糖耐量减低的绝经后女性的和肽素水平对冠状动脉粥样硬化的影响

The impact of copeptin levels on coronary atherosclerotic lesions in postmenopausal women with impaired glucose tolerance

目的观察糖耐量减低的绝经后女性基线血浆和肽素(copeptin)水平对冠状动脉粥样硬化病变发生、发展的影响。方法新发糖耐量减低(空腹血糖≤6.2 mmol/L,7.8 mmol/L≤早餐后2 h血糖≤9.4 mmol/L)的绝经后女性(年龄在56~59岁之间)共80例,依据基线时copeptin水平,分成对照组(<5 pmol/L)、高和肽素组(>20 pmol/L),每组各40例。分析两组间基线时和3个月后冠状动脉CTA狭窄程度积分的差异。结果 (1)基线时,两组间的copeptin差异有统计学意义(P<0.05),而在体重、空腹全血血糖、早餐后2 h血糖、空腹血清三酰甘油、血清总胆固醇、血清低密度脂蛋白胆固醇、平均动脉压、血清肌酐水平、年龄等指标上两组结果相似,差异无统计学意义(P>0.05)。(2)予以调整生活方式及口服阿司匹林(100mg qd)、瑞舒伐他汀(10 mg qd)3个月后,在copeptin水平、冠状动脉CTA的狭窄程度积分、早餐后2 h血糖指标上,高和肽素组明显高于对照组,差异有统计学差异(P<0.05),且高和肽素组有冠心病的发病,对照组没有。结论在糖耐量减低、绝经后女性的冠心病危险因素的基础上,高血浆copeptin水平会进一步促进冠状动脉粥样硬化病变发生和恶化。

Objective To observe the impact of copeptin levels on coronary atherosclerotic lesions in postmenopausal women with impaired glucose tolerance（ IGT）. Methods 80 postmenopausal women（ aged 56-59 years） with the onset of IGT（ fasting blood glucose,i. e. FBG ≤ 6. 2 mmol/L,7. 8 mmol/L≤2-hour postprandial blood glucose,i. e. 2hPBG≤9. 4 mmol/L） were divided into control group（ copeptin 5 pmol/L） and high-copeptin group（ copeptin 20 pmol/L）,according to serum copeptin levels at baseline,40 cases in each group. The discrepancy of coronary CTA stenosis scores were analyzed between the two groups at baseline and after 3-months follow-up. Results（1）At baseline,the difference was statistically significant in copeptin levels（ P〈0. 05）,but not in weight,FBG,2hPBG,fasting serum triglyceride（ TG）,total serum cholesterol（TC）,serum low-density lipoprotein cholesterol（LDL-C）,mean arterial pressure,serum creatinine and age between the two groups（P〈0. 05）.（2） After 3-months therapeutic lifestyle adjustment as well as oral administration of aspirin（100 mg qd） and rosuvastain（10 mg qd）,copeptin level,coronary CTA stenosis scores,and 2hPBG of high-copeptin group were statistically significantly higher compared with control group respectively（P〈0. 05）. Furthermore,some cases developed coronary heart disease（ CHD） in high-copeptin group,while not in control group. Conclusion On the basis of the influence of the atherosclerotic risk factors of IGT and postmenopausal female,high plasma copeptin level will further promote the occurrence and deterioration of coronary atherosclerotic lesions.