冠心病合并糖代谢异常患者血清不对称二甲基精氨酸、脂联素及Apelin水平的变化

Changes of serum asymmetric dimethylarginine,adiponectin and Apelin levels in coronary heart disease patients with abnormal glucose metabolism

目的探讨合并冠心病的糖代谢异常患者血清不对称二甲基精氨酸(ADMA)、脂联素(APN)及Apelin水平的变化。方法选取临床疑似冠心病并行选择性冠状动脉造影(CAG)检查患者,根据口服糖耐量试验分为冠心病合并糖耐量异常(CHD+IGT)组30例,冠心病合并2型糖尿病(CHD+DM)组32例,单纯冠心病(CHD)组28例,正常对照组(NC)33例。测定ADMA、APN、Apelin、血脂、胰岛素水平,并计算BMI及HOMA-IR。测定Gensini积分。结果 CHD+IGT组及CHD+DM组的BMI指数显著高于NC组(P=0.000);CHD+DM组的FPG显著高于NC组和CHD组(P=0.000);CHD+IGT组及CHD+DM组的PPG显著高于NC组和CHD组(P=0.000);CHD+IGT组及CHD+DM组的FINS、HOMA-IR均显著高于NC组(P<0.05);CHD+IGT组及CHD+DM组的APN显著低于NC组(P<0.05);CHD+IGT组及CHD+DM组的ADMA、Apelin均显著高于NC组及CHD组(P=0.000);CHD+IGT组及CHD+DM组的Gensini积分显著高于NC组(P<0.05);以Gensini积分为应变量,多因素逐步回归分析表明ADMA、APN和Apelin是其主要独立相关影响因素。结论高ADMA、Apelin和低APN水平相比于其他因素能更为敏感地预测糖尿病大血管病变的严重程度。

Objective To investigate the changes of asymmetric dimethylarginine （AD- MA）, adiponectin （APN） and Apelin levels in coronary heart disease （CHD） patients with abnormal glucose metabolism. Methods Patients with suspected coronary artery disease （CAD） were treated with parallel selective coronary angiography （CAG）, and they were divided into four groups, inclu- ding 28 cases in CHD group, 30 cases in CHD ＋ IGT group, 32 cases in CHD ＋ DM group, and 33 cases in NC group. Body mass index （BMI） , HOMA-IR, blood pressure, blood lipid, insulin, ADMA, APN and Apelin were measured, and Gensini score was calculated. Results The values of BMI in CHD ＋ IGT group and CHD ＋ DM group were significantly higher than NC group （P = 0. 000）. FPG in CHD ＋ DM group was significantly higher than CHD group and NC group （ P = 0.000）. PPG in CHD ＋ IGT group and CHD ＋ DM group were significantly higher than CHD group and NC group （ P = 0. 000）. The values of FINS, HOMA-IR in CHD ＋ IGT group and CHD ＋ DM group were significantly higher than the NC group （P 〈 0.05 ）. APN values in CHD ＋ IGT group and CHD ＋ DM group were significantly lower than the NC group （ P 〈 0. 0 5 ） , and ADMA , Apelin values in CHD ＋ IGT group and CHD ＋ DM group were significantly higher than the CHD group and NC group （P = 0. 000）. Gensini score in CHD ＋ IGT group and CHD ＋ DM group were significantly higher than the NC group （ P 〈 0.05 ）. Multivariate regression analysis showed that ADMA, APN and Apelin values were correlated with Gensini score. Conclusion Values of ADMA, APN and Apelin maybe correlated with the degree of abnormal glucose metabolism, and these indexes are useful in evaluating and reflecting the disease severity.