低密度脂蛋白胆固醇亚型与2型糖尿病患者冠状动脉病变程度相关研究

Correlation between low density lipoprotein cholesterol subfractions and severity of coronary artery disease in patients with type 2 diabetes mellitus

目的探讨低密度脂蛋白胆固醇(LDL-C)亚型与2型糖尿病患者冠状动脉病变程度的相关性。方法 100例2型糖尿病合并冠心病患者(糖尿病冠心病组),根据SNYTAX评分分为低分亚组和中高分亚组,100例2型糖尿病非冠心病患者为糖尿病组,采用Lipoprint系统高分辨率聚丙烯酰胺凝胶柱电泳及数字化扫描技术检测LDL-C亚型,比较各组LDL-C亚型水平。结果糖尿病冠心病组小密度低密度脂蛋白胆固醇(sdLDL-C)水平、sdLDL-C/LDL-C [(1.02±0.10)mmol/L、(0.31±0.08)]均高于糖尿病组[(0.62±0.13)mmol/L、(0.21±0.05)],差异有统计学意义(P<0.01)。糖尿病冠心病组患者中高分亚组sdLDL-C水平为(1.32±0.58)mmol/L高于低分亚组(0.73±0.34)mmol/L,其中3亚型最为明显(0.74±0.33)mmol/L vs(0.42±0.20)mmol/L,差异有统计学意义(P<0.01)。应用logistic回归分析,sdLDL-C、3亚型sdLDL-C是糖尿病患者冠心病严重程度的独立危险因素(OR=2.875、2.248,95%CI=1.273~3.258,0.018~0.780,P<0.05)。结论 sdLDL-C及其3亚型与糖尿病患者冠心病严重程度相关。

Objective To investigate the correlation between low density lipoprotein cholesterol （LDL-C） subfractionsand the severity of coronary artery disease （CAD） in patients with type2 diabetes mellitus （T2DM）. Methods 100 caseswith both T2DM and CAD （DM-CAD group） were enrolled and divided into low score subgroup and mid-high score groupbased on SNYTAX score. 100 T2DM patients without CAD were enrolled as DM group. LDL-C subfractions weremeasured by lipoprint system high-resolution polyacrylamide gel column electrophoresis and digital scanning technology.The level of LDL-C subfractions was compared between different groups. Results The level of small-dense LDL-C（sdLDL-C） and the ratio of sdLDL-C/LDL-C were significantly higher in DM-CAD group than in DM group （1.02±0.10mmol/L vs. 0.62±0.13mmol/L, and 0.31±0.08 vs. 0.21±0.05, both P〈0.01）. The level of sdLDL-C was significantlyhigher in mid-high score group than in low score group （1.32±0.58mmol/L vs. 0.73±0.34mmol/L, P〈0.01）, with LDL-Csubfraction 3 being the most significant （0.74±0.33mmol/L vs. 0.42±0.20mmol/L, P〈0.01）. Logistic regression analysisshowed that sdLDL-C（OR=2.875, 95% CI=1.273~3.258, P〈0.05） and LDL-C subfraction 3（OR=2.248, 95% CI=0.018~0.780, P〈0.05） were independent risk factors of serious coronary lesions in diabetic patients. Conclusion Thelevel of sdLDL-C and LDL-C subfraction 3 are correlated with the severity of coronary lesions in patients with T2DM.