血脂水平对稳定性冠状动脉粥样硬化性心脏病合并糖尿病患者炎症的影响

Effect of Lipid Pattern on Systemic Inflammation in Patients with Stable Coronary Artery Disease and Diabetes Mellitus

目的探讨血脂水平对合并糖尿病(DM)的稳定性冠状动脉粥样硬化性心脏病(SCAD)患者机体炎症的影响及其临床意义。方法收集2016年9月至2017年2月中国医科大学附属盛京医院心血管内科住院和门诊合并DM的SCAD病例44例。收集患者空腹及早餐后4 h血脂、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿微量白蛋白/肌酐比值(UACR)等指标。ELISA法检测患者空腹及早餐后4 h血清白介素6 (IL-6)及肿瘤坏死因子α(TNF-α)水平。结果与空腹比较,早餐后4 h血清总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)和低密度脂蛋白-胆固醇(LDL-C)水平无统计学差异(均P> 0.05);而血清甘油三酯(TG)和血清残粒脂蛋白-胆固醇(RLP-C)水平均显著升高(均P <0.01)。Pearson相关分析显示,血清TG与RLP-C水平在空腹(r=0.686,P <0.01)及早餐后4 h (r=0.814,P <0.01)均呈正相关。早餐后4 h,血清TG与IL-6水平(r=0.541,P <0.001)、TNF-α(r=0.684,P <0.001)以及UACR (r=0.339,P=0.026)水平呈正相关;血清RLP-C与IL-6 (r=0.391,P <0.001)、TNF-α(r=0.527,P <0.001)、UACR (r=0.341,P=0.025)正相关;UACR与血清IL-6 (r=0.503,P=0.001)、TNF-α(r=0.525,P <0.001)之间亦存在正相关。结论合并DM的SCAD患者餐后TC和LDL-C水平与空腹时一致;而餐后TG、RLP-C水平增高。餐后TG、RLP-C水平与TNF-α、IL-6、UACR水平相关;合并DM的SCAD患者餐后血脂水平对其炎症和早期肾损伤具有重要预测价值。

Objective To investigate the effect of dyslipidemia on inflammation and its clinical significance in patients with diabetes mellitus(DM)and stable coronary artery disease(SCAD).Methods We enrolled 44 patients with DM and SCAD in the Department of Cardiology of Shengjing Hospital between September 2016 and February 2017.Blood lipid,fasting glucose,and glycated hemoglobin levels,and urinary microalbumin to creatinine ratio(UACR)were determined,and serum interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-α)levels were determined using enzyme-linked immunosorbent assay.Results Compared with fasting levels,4 h postprandial serum total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)levels showed no significant difference(P>0.05);however,triglyceride(TG)and remnant lipoprotein-cholesterol(RLP-C)levels increased significantly(P<0.01).Pearson correlation analysis showed that TG and RLP-C were positively associated with both fasting(r=0.686,P<0.01)and postprandial conditions(r=0.814,P<0.01).Postprandial TG was positively associated with IL-6(r=0.541,P<0.001),TNF-α(r=0.684,P<0.001),and UACR(r=0.339,P=0.026);RLP-C was positively associated with IL-6(r=0.391,P<0.001),TNF-α(r=0.527,P<0.001),and UACR(r=0.341,P=0.025),and IL-6(r=0.503,P=0.001),and TNF-α(r=0.525,P<0.001)were also positively associated.Conclusion In patients with DM and SCAD,postprandial TC and LDL-C were consistent with the fasting state;TG and RLP-C showed significant increases.Postprandial TG and RLP-C were strongly associated with TNF-α,IL-6,and UACR.The postprandial lipid profile has important predictive value for inflammation and early renal impairment.