2型糖尿病大血管病变患者血清视黄醇结合蛋白水平变化及意义

Changes in levels of serum retinol binding protein in patients with type 2 diabetes mellitus and macroangiopathy

目的观察2型糖尿病(T2DM)大血管病变患者血清视黄醇结合蛋白(RBP)水平变化,并探讨其临床意义。方法将106例T2DM患者分为合并大血管病变组58例、未合并大血管病变组48例,选择体检健康者52例作为正常对照组。用免疫比浊法检测三组血清RBP,按血清RBP水平将T2DM患者分为RBP低水平(RBP≤35 mg/L)组53例、RBP高水平(RBP>35 mg/L)组53例;生化分析仪检测空腹血糖(FPG)、尿酸(UA)、TG、TC、HDL-C、LDL-C、载脂蛋白AⅠ(apo AⅠ)、载脂蛋白B(apo B)、脂蛋白(a)[Lp(a)]、同型半胱氨酸(HCY);用高效液相色谱法检测糖化血红白蛋白(Hb A1C);化学发光法检测空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR);Pearson相关分析RBP与其他指标的相关性;Logistic多元回归分析T2DM大血管病变的影响因素;比较调脂前后T2DM合并大血管病变患者血清RBP水平变化。结果合并大血管病变组患者血清RBP水平高于未合并大血管病变组及正常对照组(P均<0.05);RBP高水平组年龄、病程、BMI、SBP、FPG、FINS、HOMA-IR、Hb A1c、TG、apo B、Lp(a)、LDL-C、UA及HCY与低水平组比较均升高(P均<0.05)。Pearson相关分析结果显示:T2DM大血管病变组血清RBP水平与BMI、病程、SBP、FINS、HOMA-IR、apo B、LDL-C、TG、UA、HCY呈正相关(r分别为0.46、0.38、0.41、0.44、0.36、0.40、0.38、0.62、0.80、0.65,P均<0.05)。Logistic多元回归分析结果显示:年龄、RBP、HCY、Lp(a)、LDL-C是T2DM患者大血管病变的影响因素(OR分别为1.086、1.119、1.514、1.178、3.105,P均<0.05)。T2DM大血管病变患者调脂后血清RBP水平低于调脂前(P<0.05)。结论 T2DMA大血管病变患者血清RBP水平升高,其可能通过导致IR、血脂紊乱等引发或加重T2DM患者大血管病变。

Objective To observe the changes in levels of serum retinol binding protein（ RBP） in patients with type2 diabetes mellitus（ T2DM） and macroangiopathy,and to investigate the clinical significance. Methods Totally 106T2 DM patients were divided into two groups according to with or without macroangiopathy（ n = 58,48,repectively）,and52 controls were also selected in this study. After using immunoturbidimetry to detect serum RBP,we divided T2 DM patients into RBP low level group（ RBP≤35 mg / L,n = 53） and RBP high level group（ RBP 35 mg / L,n = 53）. The levels of fasting plasma glucose（ FPG）,uric acid（ UA）,TG,TC,HDL-C,LDL-C,apolipoprotein A Ⅰ（ apo A Ⅰ）,apolipoprotein B（ apo B）,lipoprotein（ A） [Lp（ a） ] and homocysteine（ HCY） were detected by biochemical analyzer; using high performance liquid chromatography（ HPLC） to detect glycosylated hemoglobin（ Hb A1c）; using chemiluminescence to detect the fasting insulin（ FINS）,and calculating homeostasis model assessment of insulin resistance（ HOMA-IR） index.Pearson correlation analysis was used to analyze the correlation between RBP and other indicators; Logistic multivariate regression analysis was applied to analyze the influence factors for macroangiopathy of T2 DM patients. The serum RBP changes were compared in T2 DM patients complicated with macroangiopathy between before and after regulating lipids. Results The serum RBP level was higher in T2 DM patients with macroangiopathy than that of T2 DM patients without macroangiopathy and that of the control group（ all P〈0. 05）. The age,course of disease,SBP,FPG,FINS,HOMA-IR,HbA 1c,TG,apoB,Lp（ a）,LDL-C,UA and HCY were elevated in the group with a higher level of RBP as compared with those with a lower level of RBP（ all P〈0. 05）. Pearson correlation analysis showed that serum RBP was positively correlated with BMI,course of disease,SBP,FINS,HOMA-IR,apoB,LDL-C,TG,UA and HCY in T2 DM patients with macroangiopathy（ r = 0. 46,0. 38,0. 41,0. 44,0. 36,0. 40,0. 38,0. 62,0. 80 and 0. 65,respectively; all P〈0. 05）. Logistic multiple regression analysis showed that age,RBP,HCY,Lp（ a） and LDL-C were risk factors for T2 DM patients with macroangiopathy（ OR = 1. 086,1. 119,1. 514,1. 178,3. 105,respectively; all P〈0. 05）. The RBP level was significantly decreased after adjustment of lipid as compared with that before（ P〈0. 05）. Conclusion Serum RBP may cause or exacerbate macroangiopathy in patients with T2 DM and macroangiopathy through IR,dyslipidemia and other mechanisms.