2型糖尿病伴高血压患者血清Hcy、脂质水平与颈动脉粥样硬化的相关性分析

Correlation between serum levels of Hcy,lipid and carotid atherosclerosis in patients with type 2 diabetes mellitus complicated by hypertension

目的探讨2型糖尿病(T2DM)伴高血压患者血清同型半胱氨酸(Hcy)水平、脂质水平,分析血清Hcy水平、脂质水平与颈动脉粥样硬化的相关性。方法选取T2DM患者根据其是否患有高血压分为T2DM组和T2DM+HBp组,每组患者随机抽取60例,同时抽取健康体检的老年人60例为对照组。检测指标包括:空腹血糖(FPG)、血脂(TC、TG、HDL-C及LDL-C)、Lpa、Apo A-Ⅰ、Apo B、Hcy水平及IMT、斑块Crouse积分、斑块的检出率。其中FPG检测采用葡萄糖氧化酶法,TC、TG、HDL-C及LDL-C检测采用双试剂酶法,Lpa、Apo A-Ⅰ及Apo B检测采用双试剂免疫比浊法,Hcy水平检测采用速率法。分析FPG、血脂、Lpa、Apo A-Ⅰ、Apo B及Hcy与IMT的相关性。结果 TC、TG、LDL-C、Lpa、Apo B、IMT、斑块Crouse积分、斑块的检出率3组比较,对照组、T2DM组和T2DM+HBp组水平均依次升高,且组间两两差异有统计学意义(P<0.05);3组FPG水平比较,T2DM组和T2DM+HBp组水平均显著高于对照组,差异有统计学意义(P<0.05),而T2DM组和T2DM+HBp组水平比较,差异无统计学意义(P>0.05);T2DM组和T2DM+HBp组HDL-C及Apo A-Ⅰ水平较对照组均显著下降,差异有统计学意义(P<0.05),而T2DM组和T2DM+HBp组水平比较,差异无统计学意义(P>0.05);IMT与FPG、TC、TG、LDL-C、Lpa、Apo B及Hcy水平呈正相关(r=2.332、3.412、3.571、3.274、3.841、3.466、4.872,P<0.05),与HDL-C及Apo A-Ⅰ水平负相关(r=-0.561,-0.759,P<0.05)。结论 T2DM伴高血压患者患有更高的颈动脉粥样硬化风险,空腹血糖、脂质及血清Hcy水平均与颈动脉粥样硬化密切相关,监控血清Hcy及IMT水平并早期干预对减轻颈动脉粥样硬化的发生发展具有一定的临床价值。

Objective To investigate the dynamic changes of serum levels of Hey and lipid levels in patients with type 2 diabetes mellitus （T2DM） complicated by hypertension, and to analyze the correlation between serum levels of Hey, lipid and carotid atherosclerosis. Methods The patients with T2DM were divided into T2DM group （ n =60） and HBP ＋ T2DM group （ n =60） according to whether they had hypertension,at the same time,60 healthy olderly subjects were served as control group. The detection indexes included fasting blood glucose （FPG）, blood lipids （TC,TG,HDL-C and LDL-C）, Lpa,ApoA- I ,ApoB,Hcy and IMT,plaque Crouse integral,the detection rate of plaques, in which, FPG was determined by glucose oxidase method,the levels of TC,TG,HDL-C and LDL-C were detected by double enzymatic reagent method,the levels of Lpa, ApoA- I and ApoB were detected by double reagent immunoturbidimetry, and Hey levels were detected by double reagent circulating enzyme method. Results The levels of TC, TG, LDL-C, Lpa,ApoB, IMT, plaque Crouse integral and the detection rate of plaques were increased in order of control group, T2DM group and T2DM group, moreover, there were significant differences between every two groups （ P 〈 0.0 5 ） . The FPG levels in T2DM group and T2DM ＋ HBP group were significantly higher than those in control group （ P 〈 0. 05 ） , however, there were no significant differences between T2DM group and T2DM ＋ HBP group （ P 〉0. 05）. As compared with those in control group, the levels of HDL-C and ApoA- I in T2DM group and T2DM ＋ HBP group were significantly decreased （ P 〈 0. 05 ）, however, there were no significant differences between T2DM group and T2DM ＋ HBP group （ P 〉 0. 05 ） . The levels of IMT were positively correlated to those of FPG, TC, TG,LDL-C,Lpa,ApoB and Hey （ r =2.332,3.412, 3.571,3.274, 3.841,3.466,4.872, respectively, P 〈 0.05） ,however,which were negatively correlated to those of HDL-C and ApoA- I （ r = -0.561,-0 . 759 Respectively,P 〈 0.05）. Conclusion The patients with type 2 diabetes mellitus complicated by hypertension have higher risk of carotid atherosclerosis, moreover, fasting blood glucose, lipid and serum Hey levels are closely correlated to carotid atherosclerosis, thus,monitoring serum Hey and IMT levels and early intervention have a certain clinical value to decrease the occurrence and development of carotid atherosclerosis.