冠心病伴糖代谢异常患者血浆脂联素和Apelin的水平及临床意义  

Clinical significance of plasma Adiponectin and Apelin in coronary heart disease patients accompanied with abnormal glucose metabolism

作　　者：郭兰燕[1] 夏珂[1] 程晋芳[1] 李非[1] Md Sayed AliSheikh 李振宇[1] 方晗[1] 杨天伦[1] 

机构地区：[1]中南大学湘雅医院心内科,长沙410008

出　　处：《临床心血管病杂志》2011年第10期732-735,共4页Journal of Clinical Cardiology

摘　　要：目的:研究冠心病(CHD)伴糖代谢异常患者血浆脂肪细胞因子脂联素和Apelin的水平及临床意义。方法:选择我院心内科87例住院的CHD患者,根据是否伴糖代谢异常分为3组,即单纯CHD组、CHD伴糖耐量异常(IGT)组(CHD+IGT组)和CHD伴糖尿病(DM)组(CHD+DM组),选择健康体检者31例为正常对照者(NC组)。对所有受试者测量身高、体重、腰围、血压;测血糖、胰岛素、血脂、高敏C反应蛋白(hsCRP)、游离脂肪酸(NFFA)和肝肾功能等,酶联免疫法测脂联素和Apelin;计算体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)并进行比较。结果:①CHD+IGT组、CHD+DM组和CHD组的血浆脂联素和Apelin的血浓度均低于NC组(均P<0.05)。②在CHD+DM组,脂联素较CHD+IGT和CHD组低,且各组间差异有统计学意义(均P<0.05);而Apelin的水平介于CHD组和NC组之间(P<0.05),但与CHD+IGT组无显著差异。③相关分析显示,脂联素与HDL-C显著正相关(P<0.01),与hsCRP和餐后2h血糖(PPG)呈负相关(均P<0.05)。在CHD者,Apelin与PPG显著正相关(P<0.01),控制年龄、血压后,与BMI、PPG和HOMA正相关(r=0.804、0.996、0.998,均P<0.05)。结论:CHD+DM的患者血浆脂联素水平显著降低,一定程度上反映了病情严重程度和机体的炎症状态;而Apelin的水平介于单纯CHD和正常人之间,与伴IGT者无明显差异,提示其一定程度上可能参与了DM的发生,但可能仅在糖代谢异常的晚期发挥作用,也不能像脂联素可以较好地反映和评估CHD伴糖代谢异常患者的病情。Objective：To investigate the level and clinical significance of plasma Adiponectin and Apelin in coronary heart disease（CHD） patients accompanied with abnormal glucose metabolism.Method： 87 patients with coronary heart disease,confirmed by coronary artery angiography,were enrolled from Xiangya hospital.The according Gensini scores were figured out.Among them,28 out of 87 CHD patients were diagnosed as imparied glucose tolerence and diabetic mellitus（CHD＋IGT/CHD＋DM group）.And the other 31 patients were enrolled in CHD group.Meanwhile,31 healthy volunteers were enrolled in NC group.All subjects received detection of height,weight,waist circumstance（WC）,BMI,blood lipid,glucose,insulin,HbA1c,hs-CRP,also Apelin and Adiponectin（ELISA）.The degree of insulin resistance was assessed by the homeostasis model assessment insulin resistance index（HOMA-IR）.Result：Compared with group NC,the levels of Adiponectin and Apelin in the groups of CHD＋IGT,CHD＋DM and CHD decreased significantly（all P0.05）.The level of Adiponectin was lower in group CHD＋DM than in group CHD＋IGT and CHD（P0.05）,while Apelin were lower in group CHD than in group CHD＋DM and NC（P0.05）.Adiponectin was positively correlated with HDL-C（P0.01） and negatively correlated with hs-CRP and uric acid（P0.05）.In patients with coronary heart disease,Apelin was positively correlated with 2h post-prandial glucose（PPG）,after blood pressure and age were controlled,it was positively correlated with BMI、PPG and HOMA（all P0.05）.Conclusion：Plasma Adiponectin decreased most significantly in group of CHD patients accompanied with DM,while Apelin was lower than the normal people and higher than the CHD（had no difference with CHD＋IGT）,indicating that Apelin may be involved in the happening of DM,but not during the period of IGT.Since Apelin was usually affected by glucose metabolism,it couldn＇t exactlyevaluate and reflect the severity of disease in CHD patients accompanied with abnormal glucose metabolism

关 键 词：冠心病 糖代谢 脂联素 APELIN 

分 类 号：R541.4[医药卫生—心血管疾病]