2型糖尿病合并脑梗死患者血清视黄醇结合蛋白4水平及其临床意义

Level and Clinical Significance of Serum Retinol Binding Protein 4 in Type 2 Diabetes Mellitus Patients Combined with Cerebral Infarction

目的探讨2型糖尿病合并脑梗死患者血清视黄醇结合蛋白4(RBP4)水平及其意义。方法选取2012年11月—2013年7月在石河子大学第一附属医院住院的30例脑梗死患者(CI组)、30例2型糖尿病患者(DM组)、30例2型糖尿病合并脑梗死患者(DM+CI组)及30例同期体检健康者(对照组)。比较各组受检者的血脂〔总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)〕、脂蛋白(a)、胱抑素C、同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)、RBP4水平;采用Spearman相关分析RBP4的相关因素;采用二分类Logistic回归分析2型糖尿病合并脑梗死的影响因素。结果 (1)4组受检者血清TG、LDL、胱抑素C、Hcy、HbA1c、RBP4水平间有差异(P<0.05);其中DM+CI组患者血清RBP4水平〔(113.6±26.1)μg/L〕均高于对照组、CI组和DM组〔(71.8±29.9)、(89.7±26.6)、(99.0±26.7)μg/L〕,CI组、DM组患者血清RBP4水平亦高于对照组(P<0.05)。(2)血糖控制未达标(HbA1c>6.5%)者血清RBP4水平高于血糖控制达标(HbA1c≤6.5%)者〔(106.0±23.1)μg/L与(87.8±32.5)μg/L,t=-3.539,P=0.001〕。(3)Spearman相关分析显示,血清TC、TG、LDL水平均与RBP4呈正相关(r值分别为0.430、0.432和0.681;P均=0.001)。(4)二分类Logistic回归分析显示,Hcy(OR=1.130,P=0.040)、RBP4(OR=1.023,P=0.046)与2型糖尿病合并脑梗死存在回归关系。结论 (1)2型糖尿病合并脑梗死患者血清RBP4水平升高,提示RBP4可作为2型糖尿病并发脑梗死的预测因子;(2)血清RBP4水平升高与血糖控制不达标有关,提示需更改降糖方案;(3)血清TC、TG、LDL水平与RBP4水平呈正相关,提示兼顾血脂治疗的重要性。

Objective To explore the level and clinical significance of serum retinol binding protein 4 （RBP4） in type 2 diabetes mellitus patients combined with cerebral infarction. Methods The patients who were admitted to the First Affilia- ted Hospital of Shihezi University from November 2012 to July 2013, were selected as study subjects, 30 patients with cerebra/ infarction were included in CI group, 30 patients with type 2 diabetes mellitus were included in DM group, and 30 patients with type 2 diabetes mellitus and cerebral infarction were included in DM ＋ CI group, and 30 healthy people were included in control group. The levels of blood fat （TC, TG, LDL）, lipoprotein （a）, cystatin C, Hcy, HbAlc, RBP4 were compared among groups. The relevant factors for RBP4 levels were analyzed by Spearman correlation analysis. The influencing factors for type 2 dia- betes complicated with cerebral infarction were analyzed by a binary Logistic regression model. Results There were significant differences in serum levels of TG, LDL, cystatin C, Hcy, HbA1v, and RBP4 among 4 groups （P 〈0. 05） ; The serum RBP4 levels in DM ＋ CI group （ 113.6 ±26. 1 ） μg/L were significantly higher than those in control group [ （71.8 ±29. 9） μg/ L3, CI group （89. 7 ±26. 6） μg/L] and DM group [ （99.0 ±26. 7） μg/L, serum RBP4 levels in CI group and DM group were significantly higher than those in control group （ P 〈 0.05 ） . The serum RBP4 levels in those who did not maintain adequate blood glucose （HbAl0 〉 6. 5 % ） were significantly higher than those who maintained adequate blood glucose （HbA1c≤ 6. 5% ） （ 106. 0 ± 23. 1 ） mg/L vs. （87.8 ±32. 5 ） mg/L, t = - 3. 539, P = 0. 001] . According to result of Spearman correlation a- nalysis, serum levels of TC, TG and LDL were positively correlated with RBP4 level （r value was 0. 430, 0. 432 and 0. 430, respectively; P = 0. 001 ） . According to result of binary Logistic regression model, there were remarkable regression relation- ships between type 2 diabetes complicated with cerebral infarction and Hcy （OR = 1. 130, P = 0. 040 ）, RBP4 （OR = 1. 023, P = 0. 046） . Conclusion The serum RBP4 levels increased in type 2 diabetes mellitus patients combined with cerebral infarction, which indicated that RBP4 can be used as a predictor of type 2 diabetes complicated with cerebral infarction. High serum RBP4 lev- els were associated with blood glucose non -compliance, which indicated that therapy plan should be adjusted. The serum levels of TC, TG and LDL were positively correlated with RBP4 level, which suggested the importance of lipid - lowering therapy. [ Key words]