不同冠状动脉病变程度冠心病患者血浆脂联素水平及其相关性研究

Study on the plasma adiponectin levels and its correlations with coronary lesion in patients with coronary heart disease

目的:了解不同冠状动脉(冠脉)病变程度的冠心病(CHD)患者血浆脂联素(APN)水平及其与胰岛素抵抗(IR)、血糖(FPG)、血脂、血压、肥胖、冠脉病变程度的关系。方法:选取冠脉造影检查者共128例作为研究对象,根据冠脉病变支数,分为单支病变组32例、双支病变组30例、多支病变组32例和冠脉造影正常的对照组34例。测量血压、身高、体重、腰围(WC)和臀围。采空腹静脉血,测定血浆APN、胰岛素(FINS)、FPG、TC、TG、HDL-C、LDL-C、载脂蛋白A1(apo-A1)和载脂蛋白B(apo-B)。计算体质指数(BMI)、腰臀比(WHR)、胰岛素敏感指数(ISI)和Gensini积分。结果:CHD各组血浆APN水平低于对照组(P<0.01)。血浆APN水平与收缩压、舒张压、WC、BMI、WHR、TC、LDL-C、FINS、Gensini积分均呈负相关(P<0.05或0.01),与ISI呈正相关(P<0.01)。均衡年龄、血压、FPG、血脂、肥胖等影响后,APN仍与Gensini积分、FINS、ISI存在相关性(P<0.01)。回归分析显示,ISI、WC和Gensini积分是影响血浆APN水平的独立因素。结论:CHD患者血浆APN水平降低并与冠脉病变程度密切相关,与IR、血脂、血压和肥胖存在一定的相关性。

Objective： To explore the plasma adiponectin（APN） levels in patients with coronary heart disease （CHD） of coronary lesion with various degree and the relations between plasma APN levels and insulin resistance （IR） ,blood glucose, blood lipids, blood pressure, obesity and the damaged degree of coronary arterial stenosis. Method： Totally 128 patients who underwent coronary angiography were included and divided into four groups according to the number of coronary artery damage：single vessel damage group（n = 32）, double vessels damage group （n=30）,many vessels damage group（n=32） and normal control group （n=34）. Measurment of blood pressure, height,weight,waist circumference（WC）and hip. Fasting venous blood was drawn to detect the plasma levels of APN, fasting insulin（FINS）, fasting plasma glucose（ FPG）, total cholesterol（TC）, triglyceride （TG）, high-density lipoprotein cholesterol （ HDL-C）, low-density lipoprotein cholesterol （LDL-C）, apoprotein-A1（apo-A1）, apopro- rein - B （ apo - B ） , and calculating body mass index （ BMI ） , waist - hip ratio （ WHR ） , insulin sensitivity index（ISI） and Gensini＇s score of coronary stenosis. Result：The concentration of APN in CHD groups were significantly lower than those in the control group （P〈0.01）. The plasma APN levels were negatively and significantly correlated with SBP, DBP, WC, BMI, W HR, TC, LDL-C, FINS, Gensini＇s score （ P〈0.05 or 0.01 ）, and positively correlated with ISI（P〈0.01 ）. Balanced the influential factors such as age, blood pressure, blood＇glucose, blood lipids and obesity, APN still had significantly correlated with Gensini＇s score,FINS and ISI （P〈0.01）. Multiple regression analysis showed that ISI,WC and Gensini＇s score are independent factors to influent the plasma APN levels. Conclusion：The plasma APN levels were significantly lower in patients with CHD. The levels of plasma APN had close relationship with the severity of coronary artery stenosis, and there were correlations between plasma APN and IR,blood lipids,blood pressure and obesity.