老年2型糖尿病患者血清分泌型卷曲相关蛋白5与冠状动脉病变严重程度相关性研究

Correlation of Serum Secreted Frizzled-related Protein with the Severity of Coronary Artery Lesions in Elderly Patients with Type 2 Diabetes Mellitus

目的探讨老年2型糖尿病（T2DM）患者血清分泌型卷曲相关蛋白5（SFRP-5）与冠脉病变严重程度的相关性。方法选择2015年1月-2017年7月在西京医院心内科接受冠状动脉造影的476例老年T2DM患者纳入研究，根据造影检查结果分为冠脉病变组396例和对照组80例，计算冠脉病变组患者治疗的Gensini评分，检测所有患者血清SFRP-5及其他相关参数水平。结果冠脉病变组的体重指数、有无高血压、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）和SFRP-5与对照组比较差异具有统计学意义（均P〈0．05）。Logistics多因素回归分析结果显示SFRP-5是老年T2DM患者发生冠脉病变的保护性因素（OR=0．412，95％C10．187-0．670，P=0．000）。根据Gensini评分结果将患者分成轻度病变组（〈20分）、中度病变组（20-40分）和重度病变组（〉40分），3个亚组分别与对照组比较，血清SFRP-5水平差异均有统计学意义（均P〈0．05）；3个亚组两两比较，重度病变组血清SFRP-5水平显著高于轻度病变组和中度病变组（均P〈0．05）。血清SFRP-5水平与Gensini评分呈负相关关系（r=-0．375，P=0．000）。Spearman相关性分析结果显示：对于冠脉病变组患者，血清SFRP-5水平与体重指数（r=-0．301，P=0．000）、糖尿病病程（r=-0．228，P=0．001）、HbA1c（r=-0．270，P=0．000）和LDL—C（r=-0．281，P=0．000）均呈负相关关系；对于对照组患者，血清SFRP-5水平仅与体重指数（r=-0．268，P=0．030）和HbA1c（r=-0．223，P=0．041）呈负相关关系。结论老年T2DM患者血清SFRP-5水平与其冠脉病变程度呈负相关关系，可用于评估T2DM患者大血管病变。

Objective To investigate the correlation between serum levels of secreted frizzled - related protein - 5 （ SFRP - 5 ） with the severity of coronary artery lesions in elderly patients with type 2 diabetes mellitus （T2DM）. Methods 476 elderly pa- tients with T2DM who underwent coronary angiogmphy in our hospital from January 2015 to July 2017 were recruited in this study. The patients were divided into the coronary lesions group （ n = 396） and control group （ n = 80） according to the examination of selective coronary angiographv. Gensini score was calculated. The serum level of SFRP - 5 and other risk factors were measured. Results There were significant differences in the body mass index, fasting plasma glucose （FPG） , hemoglobin Alc （HBAlc）, triglyceride （TG） , total cholesterol （TC）, low density lipoprotein cholesterol （LDL- C）, high density lipoprotein cholesterol （HDL- C） and SFRP - 5 between the coronary lesion group and control group （ P 〈 0. 05 ）. Multivariate logistic regression analysis showed that serum SFRP -5 was protective factor of coronary artery lesions for elderly T2DM patients （ OR = 0. 412, 95% CI 0. 187 - 0. 670, P = 0. 000）. According to Gensini score, the coronary lesion group were further divided into 3 subgroups, the mild lesions （ 〈 20） , the moderate lesions （20 to 40） and the severe lesions （ 〉 40） groups. There were significant differences in SFRP - 5 level between 3 subgroups and control group （P 〈 0. 05）. Among 3 subgroups, SFRP - 5 level in the severe lesions group was lower than mild and moderate lesions group （ P 〈 0. 05 ）. In T2DM patients with coronary artery disease, the levels of serum SFRP - 5 was negatively cor- related with Gensini score （ r = - 0. 375 ,P =0. 000）. Spearman correlation analysis showed that serum level of SFRP -5 was nega- tively correlated with body mass index （ r = - 0. 301 ,P =0. 000） , course of diabetes （ r = - 0. 228 ,P =0. 001 ） , HBAlc level （ r = - 0. 270,P =0. 000） and LDL - C level （ r = - 0. 281 ,P =0. 000） in the coronary lesion group. While, only body mass index （ r =- 0. 268,P =0. 030） and HBAlc level （ r =- 0. 223,P =0. 041 ） was negatively correlated with SFRP-5 in the control group. Conclusion The serum level of SFRP - 5 is negatively correlated with the severity of coronary artery lesions in elderly patients with T2DM, and can be used as an independent predictor of diabetic macroangiopathy.