ACS合并糖尿病患者高密度脂蛋白和游离脂肪酸水平与不良心血管结局的关系

Relationship between high-density lipoprotein and free fatty acid levels in ACS patients with diabetes mellitus and adverse cardiovascular outcomes

目的探讨高密度脂蛋白和游离脂肪酸水平与急性冠状动脉综合征(ACS)合并糖尿病患者的主要不良心血管事件和死亡的关系。方法收集400例患者的病例资料,并随机分为阿格列汀治疗组(210例)与安慰剂组(190例)。入院时检测患者血清中的高密度脂蛋白及游离脂肪酸的水平。3个月后,过夜禁食至少8 h后检测血清中高密度脂蛋白、游离脂肪酸的水平。随访记录患者心血管死亡、非致命性心肌梗死或非致命性中风的时间。结果 2组患者的一般资料除利尿剂(P<0.001)的使用外,差异均无统计学意义(P>0.05);与安慰剂组相比,经阿格列汀治疗后,患者的高密度脂蛋白和游离脂肪酸水平显著下降(P<0.001);阿格列汀治疗组与安慰剂组相比较,心血管死亡事件的发生率显著降低(P=0.02),其风险比也有差异(P=0.03);游离脂肪酸水平较低的患者其心血管死亡率显著低于水平较高的患者(P=0.02);高密度脂蛋白水平较低的患者其心血管死亡率显著低于水平较高的患者(P=0.02)。结论在ACS合并糖尿病患者中,高密度脂蛋白和游离脂肪酸水平与不良心血管结局呈正相关。

Objective To investigate the relationship between high-density lipoprotein(HDL) and free fatty acid(FFA) levels and major adverse cardiovascular events and death in patients with acute coronary syndrome(ACS) complicated with diabetes. Methods Case data of 400 patients were collected and randomly divided into alogliptin treatment group(210 cases) and placebo group(190 cases). The levels of HDL and FFA in patient′s serum were measured at admission. After 3 months, the levels of HDL and FFA in the serum were measured after fasting for at least 8 h overnight. Follow-up was performed to record the time of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Results The general data of the two groups were not statistically significant(P>0.05) except for the use of diuretics(P<0.001). Compared with the placebo group, the HDL and FFA levels were significantly decreased in alogliptin treatment group(P<0.001). The incidence of cardiovascular deaths was significantly lower in the alogliptin treatment group than in the placebo group(P=0.02), and the hazard ratio was also different(P=0.03). Cardiovascular mortality was significantly lower in patients with low level FFA than with high level(P=0.02). When the serum HDL was low, the cardiovascular mortality was significantly lower in low level of HDL than in high level of HDL(P=0.02). Conclusion HDL and FFA levels were positively associated with adverse cardiovascular outcomes in patients with ACS complicated with diabetes.