血清淀粉样蛋白A与冠心病合并糖尿病患者高密度脂蛋白胆固醇外流能力的相关性

Correlation between the serum amyloid A protein and the cholesterol efflux capacity in patients with coronary heart disease and diabetes mellitus

目的探讨冠心病合并糖尿病患者血浆高密度脂蛋白(HDL)胆固醇外流能力的变化及其影响因素。方法选取北京大学第三医院心内科住院并经冠状动脉造影证实的冠心病患者140例为研究对象,依据是否合并糖尿病分为两组,即冠心病合并糖尿病组70例,单纯冠心病组70例。选取同期入院且经冠状动脉造影证实的非冠心病非糖尿病患者25例作为对照组。采用放射性核素法,建立富集[3H]标记胆固醇的J774巨噬细胞体外模型,以经过处理的受试者血浆(主要含有HDL颗粒)为胆固醇接受体诱导巨噬细胞胆固醇流出,测得HDL胆固醇外流能力(CEC);通过检测患者血浆髓过氧化物酶(MPO)、血清淀粉样蛋白A(SAA)水平评估其氧化应激、炎症程度及分析其与CEC的相关性,初步探索合并糖代谢异常的冠心病患者CEC变化的可能机制。结果冠心病合并糖尿病患者的CEC显著低于单纯冠心病患者(P<0.05)。冠心病合并糖尿病患者血浆SAA水平较单纯冠心病患者有所增加,但差异无统计学意义(P>0.05),而冠心病合并糖尿病患者血浆SAA水平与CEC负相关(r=-0.260,P<0.05)。冠心病合并糖尿病患者血浆MPO水平较单纯冠心病患者并无增加(P>0.05),而且冠心病合并糖尿病患者的MPO水平与CEC不相关(r=0.046,P>0.05)。结论糖代谢异常导致冠心病患者的HDL胆固醇外流能力下降;炎症可能是冠心病合并糖尿病患者HDL胆固醇外流能力下降的影响因素。

Aim To investigate the cholesterol efflux capacity(CEC)of plasma high-density lipoprotein(HDL)in coronary heart disease(CHD)patients with diabetes and its influencing factors.Methods 140 patients who were diagnosed as CHD by coronary angiography had one or more artery lesion degree>50%.They were divided into two groups:the CHD with diabetic mellitus(DM)group(n=70)and the CHD without DM group(n=70),patients without CHD confirmed by coronary angiography was taken an controls(n=25).The capacity of HDL to induce cellular cholesterol efflux was determined by measuring the transfer of[3H]cholesterol from J774 macrophages to the medium containing the ApoB-deleted plasma.The levels of myeloperoxidase(MPO)and serum amyloid A protein(SAA)in plasma were measured to evaluate the level of oxidative stress and inflammation.The correlation between CEC and the above indexes(MPO,SAA)was analyzed.Results The cholesterol efflux capacity in CHD patients with diabetes was significantly lower than that in CHD patients without diabetes(P<0.05);The level of SAA was increased in CHD patients with diabetes than that in CHD patients without diabetes,but the difference was not statistically significant(P>0.05).And plasma SAA level in CHD patients with diabetes were negatively correlated with CEC(r=-0.260,P<0.05).Moreover,the level of MPO in CHD patients with diabetes was not higher than that in CHD patients without diabetes,there was no correlation between MPO and CEC in CHD patients with diabetes.Conclusion CHD patients with diabetes has more impaired CEC compared with those without diabetes.Inflammation is a possible mechanism of CEC decline caused by abnormal glucose metabolism in patients with CHD.