Ⅱ型糖尿病患者的血脂变化及其与冠心病的关系

The Lipid Disorders in Type Ⅱ Diabetic Patients-Risk Role for Coronary Heart Disease

为探讨II型糖尿病患者血脂变化与伴发冠心病的关系以及脂蛋白（a）在冠心病发生中的地位，比较了健康对照组、单纯II型糖尿病组、单纯冠心病组和II型糖尿病伴冠心病组患者的血脂特征。结果发现，单纯冠心病患者的甘油三酯、总胆固醇、低密度脂蛋白胆固醇和脂蛋白（a）水平较对照组明显增高．并且单纯冠心病患者的血脂水平与单纯II型糖尿病组比较无显著差异。II型糖尿病伴冠心病患者的甘油三酯、载脂蛋白B水平较单纯II型糖尿病或单纯冠心病患者增高更明显，高密度脂蛋白-3胆固醇则较单纯II型糖尿病组明显降低．即II型糖尿病伴冠心病患者在脂代谢紊乱方面存在更多致冠心病的危险因素。Logistic回归结果显示，在血脂鼻常指标中，甘油三酯、总胆固醇和脂蛋白（a）增高是引起冠心病的高危血脂谱。

Aim To analyze the lipid disorders in type II dia-betic patients accompanied with coronary heart disease (CHD)and the important roles of lipid disorder in the development of CHD.Methods The study included 171 cases of healthy control subjects,230 cases of type II diabetic pa-tients,64 cases of CHD patients,and 61 cases of type II diabetic patients accompanied with CHD.All the subjects were examined the serum levels of triglyceride (TG).total cholesterol(TC),low density lipopro-tein-cholesterol(LDLC),high density lipoprotein-cholesterol(HDLC),HDL2C,HDL3C,apolipoprotein A,apolipoprotein B,and lipoprotein(a).Results The serum levels of TG,TC,LDLC,and Apolipoprotein B were significantly higher in type II diabetic patients than in the control subjects.The lipoprotein(a)level seemed to be higher in type II dia-betic patients than in the control subjects.The levels of TG,TC,LDLC,and lipoprotein(a)were higher in CHD patients than in the control subjects.which were similar to the type II diabetic patients.The levels of TG,apolipoprotein B were higher in type II diabetic patients accompanied with CHD than in diabetic or CHD patients separately.The level of HDL3C was lower in type II diabetic patients accompanied with CHD than in diabetic patients.The results of logistic regression showed that the increased levels of TG,lipoprotein(a),and TC were the high risk lipid factors for CHD.Conclusion There existed more severe lipids disor-ders in type II diabetic patients accompanied with CHD.The lipids disorders in type II diabetic pa-tients were atherogenic.The high risk lipid profile for CHD was the increased levels of TG,lipoprotein (a),and TC.