糖尿病及急性冠状动脉综合征患者ApoB与ApoA1比值测定的临床意义

Clinical significance of serum apolipoprotein B/A1 ratio in patients with diabetes mellitus and acute coronary syndrome

目的:研究糖尿病及急性冠状动脉综合征(ACS)患者血清载脂蛋白B(ApoB)与载脂蛋白A1(ApoA1)比值的变化并探讨其临床意义。方法:从体检人群中筛选可排除诊断为糖尿病及ACS的受检者33例为对照组、从住院患者中筛选临床确诊的单纯糖尿病患者47例、无糖尿病的ACS患者101例及ACS并发糖尿病患者52例,收集临床资料并分别检测各组空腹血糖、血脂和高敏C反应蛋白(hsCRP)水平。结果:糖尿病组、ACS非糖尿病组、ACS并发糖尿病组ApoB/ApoA1比值显著高于对照组(0.86±0.18、0.87±0.20、0.89±0.23)∶(0.76±0.15),均P<0.05。但3个患病组之间ApoB/ApoA1比值差异无统计学意义。高ApoB/ApoA1组(上4分位组)与低ApoB/ApoA1比较,BMI、FPG、TG、TC、LDL-C、hsCRP水平,糖尿病、高血压及ACS患病率均显著升高,而HDL-C水平则无显著变化。ROC曲线显示,ApoB/ApoA1较LDL-C具有更好的ACS诊断性能。结论:ApoB/ApoA1比值能较准确、灵敏地反映从糖尿病到ACS病程中脂代谢紊乱,并可用于对糖尿病预后及ACS发病风险的评估。

Objective：To assay the changes of serum apolipoprotein B/A1 ratio in subjects with diabetes melli- tus（DM） and acute coronary syndrom （ACS） ,and evaluate the clinical signification of apolipoprotein B/A1 ratio in risk assessment of DM and ACS. Method： A total of 33 cases without DM and ACS from health examination people were enrolled as control group,200 subjects （including 47 subjects with DM, 101 subjects with ACS but without DM and 52 subjects with DM and ACS） were selected from in-patients and divided into 3 patient groups. Clinical data of each subject were collected,meanwhile fasting plasma glucose（FPG）, plasma lipid, high-sensitivity C reac- tive protein （hsCRP） were determined respectively. Result： Serum apolipoprotein B/A1 ratio in 3 patient groups were significantly higher than that of control group [（0.86±0.18,0.87±0.20,0.89±0.23） vs （0.76±0.15）,P〈0.05] ,but there were no significantly difference in apolipoprotein B/A1 ratio between 3 patient groups. Com- pared with the highest quartile of apolipoprotein B/A1 ratio, BMI, FPG, TC, TG, LDL-C, hsCRP, and the preva lence rate of hypertension,DM and ACS were significantly higher than those of low B/A1 ratio group,but no sig- nificantly difference in HDL-C levels were existed;ROC showed that apolipoprotein B/A1 ratio was better indica tion than LDL C in ACS diagnosis. Conclusion： Serum apolipoprotein B/A1 ratio was an accurate and sensitive in dex to reflect abnormal of lipid metabolism during DM and ACS,it could be used for risk assessment of DM and ACS.