TG、TC、HOMA-IR、10年CHD发生风险呈负相关,HDL2b与FBG及10年CHD发生风险相关性优于HDL。结论 T2DM患者HDL2b显著降低,10年CHD发生风险显著上升,与HDL相比,HDL2b预测CHD发生风险更加敏感。

Characteristics of HDL2b changes and their significance in prediction of risks for coronary artery disease in type 2 diabetic patients

Objective To investigate the characteristics of plasma high-density lipoprotein(HDL) subfraction HDL2b changes and their significance in prediction of risks for coronary heart disease(CHD) in patients with type 2 diabetes mellitus(T2DM). Methods Totally 41 T2DM patients and 41 controls with normal fasting glucose matched in age, gender, body mass index(BMI), circumference of waist, circumference of hip, and blood pressure were enrolled. The controls were from a normal population aged 35~74 year-old from Nanfaxin, a town in Shunyi District, Beijing. A microfluidic chip method was adopted to measure total HDL, HDL2b and the ratio of HDL2b/HDL, and the 10-year CHD risk was evaluated. Results T2DM patients had higher fasting plasma glucose(FPG), Homeostasis model for insulin resistance(HOMA-IS), homeostasis model assessment-insulin resistant index(HOMA-IR), triglycerides(TG), total cholesterol(TC) and 10 year CHD risk than the controls(P<0.05), while HDL, HDL2b and the ratio of HDL2b/HDL were lower in the T2DM patients(P<0.01). HDL2b was found to be negatively correlated with FBG, fasting insulin(FINS), TC, TG, HOMA-IR and 10 year CHD risk. The relationship of FBG and 10-year CHD risk with HDL2b was stronger than with HDL. Conclusion T2DM patients have significantly lower HDL2b levels, higher 10-year CHD risk. HDL2b is therefore a more sensitive predictor than HDL.