致动脉硬化指数及血清同型半胱氨酸检测在糖尿病患者冠心病发病风险预测中的应用

Application of atherogenic index of plasma and serum homocysteine in type 2 diabetic′s risk prediction of concurrent coronary heart disease

目的探讨致动脉硬化指数(AIP)及血清同型半胱氨酸(Hcy)水平预测2型糖尿病(T2DM)患者发生冠心病的临床价值。方法选取102例T2DM患者、72例糖耐量减低(IGT)患者,与糖耐量正常(NGT)对照组75例,分别对其糖化血红蛋白(HbA1c)、同型半胱氨酸(Hcy)、脂蛋白(a)[Lp(a)]、超敏C反应蛋白(hs-CRP)以及常规血脂项目进行检测,计算AIP指数。T2DM患者再根据HbA1c的含量又分成血糖控制良好组(HbA1c≤7.0%,n=62)和血糖控制不佳组(HbA1c>7.0%,n=40),并与NGT组进行比较。结果 T2DM组和IGT组血清Hcy、AIP指数显著高于NGT组,差异具有统计学意义(P<0.01或P<0.05);T2DM组与IGT组比较,血清Hcy、Lp(a)、hs-CRP、AIP指数差异均具有统计学意义(P<0.01或P<0.05);血糖控制不佳组(HbA1c>7.0%),其血清Lp(a)、AIP指数明显高于血糖控制良好组(HbA1c≤7.0%),差异有统计学意义(P<0.01),Hcy和hs-CRP也较血糖控制良好组(HbA1c≤7.0%)升高(P<0.05),并且Hcy、Lp(a)、hs-CRP和AIP指数水平均具有随HbA1c升高而升高的趋势。结论同时监测AIP指数及血清Hcy、Lp(a)、hs-CRP水平有助于判断糖尿病的发生、发展,相比而言,AIP指数和Hcy水平优于其他动脉粥样硬化指标,可作为IGT及T2DM发生动脉粥样硬化危险性的早期预测指标。

Objective To investigate the predicting value of atherogenic index of plasma （ AIP ） and homocysteine （ Hcy ） for concurrent coronary heart disease in type 2diabetic mellitus （ T2DM ） patients.Methods 102cases of T2DM patients , 72cases of impaired glucose tolerance （ IGT ） patients and 75cases of normal glucose tolerance （ NGT ） were selected.Glycosylated hemoglobin （ HbA1c ）, Hcy , lipoprotein （ a ）[ LP （ a ）], high sensitive C-reactive protein （ hs-CRP ） and conventional serum lipids for calculating AIP in plasma were detected respectively.According to the level of HbA1c , T2DM patients were divided into the good blood glucose control group （ HbA1c≤7.0% , n=62 ） and the worse blood glucose control group （ HbA1c7.0% , n=40 ）, and compared with NGT group.Results The levels of Hcy and AIP were significantly higher in T2DM and IGT group compared with Those in NGT group （ P0.01or P0.05 ） .There were significantly difference in levels of Hcy , LP （ a ）, hs-CRP and AIP in T2DM and IGT group （ P0.01or P0.05 ） .The worse blood glucose control group , serum LP （ a ） and AIP were significantly higher （ P0.01 ） than the good blood glucose control group , while Hcy and hs-CRP were higher than the good blood glucose control group （ P0.05 ）, and the levels of Hcy , Lp （ a ）, hs-CRP and AIP were elevated with the level of HbA1c.Conclusion The simultaneous measurement of AIP , Hcy , Lp （ a ） and hs-CRP are helpful in determining of the development and progression of diabetes.Comparatively speaking , the levels of AIP and Hcy are better than other predictors of atherosclerosis , which can be used as early predictors for concurrent coronary heart diseases in patients with T2DM and IGT.