摘要
目的探讨补体C1q/肿瘤坏死因子相关蛋白3(CTRP3)对糖代谢异常的冠状动脉性心脏病患者病变程度的影响。方法选择258例行冠状动脉造影检查的患者,将其分为正常糖耐量(NGT)组(92例)、糖耐量异常(IGT)组(76例)、2型糖尿病(T2DM)组(90例)。检测并比较患者的空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、餐后2h血糖(PBG)、餐后2h胰岛素(PINS)、总胆固醇(TC)、三酰甘油(TG)、CTRP3和血清脂联素(APN)水平。根据冠状动脉造影检查结果,采用Gensini评分系统对每支血管病变程度进行定量评分。分析各组患者的CTRP3、APN水平与Gensini积分和狭窄冠状动脉支数的相关性,血清CTRP3与APN的相关性,以及糖代谢异常患者(IGT组和T2DM组)患者的CTRP3、APN水平与Gensini积分的相关性。结果 T2DM组的FBG、PBG、HbA1c、FINS、PINS、TG水平和Gensini积分均显著高于IGT组和NGT组(P值均<0.05),IGT组的以上指标均显著高于NGT组(P值均<0.05)。T2DM组的CTRP3和APN水平均显著低于IGT组和NGT组(P值均<0.05),IGT组的CTRP3和APN水平均显著低于NGT组(P值均<0.05)。3组间TC水平的差异均无统计学意义(P值均>0.05)。Pearson相关性分析显示,T2DM组和IGT组的CTRP3水平(r值分别为-0.877、-0.632)、APN水平(r值分别为-0.793、-0.607)与Gensini积分均呈负相关(P值分别<0.01、0.05)。T2DM组和IGT组的CTRP3水平(r值分别为-0.495、-0.416)、APN水平(r值分别为-0.422、-0.397)与狭窄冠状动脉支数均呈负相关(P值均<0.05)。NGT组的CTRP3、APN水平与Gensini积分和狭窄冠状动脉支数间均无明显相关性(P值均>0.05)。在校正年龄、FBG、PBG、FINS、PINS、HbA1c、TG和TC因素后,T2DM组和IGT组的CTRP3水平(r值分别为-0.805、-0.731)、APN水平(r值分别为-0.860、-0.698)与Gensini积分仍呈负相关(P值分别<0.05、0.01),T2DM组和IGT组的CTRP3的水平(r值分别为-0.294、-0.219)、APN水平(r值分别为-0.261、-0.228)与狭窄冠状动脉支数仍呈负相关(P值均<0.05),T2DM组、IGT组和NGT组的CTRP3与APN均呈正相关(r值分别为0.521、0.470和0.397,P值均<0.05)。在糖代谢异常患者中,以Gensini积分为因变量,CTRP3、APN、年龄、高血压病史、吸烟史、FBG、PBG、FINS、PINS、HbA1c、TC和TG为自变量,进行多元线性回归分析,结果显示,CTRP3和APN均为Gensini积分的独立影响因素(偏回归系数分别为-43.972、-31.352,P值均<0.05)。结论糖代谢异常患者血浆CTRP3、APN水平降低与冠状动脉病变程度呈负相关。
Objective To investigate the impact of 3 （OTRP3） on coronary heart disease in abnormal glucose undergoing coronary angiography were enrolled in this study complement C1 metabolism pat There were 92 qtumor necrosis factor-related protein ents. Methods Totally 258 patients patients with normal glucose tolerance （NGT）, 76 with impaired glucose tolerance （IGT） and 90 with type 2 diabetes mellitus （T2DM）. Serum concentrations of fasting blood glucose （FBG）, fasting insulin （FINS）, glycosylated hemoglobin （HbAlc）, 2 hours postprandial blood glucose （PBG）, 2 hours postprandial insulin （PINS）, total cholesterol （TO）, triglyceride （TG）, CTRP3 and adiponectin （APN） were detected. The severity of coronary atherosclerosis was defined by the Gensini score system according to the results of coronary angiography. The correlation between the serum concentrations of CTRP3 and APN and Gensini score and the severity of coronary artery stenosis and the correlation between serum CTRP3 and APN were analyzed in each group. The relationship between serum CTRP3 and APN and Gensini score in abnormal glucose metabolism patients were also evaluated. Results The serum levels of FBG, PBG, HbA1 c, FINS, PINS and TG and Gensini score in T2DM group were significantly higher than those in IGT group and NGT group （all P〈0.05）, and the above mentioned indexes in IGT group were also significantly higher than those in NGT group （all P〈0.05）. CTRP3 and APN in T2DM group were significantly lower than those in IGT group and NGT group （all P〈0.05） ; moreover CTRP3 and APN in IGT group were significantly lower than those in NGT group （both P〈0.05）. No significant difference was found in the TO levels in the 3 groups （P〉0.05）. Pearson correlation analysis showed that, in T2DM group and IGT group, the levels of CTRP3 （r = -0. 877 and -0. 632） and APN （r = - 0. 793 and - 0. 607） had obviously negative correlation with Gensini score （ P〈0.01, 0.05） ; the levels of CTRP3 （r = - 0. 495 and - 0.416） and APN （r = - 0. 422 and - 0. 397） were negatively correlated of the severity of coronary artery stenosis （all P〈0.05）. But the levels of CTRP3 and APN were not correlated of the Gensini score or the severity of coronary artery stenosis in NGT group （all P〉0.05）. After adjusting interference factors （age, FBG, PBG, FINS, PINS, HbAlC, TG and TO）, in T2DM group and IGT group, the levels of CTRP3 （r = - 0. 805 and - 0.731） and APN （r = - 0. 860 and - 0. 698） still had negative correlation with Gensini score （P〈0.05, 0.01）, and CTRP3 （r=-0.294 and -0.219） and APN （r= -0.261 and -0.228） also had negative correlation with the severity of coronary artery stenosis （all P〈0.05）. CTRP3 was positively correlated with APN in T2DM, IGT and NGT groups （r=0.521, 0. 470 and 0. 397, respectively, all P〈0.05）. In patients with abnormal glucose metabolism （including IGT end T2DM groups）, with Gensini score as the dependent variable, CTRP3, APN, age, history of high blood pressure, smoking history, FBG, PBG, FINS, PINS, HbA1c, TO and TG as independent variables,.multivariate linear regression analysis showed that CTRP3 and APN were independent influencing factors of Gensini scores （partial regression coefficient was - 43. 972 and - 31. 352, respectively, both P〈 0. 05）. Conclusion CTRP3 and APN were inversely associated with the severity of coronary artery stenosis in abnormal glucose metabolism patients. （Shanghai Med J, 2017, 40, 234-237）
出处
《上海医学》
北大核心
2017年第4期234-237,共4页
Shanghai Medical Journal
基金
上海交通大学医工(理)交叉研究基金资助项目(YG2014MS55)
