2型糖尿病急性时相血清淀粉样蛋白A、高密度脂蛋白胆固醇和动脉粥样硬化的关系

Relationship of acute-phase serum amyloid A and high-density lipoprotein cholesterol with atherosclerosis in type 2 diabetes

目的探讨2型糖尿病患者急性时相血清淀粉样蛋白A(SAA)、高密度脂蛋白胆固醇(HDL-C)与动脉粥样硬化的关系。方法49例2型糖尿病患者根据颈动脉内中膜厚度(IMT)及斑块分为动脉粥样硬化组(37例)和无动脉粥样硬化组(12例)。动脉粥样硬化组中又分为治疗组(22例,辛伐他汀治疗12周)和未治疗组(15例)。于随访12周后空腹抽血测糖化血红蛋白(HbA1c)、血脂和炎症细胞因子。结果(1)Spearman相关分析显示体重指数(BMI)和腰围与SAA和白细胞介素(IL)6显著正相关(P<0.01)。SAA与肿瘤坏死因子α(TNF-α)、IL-6比较显著正相关(P<0.05、(P<0.01),与超敏C反应蛋白(hsCRP)和脂联素无显著相关性。SAA与TG显著正相关,而与HDL-C和载脂蛋白A-I(ApoA-I)显著负相关(P<0.01)。hsCRP、TNF-α和脂联素与血脂各成分之间没有相关性。(2)治疗前动脉粥样硬化组hsCRP、TNF-α、SAA和IL-6与无动脉粥样硬化组比较,显著升高(P<0.01),而脂联素水平显著降低(P<0.01);与无动脉粥样硬化组比较,TG显著高,而HDL-C显著降低(P<0.05)。(3)与治疗前比较,治疗组治疗12周后hsCRP、TNF-α、SAA明显下降(P<0.01),脂联素明显升高(P<0.05),TC、TG和低密度脂蛋白胆固醇(LDL-C)显著下降(P<0.01),HDL-C上升(P<0.01)。结论2型糖尿病合并动脉粥样硬化患者SAA明显升高。SAA与肥胖和HDL-C显著相关。

Objective To study the relationship of acute-phase serum amyloid A （SAA） and high-density lipoprotein cholesterol （HDL-C） with atherosclerosis in type 2 diabetes. Methods Fourty-nine type 2 diabetic patients were divided into group A （with atherosclerosis, 37 cases） and group B （without atherosclerosis, 12 cases）. Of 37eases in group A, 22 patients were randomly selected to be given a dose of 40 nag simvastatin treatment for 12-week as group AS, and the remaining 15 patients not to be given simvastatin served as the controls（group AC）. Venous blood was drawn after a 12-h overnight fast at the beginning and the end of 12-week follow-up. Glycosylated hemoglobin lc （HbA1c）, blood lipids [ total cholesterol （TC）, triglyceride （TG）, HDL-C, LDL-C, Apolipoprotein（ApoA-I and APOB）] and inflammatory marker[high sensitive C-reactive protein （hsCRP）, tumor necrosis factor-α （TNF-α）, SAA, interleukin-6 （IL-6） and adiponectin] were determined before and after 12-week follow-up. Results Spearman correlation analysis showed that BMI and waist were positively correlated with SAA and IL-6 （P〈 0.01 ）. A similar significant correlation was observed between SAA and TNF-α （P〈0.05）, ID-6 （P〈0. 01） and TG （P〈0.01）, but SAA was negatively associated with HDL-C （P〈0. 01 ）and ApoA-I （P〈0. 01 ）. Significant associations were not observed among hsCRP, TNF-α and lipids. Serum levels of SAA, hs CRP, TNF-α,and IL-6 in group A were significantly higher and adiponectin level was significantly lower than those in group B （P〈0. 01） before 12-week follow-up. Compared to group B, group A had lower HDL-C, but higher TG （P〈0.05）. In group AS, SAA, hsCRP, TNFa values were significantly lower after 12-week treatment than those before （P〈0. 01）, but adiponectin level was increased （P〈0. 05）, TC,TG and LDL cholesterol level were decreased （P〈0.01）, HDL cholesterol level was increased （P〈0. 01）. Conclusion Acute-phase serum amyloid A is increased in type 2 diabetic patients with atherosclerosis. SAA is positively correlated with obesity, but negatively with HDL-C and ApoA-I in type 2 diabetes with atherosclerosis.