血清视黄醇结合蛋白4与2型糖尿病大血管病变的关系

The correlation study of serum retinol binding protein and large vascular disease in type 2 diabetes mellitus

目的:探讨血清视黄醇结合蛋白4(retinol binding protein 4,RBP4)水平与2型糖尿病(T2DM)大血管病变的关系。方法:选取T2DM患者189例,按照有无大血管病变分为大血管病变组85例、单纯糖尿病组104例。100例非糖尿病者为正常对照组。分别检测血清RBP4浓度、体质指数(BMI)、血压、血脂和糖化血红蛋白(HbA1c)等。根据RBP4浓度由低到高按三分位法将189例T2DM患者分为3组,比较其动脉粥样硬化的发生情况;用Spearman相关分析分别分析糖尿病动脉粥样硬化与其他指标的相关性;用Pearson相关分析RBP4与其他指标的相关性,用多元逐步Logistic回归分析影响T2DM患者动脉粥样硬化最显著的因素。结果:T2DM患者(AS组和非AS组)的血浆RBP4水平高于正常对照组(P<0.05);RBP4上三分位组收缩压(SBP)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)均高于其余2组,差异有统计学意义(P均<0.05);RBP4下、中、上三分位组患者大动脉粥样硬化的患病率也逐渐升高,分别为14.5%、21.4%和48.2%,RBP4上三分位组患者大动脉粥样硬化的患病率显著高于其余2组患者,差异有统计学意义(P均<0.05);Spearman相关分析显示,T2DM患者的大血管动脉硬化与年龄、病程、RBP4、HbA1c、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)呈正相关;Pearson相关分析显示T2DM患者RBP4浓度与BMI、SBP、血糖、FINS、HOMA-IR呈正相关。多元逐步Logistic回归分析显示T2DM患者动脉粥样硬化的发生与血浆RBP4、年龄、病程、LDL-C相关。结论:2型糖尿病患者动脉粥样硬化与血浆RBP4呈正相关关系,高血浆RBP4可能是T2DM动脉粥样硬化发生的独立危险因子之一。

Objective： To evaluate the association of retinol binding protein（RBP4） with large vascular disease in type 2 diabetes mellitus（T2DM）.Methods： There were 198 T2DM patients and 100 controls in study.The patients were divided into two groups based on with or without large vascular disease,and their clinical features,metabolic indices were compared.The T2DM patients were also divided into three groups based on the concentrations of RBP4 and the occurrence of atherosclerosis（AS） were compared.The relevance of RBP4 and other parameters were analyzed by Pearson correlation analysis.The factors that can influence AS in T2DM patients were analyzed by Logistic regression analysis.Results： Serum RBP4 level was higher in T2DM than that in the controls（P 0.05）.From RBP4 low and mediam tertile group to RBP4 high tertile group,the prevalence of AS were increased from 14.5%,21.4% to 48.2%,respectively.The AS prevalence of RBP4 high tertile group was significantly higher than the other two groups.It was showed by Pearson correlation analysis that the concentrationg of RBP4 in T2DM patients was positively correlated with body mass index（BMI）,systolic blood pressure（SBP）,fasting blood sugar（FBS）,postprandial blood sugar（PBS）,fasting serum insulin（FINS） and HOMA-IR.It was showed by mutiple stepwise Logistic regression analysis that AS in T2DM patients was related to plasma RBP4,age,course of disease and LDL-C.Conclusion： AS in T2DM patients is positively correlated with plasma RBP4 levels.High plasma RBP4 may be one of independent risk factors of AS in newly diagnosed T2DM patients.