2型糖尿病伴下肢血管病变患者血清人血管生成素样蛋白4、脂蛋白相关磷脂酶A2、脂联素与其病情程度的关系及相关影响因素

Relationship between human angiopoietin like protein 4,lipoprotein-associated phospholipase A2,adiponectin and the severity of disease in patients with type 2 diabetes mellitus with lower limb vascular disease and its related influencing factors

探讨2型糖尿病(T2DM)伴下肢血管病变(LVD)患者血清人血管生成素样蛋白4(ANGPTL4)、脂蛋白相关磷脂酶A2(Lp-PLA2)、脂联素(APN)与其病情程度的关系及相关影响因素。方法选取T2DM伴LVD患者96例,根据LVD严重程度分为重度组(48例)、中度组(24例)及轻度组(24例)。收集3组患者的一般资料及实验室检查结果[低密度脂蛋白胆固醇(LDL-C)、血清空腹胰岛素(FINS)、稳态胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)及血清ANGPTL4、LP-PLA2、APN]并比较。采用logistic回归分析对T2DM患者LVD的影响因素进行分析。结果随着LVD严重程度增加,轻、中、重度组患者年龄、BMI、HbA1c、FINS、HOMA-IR、血清ANGPTL4、LP-PLA2水平依次增加,而血清APN水平依次降低(P<0.05)。单因素分析结果显示,不同年龄、BMI、HbA1c、HOMA-IR、血清ANGPTL4、LP-PLA2、APN水平患者LVD发生率比较差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,APN水平升高为T2DM患者发生LVD的保护因素,而高龄及HOMA-IR、ANGPTL4、APN、LP-PLA2水平升高为T2DM患者发生LVD的危险因素(P<0.05)。结论年龄、HOMA-IR、ANGPTL4、APN、LP-PLA2水平与T2DM患者LVD显著相关,可为LVD的预防及预后评估提供参考价值。

Objective To investigate the relationship between serum human angiopoietin like protein 4(ANGPTL4),lipoprotein-associated phospholipase A2(Lp-PLA2),adiponectin(APN)and the severity of disease in patients with type 2 diabetes mellitus(T2DM)with lower limb vascular disease(LVD)and its related influencing factors.Methods Ninety-six T2DM patients with LVD were selected and divided into severe group(48 cases),moderate group(24 cases)and mild group(24 cases)according to the severity of LVD.The general data and laboratory examination results[low density lipoprotein cholesterol(LDL-C),serum fasting insulin(FINS),homeostatic model assessment of insulin resistance(HOMA-IR),glycated hemoglobin(HbA1c),serum ANGPTL4,Lp-PLA2,APN]of the 3 groups were collected and compared.Logistic regression analysis was used to analyze the influencing factors of LVD in T2DM patients.Results With the increase of LVD severity,age,BMI,HbA1c,FINS,HOMA-IR,serum ANGPTL4 and Lp-PLA2 in mild,moderate and severe groups increased in turn,while the level of serum APN decreased in turn(P<0.05).Univariate analysis results showed that there were statistically significant differences in the incidence of LVD among patients with different ages,BMI,HbA1c,HOMA-IR,serum ANGPTL4,LP-PLA2 and APN levels(P<0.05).Logistic regression analysis showed that elevated APN level was a protective factor for LVD in T2DM patients,while advanced age and elevated levels of HOMA-IR,ANGPTL4,APN and Lp-PLA2 were risk factors for LVD in T2DM patients(P<0.05).Conclusion Age,HOMA-IR,ANGPTL4,APN and Lp-PLA2 levels are significantly correlated with LVD in T2DM patients,which could provide reference value for the prevention and prognosis evaluation of LVD.