不同糖耐量冠心病患者血清内脂素水平与冠状动脉狭窄程度的关系

Relationship between serum visfatin level and coronary artery stenosis in patients with different glucose tolerance

目的 比较血清内脂素（visfatin）在不同糖耐量水平冠心病患者和正常个体中的表达情况,评价血清内脂素水平与冠状动脉狭窄程度的关系.方法 经冠状动脉造影确诊冠心病患者85例,按1999年世界卫生组织糖尿病诊断标准分为冠心病正常糖耐量组（CHD）34例、冠心病合并糖调节异常组（CIG）25例、冠心病合并2型糖尿病组（CDM）26例,选择健康志愿者30名（冠状动脉CT血管造影阴性）作为正常对照组（CON）.检测受试者人体测量学指标及糖、脂代谢指标;应用Gemini冠状动脉评分系统对冠状动脉狭窄程度进行评估;用SPSS 12.0统计软件包进行统计学分析.结果 与CON组比较,CHD、CIG及CDM组血清内脂素水平均显著增高（均P〈0.05）;与CHD组相比较,CIG和CDM组血清内脂素水平均显著增高（均P〈0.05）;内脂素水平与Gesini冠状动脉病变积分呈正相关（r=0.669,P〈0.01）;内脂素与腰围、腰臀比、甘油三酯呈正相关（r=0.200,P=0.032;r=0.185,P=0.047;r=0.321,P〈0.01）,与高密度脂蛋白胆固醇（HDL-C）呈负相关（r-0.354,P〈0.01）,多元回归分析显示,腰围、甘油三酯水平为影响内脂素水平的主要因素.结论 （1）血清内脂素水平较好地反映冠状动脉病变的严重程度,检测内脂素水平有助于冠心病的早期诊断.（2）在合并2型糖尿病及糖调节异常的冠心病患者中,血清内脂素表达显著增高,与临床糖尿病患者更重的冠状动脉病变相符合.（3）腰围、甘油三酯水平为影响血清内脂素水平的主要因素,提示内脂素水平与腹型肥胖密切相关.

Objective To investigate the relationship between serum visfatin level and coronary artery stenosis.Methods Based on coronary angiography,85 patients were diagnosed as coronary heart disease.According to oral glucose tolerance test,these patients were divided into 3 groups,34 patients with normal glucose tolerance（CHD group）,25 with impaired glucose regulation（CIG group）,and 26 with type 2 diabetes mellitus（CDM group）.30 non-comary heart disease subjects with normal glucose tolerance were selected as the control group（CON group）,and they underwent coronary CT angiography scan and were confirmed coronary disease-free.Blood pressure,body mass index（BMI）,waist circumference（WC）,waist hip ratio（WHR）,fasting plasma glucose（FPG）,blood lipid analysis,fasting insulin,and HbA1C were determined.Serum visfatin concentration was assayed and the status of coronary artery was assessed.Coronary artery stenosis was screened by coronary interventional angiography and assessed by Gemini scoring system in CHD,CIG,and CDM groups.Results Compared with control group,serum visfatin in CHD,CIG,and CDM groups were significantly higher（all P〈0.05）.Compared with CHD group,serum visfatin in CIG and CDM groups were significantly higher（all P〈0.05）.The correlation analysis showed that serum visfatin level was positively correlated with the involved branches of coronary arteries（r=0.807,P〈0.01）,serum visfatin level was positively related with Gensini coronary artery score（r=0.669,P〈0.01）.Visfatin was also positively correlated with WC,WHR,triglyceride（TG,r=0.200,P=0.032,r=0.185,P=0.047,r=0.321,P〈0.01）,while high density lipoprotein cholesterol（HDL-C）was negatively correlated with visfatin（r=-0.354,P〈0.01）.Multiple regression analysis showed that senlm hvel of TG and WC were the main influencing factors of visfatin.Conclusion （1）The level of serum visfatin may reflect the severity of coronary artery stenosis,detection of visfatin helps to make early diagnosis of CHD.（2）The raised serum level of visfatin in comary heart disease patients with imparied glucose tolerance is consistent with clinical evidence that diabetic patients have more severe coronary diseases.（3）WC and serum TG are main inilucencing factors,suggesting that visfatin is correlated with abdominal obesity.