载脂蛋白M与2型糖尿病下肢血管病变的相关性研究  

Correlation of apolipoprotein M with type 2 diabetes mellitus-induced lower limb angiopathy: a report based on 137 cases

作　　者：余文珮 王小静[1] 李英莎[1] 何洪波[1] 赵志钢[1] 祝之明[1] 闫振成[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所高血压内分泌科,全军高血压代谢病中心,重庆市高血压研究所,重庆400042

出　　处：《第三军医大学学报》2017年第5期460-465,共6页Journal of Third Military Medical University

基　　金：国家重点基础研究发展计划(973计划,2013CB531104)~~

摘　　要：目的研究2型糖尿病患者下肢血管病变与血浆载脂蛋白M(apolipoprotein M,Apo M)的相关性。方法收集2014年9月-2016年6月在第三军医大学大坪医院野战外科研究所高血压内分泌科住院治疗的2型糖尿病合并下肢血管病变患者75例、单纯2型糖尿病未合并下肢血管病变患者62例以及正常对照组的志愿者57例,采集一般情况并完善脂代谢、生化、肾功、血管功能、颈动脉内膜中膜厚度、下肢动脉CT成像或血管造影等辅助检查,采集血浆后利用酶联免疫吸附法检测血浆中Apo M的表达水平,利用Spearman相关分析明确Apo M表达水平同脂代谢、血管病变参数以及其他指标的相关性。结果 3组受试者的一般情况以及脂代谢指标差异无统计学意义,2型糖尿病合并下肢血管病变患者具有更低的踝臂指数和趾臂指数及更高的颈动脉内膜中膜厚度;2型糖尿病合并下肢血管病变的患者血浆Apo M的值为9.4(6.91,11.74)mg/L,显著低于正常对照组[18.45(15.10,23.93)mg/L,P<0.001]和单纯2型糖尿病组[15.76(11.79,18.63)mg/L,P<0.001];进一步通过相关分析表明,除同脂代谢指标相关外,Apo M同血管病变参数[ABI(r2=0.229)、TBI(r2=0.252)、IMT(r2=-0.247,r2=-0.259)]、超敏C反应蛋白(r2=-0.229)和吸烟量(r2=-0.173)呈显著相关。结论 Apo M可能通过调控脂代谢进而抑制2型糖尿病的动脉粥样硬化进展。Objective To investigate the correlation of plasma apolipoprotein M （ApoM） with type 2 diabetes mellitus （T2DM）-induced lower limb angiopathy （LLA）. Methods A total of 75 T2DM patients accompanied with LLA and 62 T2DM patients without LLA, who were hospitalized in our department from September 2014 to June 2016, were recruited in this study. And another 57 healthy volunteers were subjected as normal controls. Their demographical data and the results of lipid metabolism, blood biochemical test, vascular function, intima-media thickness （IMT） , lower limb CT scanning or interventional angiography were collected. Blood samples of these subjects were harvested to detect the plasma level of ApoM by ELISA. Spearman analysis was used to investigate the correlation of ApoM expression level with lipids parameters, vascular lesion and other factors. Results There were no significant differences in demographical data and lipid metabolism among the 3 groups of subjects. The patients suffering from T2DM combined with LLA had lower ankle brachial index （ABI） and toe-brachial index （TBI） but higher IMT. The plasma ApoM level in those patients was averagely 9.4 mg/L （ ranging from 6.91 to 11.74）, which was significantly lower than that of normal controls （ 18.45 mg/L, from 15. 10 to 23.93, P 〈 0. 001 ） and that of simole T2DM patients （ 15.76 mg/L, from 11.79 to 18.63, P 〈 0. 001 ）. Further correlation analysis indicated that, besides correlated with lipid parameters, the plasma ApoM level was also correlated with vascular lesion [ ABI （r^2 = 0. 229）, TBI （ r^2 = 0. 252 ）, IMT （ r^2 = - 0. 247, r^2 = - 0. 259 ） ], hypersensitive C-reactive protein （ hs- CRP, r^2 =- 0. 229 ） and amount of smoking （ r^2 = - 0. 175 ）. Gonclusion ApoM may prevent the progression of atherosclerosis in T2DM through regulation of lipid metabolism.

关 键 词：2型糖尿病 下肢血管病变 载脂蛋白M 颈动脉内膜中膜厚度 踝臂指数 趾臂指数 

分 类 号：R446.112[医药卫生—诊断学] R543[医药卫生—临床医学]