新诊断2型糖尿病脂肪细胞脂肪酸结合蛋白／脂联素比值与股动脉中膜厚度及内皮舒张功能的关系

Relationship of adipocyte fatty acid-binding protein to adiponectin ratio with femoral intima-media thickness and endothelium-dependent vasodilation in patients with newly-diagnosed type 2 diabetes mellitus

目的探讨新诊断2型糖尿病（T2DM）患者血浆脂肪细胞脂肪酸结合蛋白（A－FABP）、脂联素（APN）及二者比值与股动脉内膜中层厚度（FA—IMT）及血管内皮舒张功能的关系。方法将133例新诊断的T2DM患者，测定空腹血浆A—FABP和APN，采用高分辨超声检测FA．IMT及肱动脉血流介导的内皮依赖性舒张功能和硝酸甘油介导的内皮非依赖性舒张功能。FA—IMT以上1／4位点为增厚切点，定义为早期动脉粥样硬化（AS）。将133例患者按FA—IMT四分位分为4组，分别为低IMT组（FA—IMT〈0．60MM，n=34）、中FA—IMT组（0．60mm≤FA—IMT〈0．73mm，n=33）、高FA—IMT组（0．73mm≤FA—IMT〈0．80mm，n＝33）及早期AS组（FA—IMT≥0．80mm，n=33）。结果与低FA—IMT组相比（0．59±0．02）mm，早期AS组FA—IMT为（0．81±0．03）mm明显增高（P〈0．01）。A—FABP／APN比值明显增加[（A—FABP／APN×1000，APN血浆浓度为A—FABP的1000倍，3．9（2．8～6．1）比2．9（1．8～5．7），P〈0．05]；FA—IMT与A—FABP／APN比值呈正相关（r=0．216，P=0．006），与APN仍呈负相关（r=-0．179，P=0．020），在校正年龄、性别、BMI之后，FA-IMT与A—FABP／APN比值呈正相关（r=0．217，P=0．007）、与APN仍呈负相关（r=-0．172，P=0．026）；内皮依赖性舒张功能与A—FABP／APN比值呈负相关（r=-0．166，P=0．028），在校正年龄、性别、体质指数之后，内皮依赖性舒张功能与A—FABP／APN比值仍呈负相关（r=-0．153，P=0．042）。结论新诊断T2DM患者血浆A—FABP／APN比值与FA—IMT及内皮依赖性舒张功能密切相关；可能是评价新诊断T2DM患者内皮功能紊乱和早期AS程度更好的指标。

Objective To explore the relationship between plasma adipocyte fatty acid-binding protein （A-FABP）, adiponectin （APN） levels and A-FABP/APN ratio with femoral intima-media thickness （FA-IMT） and endothelium-dependent vasodilation in patients with newly diagnosed type 2 diabetes mellitus （T2DM）. Methods Plasma A-FABP and APN in 133 patients with newly diagnosed T2DM were measured by enzyme-linked immunosorbent assays. FA-IMT, endothelium-dependent and independent vasodilation of brachial artery was measured by high-resolution vascular ultrasound. Upper quartile of FA-IMT was regarded as a criterion of elevated FA-IMT, defined as early atherosclerosis （AS）. The patients were subdivided into low FA-IMT group （FA-IMT 〈0. 60 mm, n =34）, middle FA-IMT group （0. 60 mm≤FA-IMT 〈0. 73 mm, n = 33 ）, high FA-IMT group （ 0. 73 mm ≤ FA-IMT 〈 0. 80 mm, n = 33 ） and early AS group （ FA-IMT ≥ 0. 80 ram, n = 33 ）. Results Plasma A-FABP/APN ratio was higher in early AS group than in low IMT control group [ A-FABP/APN x 1000, 3.9（2. 8 -6. 1 ） vs 2.9（ 1.8 -5.7）, P 〈0. 05]. FA-IMT correlated positively with plasma A-FABP/APN ratio （r =0. 216, P =0. 006） and negatively with APN （r = -0. 179, P = 0. 020）. After adjusted for age, gender and BMI, FA-IMT still correlated positively with plasma A- FABP/APNratio （r =0.217, P =0.007） and negatively with APN （r = -0.172, P =0.026）. Endothelium-dependent vasodilation correlated negatively with plasma A-FABP/APN ratio （r = -0. 166, P = 0. 028）. After adjusted for age, gender and BMI, endothelium-dependent vasodilation still correlated negatively with plasma A-FABP/APN ratio （r = -0. 153, P = 0.042）. Conclusion Plasma A-FABP/APN ratio is closely associated with FA-IMT and endothelium-dependent vasodilation. Plasma A-FABP/APN ratio may be a better clinical marker of AS and endothelial dysfunction than A-FABP or APN alone in patients with newly diagnosed T2DM.