糖尿病患者低密度脂蛋白胆固醇与冠状动脉血流储备的相关性

Correlation of low density lipoprotein cholesterol with coronary flow reserve in patients with type 2 diabetes

目的:探讨2型糖尿病患者血浆低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平与冠状动脉血流储备(coronary flow reserve,CFR)的相关性。方法:连续选取2007年10月至2012年3月在北京大学第三医院心内科就诊的200例患者,分为糖尿病组(n=95)和对照组(n=105)。测定患者的血浆LDL-C、HDL-C,并用经胸多普勒超声心动图测定腺苷诱导的左前降支CFR,分析血浆LDL-C、HDL-C与CFR的关系。结果:糖尿病组血浆LDL-C水平显著高于对照组[(3.05±0.73)mmo/L vs.(2.74±0.72)mmo/L,P=0.003],HDL-C水平显著低于对照组[(1.08±0.24)mmo/L vs.(1.17±0.29)mmo/L,P=0.044]。糖尿病组的CFR显著低于对照组(2.74±0.63 vs.3.20±0.69,P<0.001)。所有患者的血浆LDL-C水平与CFR呈负相关(r=-0.17,P=0.015),糖尿病组的LDL-C水平与CFR亦呈负相关(r=-0.23,P=0.021)。所有患者及糖尿病组的HDL-C与CFR均无相关性。多因素分析显示,糖尿病组CFR与LDL-C独立相关(P=0.036)。结论:2型糖尿病患者血浆LDL-C水平与CFR独立相关。

Objective： To investigate whether plasma levels of low density lipoprotein cholesterol （ LDL- C）, high density lipoprotein cholesterol （HDL-C） are associated with coronary flow reserve （CFR） in patients with type 2 diabetes mellitus （DM）. Methods： Between October 2007 and March 2012, we con- tinuously enrolled 200 participants registered to Department of Cardiology, Peking University Third Hospi- tal, who were divided into 2 groups ： DM group （n = 95 ） and control group （n = 105 ）. Quantification of CFR was administrated after rest and after adenosine by noninvasive Doppler echocardiography in all the subjects. The CFR, which was performed in the distal part of left descending artery, was used as an indi- cator of coronary endothelial dysfunction. Results： The plasma levels of LDL-C were significantly higher in the patients with DM than in the controls [ （3.05 ±0.73 ） mmo/L vs. （2.74 ± 0.72） mmo/L, P = 0. 003 ） ], while the plasma levels of HDL-C were significantly lower in the patients with DM than in the controls [ （1.08 ±0.24） mmo/L vs. （1.17 ±0.29） mmo/L, P =0.044]. Furthermore, a lower CFR value was seen in the patients with DM than in the controls [ （2.74 ± 0.63 ） vs. （3.20 ± 0.69）, P 〈 0.001 ]. The plasma levels of LDL-C were negatively correlated with the CFR values in all the subjects （r= -0.17, P=0.015） and in the DM group （r = -0.23, P =0.021）. The LDL-C remained inde- pendently correlated with the CFR in the DM group （P = 0. 036）. However, no significantly correlation was found between HDL-C and CFR in the DM group or in all the subjects. Conclusion： LDL-C is inde- pendently associated with CFR in patients with diabetic mellitus.