冠心病合并糖尿病患者胆固醇外流能力变化及其与动脉僵硬度左室舒张功能关系研究  

Alteration of cholesterol efflux capacity in patients with coronary heart disease and diabetes mellitus and its relationship with arterial stiffness and left ventricular diastolic function

作　　者：王冲[1] 王富华[1] 于海奕[1] 肖晗[1] 王贵松[1] WANG Chong;WANG Fu-hua;YU Hai-yi;XIAO Han;WANG Gui-song.(Department of Cardiology, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Educateon, Beijing 100191, China)

机构地区：[1]北京大学第三医院心内科国家卫生计生委心血管分子生物学与调节肽重点实验室分子心血管学教育部重点实验室,北京100191

出　　处：《中国实用内科杂志》2018年第7期638-643,共6页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81170179)

摘　　要：目的探讨冠心病合并糖尿病患者血浆高密度脂蛋白(HDL)胆固醇外流能力的变化及其与动脉僵硬度、左室舒张功能的相关性。方法选取2017年5月至2017年12月于北京大学第三医院心内科住院并经冠脉造影证实的冠心病患者140例为研究对象,其中男99例、女41例,年龄(63±10)岁。依据是否合并糖尿病分为两组,即冠心病合并糖尿病患者70例、冠心病未合并糖尿病患者70例,选取同期入院且经冠脉造影证实的非冠心病患者25例作为对照组。采用放射性核素法,建立富集[3H]标记胆固醇的J774巨噬细胞体外模型,以经过处理的受试者血浆(主要含有HDL颗粒)为胆固醇接受体诱导巨噬细胞胆固醇流出,测得HDL胆固醇外流能力(CEC);采用Sphygmo Cor脉搏波分析系统测量颈股动脉脉搏波传导速度(CF-PWV)、心率75次/min标准化的桡动脉反射波增强指数(AIXHR75),超声心动图检测二尖瓣舒张早期血流峰速度/二尖瓣环舒张早期运动峰速度(E/Em),分析CEC与上述指标(CF-PWV、AIXHR75、E/Em)的相关性。结果冠心病合并糖尿病患者的CEC显著低于冠心病未合并糖尿病患者[(14.37±4.08)%与(15.77±3.37)%,P=0.007];而CF-PWV、AIXHR75和E/Em则明显高于冠心病未合并糖尿病患者[(10.38±2.47)m/s比(9.29±2.21)m/s,P=0.006;(21.06±9.93)%比(15.76±7.75),P<0.001;7.00(6.00-10.00)]比6.00(5.00-8.00),P=0.006]。相关分析发现,冠心病合并糖尿病患者CF-PWV、AIXHR75、log(E/Em)与CEC呈负相关(r=-0.421、-0.291、-0.298,均P<0.05);多因素逐步回归分析发现,CEC为CF-PWV(β=-0.169,P=0.033)、E/Em(β=-0.131,P<0.01)的独立负相关因素。结论冠心病合并糖尿病患者较冠心病未合并糖尿病患者HDL胆固醇外流能力降低、动脉僵硬度增加及左室舒张功能下降;冠心病合并糖尿病患者CEC与其动脉僵硬度、左室舒张功能密切相关,CEC降低可能是其动脉僵硬度增加及左室舒张功能下降的重要影响因素。Objective To investigate the cholesterol efflux capacity（CEC） of plasma high-density lipoprotein（HDL） in coronary heart disease（CHD） patients with diabetes and whether its play a role in arterial stiffness and left ventricular diastolic function. Methods 140 patients of coronary heart disease who were dignosed as coronary heart disease by coronary angiography having one or more artery lesion degree〉 50%. They were divided into two groups： the CHD with diabetic mellitus（DM） group（n=70） and the CHD without DM group（n=70）, patients without coronary heart disease confirmed by coronary angiography was taken an controls（n=25）. The capacity of HDL to induce cellular cholesterol efflux was determined by measuring the transfer of [3H] cholesterol from J774 macrophages to the medium containing the apoB-deleted plasma. The arterial stiffness parameter include Carotid-femoral pulse wave velocity （CF-PWV） and radial artery augmentation index（rAI） was obtained non-invasively by pulse wave analysis and applanation tonometry , rAI was adjusted for a heart rate of 75 beats per minute（AIXHR75）, which was used for analyses. The ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity（E/Em） was measured simultaneously. The correlation between cholesterol efflux capacity（CEC） and CF-PWV, AIXHR75, E/Era was analyzed. Results The cholesterol efflux capacity in CHD patients with diabetes was significantly lower than that in CHD patients with non-diabetes [ （14.37±4.08）% vs. （15.77±3.37）%, P=0.007]. Compared with non-diabetes subjects, CHD patients with diabetes had significantly higher CF-PWV, AIXHR75 and E/Em[（10.38±2.47）m/s vs. （9.29±2.21）m/s, P=0.006; （21.06±9.93） % vs. （15.76±7.75 ）, P〈0.001; 7.00（6.00-10.00） ]vs. 6.00（5.00-8.00）, P=0.006]. Pearson correlation and multiple stepwise regression results revealed that the CEC independently and inversely with CF-PWV（β=-0.169,P=0.033） and E/Em（β=-0.131, P〈

关 键 词：冠状动脉疾病 糖尿病 胆固醇外流能力 动脉僵硬度 左室舒张功能 

分 类 号：R541.4[医药卫生—心血管疾病]