人血浆脂蛋白磷脂酶A2和C反应蛋白与冠心病合并2型糖尿病的关系

ASSOCIATION OF LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 AND C-REACTIVE PROTEIN WITH CORONARY HEART DISEASE WITH TYPE 2 DIABETES MELLITUS

目的探讨冠状动脉粥样硬化性心脏病(冠心病,CHD)合并2型糖尿病(T2DM)病人人血浆脂蛋白磷脂酶A2(Lp-PLA2)和C反应蛋白(CRP)水平变化及其临床意义。方法选取1051例住院病人作为研究对象,其中非CHD非T2DM病人(对照组)268例,单纯CHD病人(CHD组)263例,单纯T2DM病人(T2DM组)234例,CHD合并T2DM病人(CHD+T2DM组)286例。比较各组Lp-PLA2、CRP水平的差异;采用Logistic回归分析Lp-PLA2、CRP对CHD合并T2DM发病的影响;应用受试者工作特征(ROC)曲线分析Lp-PLA2、CRP对CHD合并T2DM发病的预测价值。结果CHD+T2DM组病人Lp-PLA2、CRP水平明显高于对照组、CHD组和T2DM组(F=127.24、84.25,t=6.71~19.08,P<0.05)。Logistic回归分析显示,Lp-PLA2(OR=1.029,95%CI=1.021~1.037,P<0.001)、CRP(OR=1.668,95%CI=1.376~2.022,P<0.001)是CHD合并T2DM发病的危险因素。Lp-PLA2、CRP及两者联合检测预测CHD合并T2DM发病的ROC曲线下面积分别为0.814、0.790和0.921。分别以179μg/L、5.1 mg/L为截断值,Lp-PLA2、CRP预测CHD合并T2DM发病的灵敏度分别为65.03%、67.13%,特异度分别为88.06%、82.46%,两者联合预测的灵敏度和特异度分别为80.77%、89.55%。结论Lp-PLA2、CRP是CHD合并T2DM的危险因素,两个指标联合检测可提高预测CHD合并T2DM发病的灵敏度和特异度。

Objective To investigate the changes in the levels of lipoprotein-associated phospholipase A2(Lp-PLA2)and C-reactive protein(CRP)and their clinical significance in patients with coronary heart disease(CHD)with type 2 diabetes mellitus(T2 DM).Methods A total of 1051 inpatients were enrolled in this study and divided into patients without CHD or T2 DM(control group,n=268),patients with CHD alone(CHD group,n=263),patients with T2 DM alone(T2 DM group,n=234),and patients with CHD and T2 DM(CHD+T2 DM group,n=286).The four groups were compared in terms of the levels of Lp-PLA2 and CRP.Logistic regression was used to analyze the effects of Lp-PLA2 and CRP on the development of CHD complicated with T2 DM.The receiver operating characteristic(ROC)curve was applied to analyze the predictive value of Lp-PLA2 and CRP for the development of CHD complicated with T2 DM.Results Compared with the control group,CHD group,and T2 DM group,the CHD+T2 DM group had significantly higher levels of Lp-PLA2 and CRP(F=127.24,84.25;t=6.71-19.08;P<0.05).The Logistic regression analysis showed that Lp-PLA2(OR=1.029,95%CI=1.021-1.037,P<0.001)and CRP(OR=1.668,95%CI=1.376-2.022,P<0.001)were risk factors for CHD with T2 DM.The areas under the ROC curves of Lp-PLA2,CRP,and combined measurement of them for predicting CHD with T2 DM were 0.814,0.790 and 0.921,respectively.When using Lp-PLA2=179μg/L and CRP=5.1 mg/L as cut-off values,the sensitivities of Lp-PLA2 and CRP for predicting CHD with T2 DM were 65.03%and 67.13%,respectively,and the specificities were 88.06%and 82.46%,respectively.And the combination of Lp-PLA2 and CRP for predicting CHD with T2 DM had a sensitivity of 80.77%and a specificity of 89.55%.Conclusion Lp-PLA2 and CRP are risk factors for CHD with T2 DM.The combined measurement of Lp-PLA2 and CRP can improve the sensitivity and specificity for predicting CHD with T2 DM.