2型糖尿病患者血清脂联素/瘦素比值与冠状动脉病变的关系

目的 探讨2型糖尿病患者血清脂联素、瘦素及二者比值与冠状动脉病变的关系.方法 对行冠状动脉造影的180例2型糖尿病患者的大血管病变危险因素进行采集,分为冠心病组和对照组,冠心病组又分为单支病变组、双支病变组和多支病变组,测量脂联素和瘦素的变化,分析脂联素/瘦素比值与冠状动脉病变的关系.结果 与对照组比较,冠心病组总胆固醇、纤维蛋白原定量和空腹血C反应蛋白升高,高密度脂蛋白胆固醇、脂联素和脂联素/瘦素比值(2.78比1.16)降低.相关分析表明,冠心病组中冠状动脉狭窄程度与年龄、纤维蛋白原定量和C反应蛋白呈正相关,与脂联素和脂联素/瘦素比值(r=-0.314)呈负相关.在校正体质指数后,冠状动脉狭窄程度与脂联素/瘦素比值仍呈负相关(r=-0.541).多因素Logistic回归分析显示,脂联素/瘦素比值降低是冠状动脉病变的危险因素.脂联素/瘦素比值随冠状动脉病变支数增加而变小(2.10比1.37比 0.72 ),组间差异有统计学意义.分层结果显示,当冠状动脉病变支数逐渐升高时,脂联素/瘦素比值与冠状动脉危险因素仍然相关,而稳态胰岛素评估模型胰岛素抵抗与冠状动脉危险因素不再相关.结论 2型糖尿病患者中,脂联素/瘦素比值降低与动脉粥样硬化的形成有关.脂联素/瘦素比值可望作为评估动脉粥样硬化程度的血清学标志.脂联素/瘦素比值相对于稳态胰岛素评估模型胰岛素抵抗是一个较好评估胰岛素抵抗致冠状动脉病变的指标.

Relationship of Adiponectin-to-Leptin Ratio with Coronary Lesion in Patients with Type 2 Diabetes

Aim To explore the relationship of serum leptin,adiponectin concentrations and adiponectin-to-leptin ratio(A/L) to coronary lesion in patients with type 2 diabetes mellitius. Methods Serum levels of adiponectin and leptin in 180 patients with type 2 diabetes mellitius were measured by specific monoclonal antibody-based amplified ELISA.Coronary lesion was measured by using coronary angiography.The patients with type 2 diabetes mellitius were divided into coronary heart disease group(coronary artery stenosis in a major blood vessel was more than 50%,n=94) and control group(coronary artery stenosis in a major blood vessel was less than 25%,n=86).Coronary heart disease group was subdivided into single-vessel disease group(n=31),double-vessel disease group(n=31) and multi-vessel disease group(n=32).Then,the correlation between risk factors for coronary heart disease and A/L or homeostasis assessment for insulin resistance(HOMA-IR) was analyzed. Results Age,gender composition ratio,blood pressure,blood sugar and body mass index(BMI) were matched in two groups.Serum levels of total cholesterol,C-reactive protein(CRP) and fibrinogen in coronary heart disease group were significantly higher than those of the control group.Serum levels of high-density lipoprotein cholesterol(HDLC),adiponectin and A/L in coronary heart disease group were significantly lower than those of the control group.Correlation analysis showed that age,fibrinogen and CRP were positively associated with coronary lesion and that adiponectin and A/L were negatively associated with coronary lesion.After calibration of BMI,there was also a negative correlation between severity of coronary artery stenosis and A/L(r=-0.541).This relationship remained in multivariate Logistic regression analysis.A/L became smaller with the increase in the number of coronary lesions branches(2.10 vs 1.37 vs 0.72),with a significant difference in the three groups.The hierarchical results showed that A/L ratio was significantly correlated with BMI,blood pressure,blood sugar,triglycerides,HDLC,CRP and fibrinogen in coronary heart disease group,and significant correlation of these parameters except HOMA-IR with A/L ratio still existed as degree of coronary lesion was gradually increased. Conclusion A/L is in relation to the formation of atherosclerosis and may serve as atherosclerosis index.A/L is also effective as a parameter of insulin resistance to coronary artery disease as compared with adiponectin,leptin,or HOMA-IR alone in patients with type 2 diabetes.