糖尿病无症状性心肌缺血患者血清孤啡肽与脂蛋白相关磷脂酶A2水平变化的研究  

Changes of serum nociceptin/orphanin FQ and lipoprotein⁃associated phospholipase A2 levels in diabetic patients with silent myocardial ischemia

作　　者：解梦莉 苏敬[2] 李静[2] 韩毅[3] XIE Meng-li;SU Jing;LI Jing;HAN Yi(School of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Endocrinology,the Central Hospital of China Railway 12th Bureau Group;Department of Anesthesiology,the Second Hospital of Shanxi Medical University)

机构地区：[1]山西医科大学麻醉学院,030001 [2]中铁十二局集团中心医院内分泌科 [3]山西医科大学第二医院麻醉科

出　　处：《天津医药》2021年第4期390-395,共6页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(81400260);山西省青年科技研究基金(201701D12111145)。

摘　　要：目的观察糖尿病合并无症状性心肌缺血(SMI)患者血清内源性孤啡肽(N/OFQ)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平变化并探讨其意义。方法纳入行冠状动脉造影术的糖尿病患者120例。根据是否合并SMI分为单纯2型糖尿病患者60例(D组)和2型糖尿病合并SMI的患者60例(DS组)。收集2组临床资料,检测空腹血糖(FBG)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血清N/OFQ、Lp-PLA2水平,比较2组血清N/OFQ、Lp-PLA2水平的差异,分析2型糖尿病合并SMI的危险因素,分析N/OFQ、Lp-PLA2与各项指标的相关性,受试者工作特征(ROC)曲线分析N/OFQ、Lp-PLA2及两者联合预测因子对2型糖尿病合并SMI的预测价值。结果DS组糖尿病病程、FBG、TG、LDL-C、血清N/OFQ、Lp-PLA2水平高于D组,HDL-C水平低于D组(P<0.01)。Logistic回归分析结果显示血清FBG、TG、LDL-C、N/OFQ、Lp-PLA2水平升高是糖尿病患者合并SMI的危险因素(P<0.05)。DS组FBG、LDL-C、Gensini积分与血清N/OFQ、Lp-PLA2水平呈正相关;糖尿病病程、HbA1c与血清N/OFQ水平呈正相关,而与血清Lp-PLA2水平无显著相关;血清N/OFQ与Lp-PLA2水平呈正相关。ROC曲线分析结果显示,N/OFQ、Lp-PLA2、联合预测因子预测糖尿病合并SMI发生的曲线下面积分别为0.949、0.899、0.956(P<0.01)。结论糖尿病合并SMI患者血清N/OFQ、Lp-PLA2水平较高,N/OFQ、Lp-PLA2与糖尿病合并SMI的发生密切相关。Objective To observe the changes of serum endogenous nociceptin/orphanin FQ(N/OFQ)and serum lipoprotein-associated phospholipase A2(Lp-PLA2)levels in diabetic patients with silent myocardial ischemia(SMI),and to explore its significance.Methods A total of 120 diabetes patients underwent coronary angiography were included in this study.Patients were divided into simple type 2 diabetes group(D group,n=60)and type 2 diabetes with SMI group(DS group,n=60).Clinical data of both groups were collected.The levels of fasting blood glucose(FBG),triacylglycerol(TG),lowdensity lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),aspartate aminotransferase(AST),alanine aminotransferase(ALT),serum N/OFQ and Lp-PLA2 were detected.The differences of serum N/OFQ and Lp-PLA2 levels were compared between the two groups.The risk factors of type 2 diabetes with SMI and the correlation between N/OFQ,Lp-PLA2 and various indicators were analyzed.The receiver operating characteristic(ROC)curve was used to analyze the predictive values of N/OFQ and Lp-PLA2 for type 2 diabetes with SMI.Results The diabetes course,FBG,TG,LDL-C,serum N/OFQ and Lp-PLA2 levels were significantly higher in DS group than those in D group,and the HDLC level was significantly lower in DS group than that in D group(P<0.01).Multiple Logistic regression analysis showed that the increased serum levels of FBG,TG,LDL-C,N/OFQ and Lp-PLA2 were the risk factors of diabetic patients with SMI(P<0.05).The serum levels of N/OFQ and Lp-PLA2 were positively correlated with FBG,LDL-C,and Gensini score in DS group.The diabetes course,HbA1c and serum N/OFQ levels were positively correlated.There was no significant correlation between diabetes course,HbA1c and serum Lp-PLA2 levels.The serum N/OFQ and Lp-PLA2 levels were positively correlated.ROC curve analysis results showed that the areas under the curves of N/OFQ,Lp-PLA2 and combined predictors predicting the occurrence of diabetes with SMI were 0.949,0.899 and 0.956(P<0.01).Conclusion The serum levels of N/O

关 键 词：糖尿病 2型 冠心病 磷脂酶类A2 脂蛋白类 无症状性心肌缺血 孤啡肽 

分 类 号：R543.3[医药卫生—心血管疾病] R587.23[医药卫生—内科学]