脂联素在糖调节受损患者冠状动脉病变风险中的意义  

Significance of adiponectin in the risk of coronary lesions in patients with impaired glucose regulation

作　　者：黄珊[1] 彭文芳[1] 蒋利[2] 顾卫琼[3] 王寅[2] 王卫庆[3] 

机构地区：[1]上海市长宁区中心医院内分泌科,200336 [2]上海市长宁区中心医院心内科,200336 [3]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病临床医学中心,上海市内分泌代谢病研究所,200025

出　　处：《中华内分泌代谢杂志》2012年第12期984-988,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市卫生局科研课题（20124248）

摘　　要：目的探讨脂联素在不同糖调节受损者冠脉病变发生及严重程度中的临床意义。方法疑似冠心病行冠脉造影者210例，分为正常血糖组（NGT）42例，空腹血糖调节受损组（IFG）36例，糖耐量受损组（IGT）92例（其中IGTl组44例2h血糖〈10mmol／L；IGT2组48例2h血糖≥10mmol／L），IFG＋IGT组40例。检测体重指数、血压、血脂、胰岛素、脂联素、C反应蛋白，并进行Gensini评分。结果IGT、IFG＋IGT组冠心病患病率及Gensini评分显著高于IFG及NGT（P〈0．05）；脂联素在IGT、IFG＋IGT两组中显著低于IFG、NGT组（P〈0．05），C反应蛋白在IGT、IFG＋IGT两组显著升高（P〈0．05）；IGT2组较IGTl组Gensini显著升高、脂联素显著下降（P〈0．05）；Gensini与脂联素负相关，与C反应蛋白、HOMA—IR正相关（P〈0．05）：多因素逐步回归分析显示脂联素和HOMA．IR是冠脉病变严重程度独立影响因素。结论低脂联素血症可更敏感地预测IGR患者的冠脉病变程度，尤其在IGT组中，如餐后血糖控制在10mmol／L以下可能会带来更大的心血管获益．Objective To investigate the association of impaired glucose regulation and adiponectin （APN） with the clinical severity of coronary lesions. Methods A total of 210 cases of suspected coronary heart disease were examined by coronary artery angiography. The patients were differentiated as 4 groups ： 42 patients with normal glucose tolerance （ NGT）, 36 patients with impaired fasting glucose （ IFG）, 92 patients with impaired glucose tolerance （ IGT; including 44 cases with postpraudial 2h plasma glucose（2 hPG） 〈 10 mmol/L as IGT1 subgroup and 48 cases with 2h PG i〉 10 mmol/L as IGT2 subgroup）, and 40 patients with combination of IFG and IGT. Accordingly, body mass index （ BMI）, blood pressure, blood lipid, insulin, APN and CRP were measured to evaluate by Gensini score. Results The incidence of coronary heart disease and Gensini scores in IGT and IGT＋IFG groups were significantly higher than those in either IFG or NGT subset（ P〈0.05 ）. APN in both IGT and IGT＋IFG subsets was significantly lower than that in IFG or NGT subsets（ P〈0.05 ） , CRP values were significantly raised in both IGT and IGT＋IFG subgroups compared with tile other 2 subgroups （ P〈0.05 ）. Statistical difference in Gensini scores and APN was found between the 2 IGT subgroups （P〈 0.05 ）. Gensini scores were negatively cmTelated with APN level. Multivariate regression analysis showed that both APN and HOMA-IR values were independently correlated with the Gensini scores. Conclusion The lowered APN may serve as a more sensitive factor in predicting the coronary lesions in patients with IGR, especially in IGT eases. It woula be beneficial to cardiovascular complication by controlling the postprandial blood glucose level below 10 mmol/L.

关 键 词：糖调节受损 空腹血糖受损 糖耐量受损 脂联素 C反应蛋白 GENSINI评分 

分 类 号：R587.1[医药卫生—内分泌]