2型糖尿病患者脂蛋白亚组分与冠心病的相关性分析

The association of lipoproteins subfractions with coronary heart disease in type 2 diabetic patients

目的探讨2型糖尿病(T2DM)患者脂蛋白亚组分与冠心病(CHD)的关系。方法采用超速离心及高效液相色谱法测定84例(T2DM)患者的血清脂蛋白亚型。结果(1)CHD组年龄、高血压患病率升高(P<0.05)。(2)CHD与HDL和HDL2呈负相关;TG与LDLb呈正相关,与HDL、HDL2、HDL3和LDLa呈负相关(P均<0.05)。回归分析显示,年龄和HDL2是T2DM合并CHD的独立危险因素。结论HDL的抗动脉粥样硬化作用可能由HDL2完成,HDL2是比总HDL更好的糖尿病合并CHD的预测因子。

Objective To investigate the association of lipoproteins subfractions with coronary heart disease（CHD） in type 2 diabetes mellitus（T2DM）. Methods The subfractions of lipoproteins were determined by ultracentrifugation and high - performance liquid chromatography in 84 T2DM patients, including 29 with CHD. The relationship between the subfractions and CHD was investigated. Results The frequencies of older age and hypertension were more common in patients with CHD than without CHD （P 〈 0. 01 and P 〈 0.05 respectively）. The levels of LDL and its subfractions trend to be higher and the level of HDL and its subfractions trend to be lower in group of T2DM with CHD, but the differences were not significant （P 〉 0.05 ）. After adjusting the age, sex and hypertension, CHD is negatively correlated with HDL and HDL2, （ r = -0.3499 and r = -0. 3586,respectively,all P 〈 0. 005 ）. TG is positively correlated with LDLb （r = 0. 3368, P =0. 002） ,negatively correlated with HDL, HDL2, HDL3 and LDLa （ r = - 0. 3681, P = 0.001 ; r = - 0. 3575, P = 0. 001 ; r = - 0. 2978, P = 0. 008 ; r= - 0. 2496, P = 0. 030 respectively）. With logistic stepwise regression analysis, older age and low serum level of HDL2 were identified as significant and independent risk factors for CHD in T2DM（t =5.700, P =0.000 and t = -3. 169, P =0.002 respectively）. Conclusion The protective role of total HDL against CHD might be mediated through HDL2 fraction. Therefore, HDL2 probably is a better predictor of CHD orotective factor than total HDL in type 2 diabetes mellitus.