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目的探讨2型糖尿病(T2DM)血管病变与血脂和脂蛋白水平的关系,为提高对糖尿病的认识、重视早期诊断、有效预防和治疗并发症提供依据。方法选取2013年11月至2014年12月在西京医院和口腔医院综合科住院并诊断为T2DM的130例患者为研究对象,依据临床表现将患者分为4组(无血管并发症组、视网膜微血管病组、肾脏病组和冠心病组)。并选择同期西京医院60例健康体检者为对照组。从130例T2DM患者中选出60例,初检血糖水平≥11.10 mmol/L为A组,≤11.09 mmol/L为B组,每组30例。测定T2DM患者和健康对照者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A-I(APOA-I)和载脂蛋白B(APOB)的水平。应用SPSS13.0统计软件进行t检验和方差分析。结果 T2DM各组TG、TC、LDL-C、APOB和APOA-I/APOB与对照组比,差异均有统计学意义(P<0.05,P<0.01)。无血管并发症组、视网膜微血管病组、肾脏病组和冠心病组TG和APOB水平均高于对照组,APOA-I/APOB低于对照组,差异均有统计学意义(P<0.05,P<0.01)。肾脏病组和冠心病组LDL-C水平均高于对照组,差异均有统计学意义(P<0.01)。A组的APOA-I/APOB(0.9±0.3)明显低于B组(1.2±0.5),而A组TC、TG、LDL-C和APOB水平均明显高于B组,差异均有统计学意义(P<0.01,P<0.05)。结论 T2DM患者血脂和载脂蛋白水平与血管并发症关系密切,APOA-I/APOB比值是反映T2DM脂质代谢紊乱和动脉粥样硬化的敏感指标,APOB可能是血管内皮细胞功能受损而致动脉粥样硬化的早期标志。
Objective To investigate the relationship between vascular changes of type 2 diabetes mellitus (T2DM) and serum lipids and lipoproteins, and to provide evidences for improving the understanding of diabetes, paying attention to early diagnosis and preventing and treating complications. Methods 130 patients diagnosed as T2DM from Xijing Hospital and Stomatology Hospital from November 2013 to December 2014 were selected as the research objects. The patients were divided into 4 groups according to the clinical manifestations (no vascular complications group, retinal microvascular Disease group, kidney disease group and coronary heart disease group). Sixty healthy subjects in Xijing Hospital of the same period were selected as the control group. Sixty patients were selected from 130 patients with T2DM. The initial blood glucose level was 11.10 mmol / L in group A, and 11.09 mmol / L in group B, with 30 in each group. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein AI (APOA- I) and apolipoprotein B (APOB) levels. SPSS13.0 statistical software was used for t test and analysis of variance. Results The differences of TG, TC, LDL-C, APOB and APOA-I / APOB between T2DM group and control group were statistically significant (P <0.05, P <0.01). The levels of TG and APOB in non-vascular complication group, retinal microangiopathy group, nephropathy group and coronary heart disease group were higher than those in control group, APOA-I / APOB was lower than that in control group (P <0.05, P <0.01). The levels of LDL-C in kidney disease group and coronary heart disease group were higher than those in control group, with statistical significance (P <0.01). The APOA-I / APOB (0.9 ± 0.3) in group A was significantly lower than that in group B (1.2 ± 0.5), while the levels of TC, TG, LDL-C and APOB in group A were significantly higher than those in group B (P <0.01, P <0.05). Conclusions The levels of serum lipids and apolipoproteins in T2DM patients are closely related to the vascular complications. The APOA-I / APOB ratio is a sensitive index to reflect the disturbance of lipid metabolism and atherosclerosis in T2DM. APOB may be an impaired function of vascular endothelial cells Early signs of atherosclerosis.