2型糖尿病患者空腹C肽水平与冠状动脉病变的相关性研究

Study on the correlation between fasting C peptide level and coronary artery disease in patients with type 2 diabetes mellitus

目的:探讨2型糖尿病(DM)患者空腹C肽(FCP)水平对发生冠状动脉(冠脉)疾病(CAD)的影响,为明确FCP与2型DM心血管病变之间的相关性提供理论依据。方法:采用横断面调查方法收集2015-03-2017-03于我院内分泌科住院的单纯2型DM患者及2型DM合并CAD患者615例,记录入选患者一般临床资料及各项实验室检查指标,按照是否合并CAD及病变程度分为单纯糖尿病组(DM组,292例)和合并冠脉轻度病变组(DM+CAD1组,86例)、合并冠脉中度病变组(DM+CAD2组,150例)、合并冠脉重度病变组(DM+CAD3组,87例)。比较各组的FCP水平的差异,多元线性回归分析影响FCP的因素,并利用多分类logistic逐步回归分析探讨不同冠脉病变程度与FCP的关系。结果:2型DM合并冠脉病变患者体内FCP高于单纯DM患者[(0.57±0.32):(0.74±0.56),P<0.05],且随着病变程度的增加,FCP升高显著。双变量相关分析显示FCP与糖化血红蛋白呈负相关(r=-0.256,P=0.000),与体质指数、血尿酸、超敏C反应蛋白、颈动脉内中膜厚度呈正相关(r=0.190,0.219,0.171,0.180,P均为0.000)。多分类logistic回归分析显示,FCP、年龄是DM合并冠脉病变的危险因素,心率是保护因素。结论:FCP水平可以在一定程度上反映应DM合并CAD的发生风险,FCP越高,DM合并CAD的可能越大。

Objective：To explore the effect of fasting plasma C peptide（FCP）levels on coronary artery disease（CAD）in patients with type 2diabetes mellitus（T2DM）.Method：We collected a total of 615 patients with T2 DM or T2 DM patients with coronary artery disease who hospitalized in the department of endocrinology of our hospital from March in 2015 to March in 2017 by cross-sectional study.We recorded their general clinical data and laboratory indexes,according to whether the merger of coronary lesions and the severity of the disease.They were divided into simple diabetic group（DM group,n=292）,diabetic with mild coronary artery lesion group（DM＋CAD1group,n=86）,diabetic with coronary moderate lesion group（DM＋CAD2group,n=150）,and diabetic with severe coronary artery disease group（group DM＋CAD3,n=87）.The differences of FCP levels in each group were compared,and the factors affecting FCP were analyzed by multiple linear regression.Result：Compared with DM patients,the level of FCP was higher in patients with DM and CAD（0.57±0.32 vs 0.74±0.56,P0.05）.And with the increase of lesion degree,FCP increased significantly.Bivariate correlation analysis showed a negative correlation between FCP and glycosylated hemoglobin（r=-0.256,P=0.000）,and positive correlation with body mass index,serum uric acid,high sensitive C reactive protein and carotid intima-media thickness（r=0.190,0.219,0.171,0.180,all P=0.000）.Multiple logistic regression analysis showed that FCP and age were the risk factors of DM combined with coronary artery disease,and heart rate was a protective factor.Conclusion：In some extent,the level of FCP can reflect the risk of DM combined with CAD.The higher the FCP,the more likely the diabetes mellitus complicated with CAD.