代谢综合征并发冠心病患者氧化修饰型低密度脂蛋白与胰岛素抵抗的关系

Relationship between oxidized low density lipoprotein and insulin resistance in patients with metabolic syndrome complicated by coronary atherosclerotic heart disease

目的:探讨代谢综合征(MS)及并发冠心病(CHD)患者氧化修饰型低密度脂蛋白(ox-LDL)水平和胰岛素抵抗及MS其他指标的关系。方法:用酶联免疫吸附法(ELISA)测定单纯MS组(17例)、MS并发CHD组(40例)和正常对照组(19例)ox-LDL水平和空腹血浆胰岛素水平,并收集MS的其他有关数据:腰围、体质指数、空腹血糖和血脂,计算胰岛素敏感指数(ISI)。结果:①ox-LDL水平在正常对照组为(5.97±5.18)μg/L,MS组为(24.68±12.00)μg/L,MS并发CHD组为(41.45±35.80)μg/L,3组间差异有统计学意义(F=11.48,P<0.05);②ox-LDL水平与ISI呈负相关(r=-0.472,P<0.05),与体质指数、腰围、LDL-C、空腹真胰岛素无明显相关性;③以ox-LDL水平为应变量的多元逐步回归分析提示,ISI(r2=0.224)与ox-LDL具有相关性,体质指数、腰围、LDL-C、空腹真胰岛素与ox-LDL无明显相关性。结论:MS患者的ox-LDL水平增加,并发CHD的MS患者更为明显,并与胰岛素抵抗相关,可能在MS发展为CHD中起一定作用。

Objective： To investigate the relationship between oxidized low density lipoprotein and insulin resistance and the metabolic parameters in patients with metabolic syndrome （MS） or MS complicated by coronary atherosclerotie heart disease（MS＋ CHD）. Method： Oxidized low density lipoprotein level and fasting plasma insulin levels were measured by means of enzyme linked immunosorbent assay in 17 MS patients,40 MS＋CHD patients and 19 healthy controls. Information of the conventional clinical features of MS, such as waist, BMI, fasting blood glueose, and blood fat were collected and the insulin sensitivity index （ISI） were calculated. Resuit：（1）There was significant difference of oxidized low density lipoprotein concentrations among the controls （[5. 97±5. 18] μg/ L）, subjects with MS （[24.68±12.00] μg/L） and subjects with MS＋CHD （[41.45±35. 80] μg/L）. （2）Correlation analysis results suggested that the oxidized low density lipoprotein concentration was related to insulin sensi tivity index （r=-0. 472, P〈0.05） and there was no obvious relation between oxidized low density lipoprotein concentration and the metabolic parameters including body mass index, waist, low density lipoprotein cholesterol, fasting insulin. （3）Logistic regression analysis indicated a statistically significant relationship between oxidized low density lipoprotein concentration and ISI （r^2 =0. 224, P〈0.05）. The metabolic parameters including body mass index, waist, low density lipoprotein cholesterol, fasting insulin were not correlated to oxidized low density lipoprotein. Conclusion：The oxidized low density lipoprotein concentration was highest in patients with MS＋CHD and increased in patients with MS, which were significantly correlated with insulin resistance. It may contribute to development of coronary atherosclerotic heart disease from metabolic syndrome.