糖尿病合并急性冠状动脉综合征患者卵磷脂胆固醇脂酰基转移酶水平的变化及与心血管事件的相关性研究

Change of lecithin cholesterol aeyltransferase indiabetes mellitus patients with acute coronary syndromes and its relationship with cardiovascular event

目的观察糖尿病合并急性冠状动脉综合症(ACS)患者卵磷脂胆固醇酰基转移酶(LCAT)水平的变化并分析其与心血管事件的相关性。方法选取糖尿病患者299例,根据是否合并ACS分为糖尿病合并ACS组(DM+ACS)179例、单纯糖尿病组(DM)120例,另选取健康体检者100名为正常对照组(NC)。收集各组临床资料和生化指标,ELISA检测LCAT水平。另根据LCAT水平将DM+ACS组由低到高分为低分位(27.46~35.25mg/ml)亚组55例、中分位(35.26~43.06mg/ml)亚组67例及高分位(43.07~50.86mg/ml)亚组57例。分析不同水平LCAT与心血管事件的相关性。采用多元性线性回归分析LACT水平可能的影响因素。结果 (1)DM+ACS组胰岛素、阿司匹林、钙离子拮抗剂(CCB)使用率高于DM组[141(78.77%)vs 65(54.17%);179(100.00%)vs 114(95.00%);88(49.16%)vs 40(33.33%),P<0.05]。DM+ACS组和DM组WC、BMI、FPG、2hPG、HbA_1c、TC及LDL-C水平高于NC组,HDL-C和LCAT水平低于NC组,且DM+ACS组FPG、2hPG、HbA_1c、TC及LDL-C高于DM组,HDL-C和LCAT水平低于DM组(P<0.05或P<0.01);(2)随着LACT水平升高,FPG、2hPG、HbA_1c、TC及TG降低,HDL-C升高(P<0.05)。6个月内,高分位亚组和中分位亚组血管事件的发生次数低于低分位亚组(0.49 vs 0.83 vs 1.84次/例,P<0.01);(3)多元线性回归分析显示,年龄、FPG、HbA_1c及HDL-C是LCAT的影响因素(P<0.05或P<0.01)。结论糖尿病患者LCAT水平降低,合并ACS患者降低的更明显,LCAT水平可能是糖尿病合并ACS患者的心血管事件的预测指标之一,年龄、FPG、血糖控制水平及HDL-C可能是其影响因素。

Objective To investigate the change of lecithin cholesterol aeyltransferase（LCAT）in diabetic patients with acute coronary syndromes（ACS）and analysis the relationship between LACT and cardiovascular event. Methods A total of 399 subjects were enrolled in this study and divided into three groups：diabetes mellitus with ACS group（DM＋ACS,n=179）,diabetes mellitus without ACS group（DM,n=120）and healthy subjects selected from medical examination center as normal control group（NC,n=100）.Clinical characteristics and biochemical index were gathered from all the subjects.LCAT level was tested by ELISA.Then according to LCAT levels,DM＋ACS group were further divided into three groups by tertiles：low tertile subgroup（27.46-35.25 mg/ml,n=55）,middle tertile subgroup（35.26-43.06 mg/ml,n=67）and the high tertile subgroup（43.07-50.86 mg/ml,n=57）.The relationship between different levels of LCAT and cardiovascular events were analyzed.Multivariate linear regression was used to analysis the influencing factors for LACT. Results（1）The percentage of insulin,aspirin and CCB treatment were higher in DM＋ACS group than in DM group[141（78.77%）vs 65（54.17%）;179（100.00%）vs 114（95.00%）;88（49.16%）vs 40（33.33%）,P〈0.05].The levels of WC,BMI,FPG,HbA1 c,TC and LDL-C were higher,while HDL-C and LCAT were lower in DM＋ACS group and DM group than in NC group.Meanwhile,the FPG,HbA1 c,TC and LDL-C were higher,HDL-C and LCAT were lower in DM＋ACS group than in DM group（P〈0.05 or P〈0.01）;（2）Along with the rise of LCAT levels,FPG,2 hPG,HbA1 c,TC and TG were reduced and HDL-C were increased（P〈0.05）.During 6 months,the number of cardiovascular events were lower in middle tertile subgroup and high tertile subgroup than in low tertile subgroup（0.49 vs 0.83 vs 1.84 time/n,P〈0.01）;（3）Multivariate linear regression analysis showed that age,FPG,HbA1 c and HDL-C were influence factors for LCAT（P〈0.05 or P〈0.01）. Conclusion The LCAT level was reduced in diabetic patient,especially in diabetic patients with ACS.LCAT level maybe a predictor of cardiovascular event in diabetic patients with ACS.Age,FPG,HbA1 c and HDL-C were influence factors for LCAT.