不同糖耐量状态的冠心病患者内源性胰升糖素样肽1水平与冠状动脉病变的相关性

Correlation between the level of glucagon like peptide-1 and the extent of coronary lesions in patients with coronary heart disease at different glucose tolerance state

目的探讨胰升糖素样肽1(GLP-1)水平与冠状动脉病变严重程度的关系。方法收集192例冠心病患者,其中单纯冠心病组60例,冠心病合并糖耐量受损(IGT)组67例,冠心病合并2型糖尿病(T2DM)组65例,对照组48例,所有患者均采用酶联免疫吸附法测定GLP-1,进行口服葡萄糖耐量试验(OGTT),检测血糖、胰岛素、C肽,计算胰岛素曲线下面积(AUCINS)、C肽曲线下面积(AUCC-P)、血糖曲线下面积(AUCClu)、GLP-1曲线下面积(AUCGLP-1),根据住院期间冠状动脉造影(CAG)结果,采用冠状动脉狭窄程度积分统计冠脉狭窄程度。采用相关分析和多元线性逐步回归分析,分析GLP-1水平与冠状动脉狭窄程度的关系。结果冠心病合并T2DM组OGTT各时间点血糖及AUCGlu均较冠心病合并IGT组明显升高(P<0.01),胰岛素、C肽释放水平及AUCINS、AUCC-P明显降低(P<0.05)。冠心病合并IGT组糖负荷后血糖、胰岛素、C肽水平及AUCGlu、AUCINS、AUCC-P均较对照组、单纯冠心病组明显升高(P<0.01)。与单纯冠心病组及冠心病合并IGT组比较,冠心病合并T2DM组的GLP-1水平明显降低(P<0.01),冠脉狭窄程度积分升高(P<0.05);冠心病合并IGT组GLP-1水平较单纯冠心病组明显降低(P<0.01),冠脉狭窄程度积分升高(P<0.01)。Pearson相关分析显示,GLP-1水平与冠脉病变积分呈负相关(P<0.01),多元线性相关分析显示,收缩压、高密度脂蛋白胆固醇、空腹C肽和GLP-1对冠心病患者冠脉狭窄程度评分有预测作用。结论空腹GLP-1水平与冠心病患者的冠脉病变程度密切相关,尤其在合并血糖升高患者更为明显。

Objective To explore the correlation between the level of glucagon like peptide-1 (GLP-1 )and the extent of coronary lesions in coronary heart disease (CHD).Methods One hundred and ninety-two CHD patients included in the study were divided into simple CHD group (n =60),CHD accompanied with impaired glucose tolerance(IGT)group (n =67),and CHD accompanied with type 2 diabetes mellitus (T2DM)group (n=65).48 subjects were used as controls.The levels of GLP-1 in all the patients were analyzed by ELISA.Oral glucose tolerance test (OGTr)was performed.Blood glucose,insulin,and C-peptide levels were measured.The area under curves of insulin(AUCINS),C-peptide (AUCC-P),glucose (AUCGlu),and GLP-1 (AUCGLP-1)were calculated.All the patients underwent coronary angiography and the extent of coronary lesions was analyzed by total amount of coronary narrow degree integral.The association of GLP-1 level with coronary narrow degree was analyzed by correlation analysis and multivariate linear stepwise regression analysis.Results The levels of blood glucose and AUCGlu during OGTT in CHD accompanied with T2DM group were significantly higher than those in CHD with IGT group (P<0.01 ),while the levels of insulin and C-peptide,AUCINS,and AUCc.P were decreased (P<0.05).The levels of blood glucose,insulin, C-peptide,AUCGlu,AUCINS,and AUCC-P in CHD accompanied with IGT group were significantly higher than those in control group and simple CHD group (P<0.01).Compared with simple CHD group and CHD accompanied with IGT group,GLP-1 level in CHD accompanied with T2DM group was markedly decreased(P<0.01 )while coronary artery narrow degree was raised(P<0.05).Compared with simple CHD group,CHD accompanied with IGT group showed lower GLP-1 level and higher coronary artery narrow degree (P<0.01).Correlation analysis revealed that GLP-1 level was negatively correlated with the coronary artery narrow degree in CHD patients (P <0.01 ).Multivariate linear regression analysis showed that systolic blood pressure,high density lipoprotein-cholesterol,fasting C-peptide and GLP-1 had a predictive effect on the coronary narrow degree integral in CHD patients.Conclusion The level of GLP-1 is closely correlated with the coronary artery narrow degree in CHD patients,especially in patients accompanied by hyperglycemia.