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目的分析老年2型糖尿病患者血清脂联素水平和早期动脉粥样硬化的关系。方法将55例老年2型糖尿病患者根据颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)进行分组,29例CIMT≤0.9mm的2型糖尿病患者为非动脉粥样硬化组,另外26例CIMT>0.9mm或发现动脉斑块的2型糖尿病患者为动脉粥样硬化组,并配对选取25例非糖尿病的健康者为对照组。同时收集入选者的临床资料,包括年龄、性别、体质量指数(BMI)、踝臂指数(ABI)、糖化血红蛋白(HbA1c)、血糖、空腹血脂以及胰岛素等生化指标,并计算稳态模型(HomaModel)的胰岛素抵抗指数HomaIR=(FINS×FPG)/22.5,取其自然对数值;用酶联免疫法测定入选者的血清脂联素。结果(1)动脉粥样硬化组的血清脂联素显著低于非动脉粥样硬化组及对照组。(2)相关性研究显示脂联素与血糖、HbA1c、高敏C反应蛋白(hs-CRP)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、CIMT负相关(r=-0.30,r=-0.32,r=-0.23,r=-0.66,r=-0.83,r=-0.63,r=-0.77,r=-0.33;P<0.01),而与高密度脂蛋白胆固醇(HDL-C)、踝臂指数正相关(r=0.89,r=0.35;P<0.01)。(3)多元逐步回归分析显示低密度脂蛋白胆固醇与高密度脂蛋白胆固醇是影响血清脂联素水平的独立因素。结论在老年2型糖尿病患者中,血清脂联素降低与动脉粥样硬化密切相关。
Objective To analyze the relationship between serum adiponectin level and early atherosclerosis in elderly type 2 diabetic patients. Methods Fifty-five elderly patients with type 2 diabetes were divided into two groups according to carotid intima-media thickness (CIMT). Twenty-nine patients with type 2 diabetes with CIMT≤0.9mm were non-atherosclerotic. Another 26 patients Type 2 diabetic patients with CIMT> 0.9 mm or atherosclerotic plaque were atherosclerotic and 25 matched non-diabetic controls were matched. The clinical data including age, sex, body mass index (BMI), ABI, HbA1c, blood glucose, fasting blood lipid and insulin were also collected. The steady state model (Homa Model ) Insulin resistance index HomaIR = (FINS × FPG) /22.5, whichever is natural logarithm; serum adiponectin levels were determined by enzyme-linked immunosorbent assay. Results (1) Serum adiponectin in atherosclerotic group was significantly lower than non-atherosclerosis group and control group. (2) The correlation study showed that adiponectin was significantly associated with blood glucose, HbA1c, hs-CRP, TC, LDL-C, TG, CIMT (R = -0.30, r = -0.32, r = -0.23, r = -0.66, r = -0.83, r = -0.63, r = -0.77, r = -0.33, P <0.01) High density lipoprotein cholesterol (HDL-C) and ankle brachial index were positively correlated (r = 0.89, r = 0.35; P <0.01). (3) Multiple stepwise regression analysis showed that low density lipoprotein cholesterol and high density lipoprotein cholesterol were independent factors affecting the level of serum adiponectin. Conclusion In elderly patients with type 2 diabetes, the decrease of serum adiponectin is closely related to atherosclerosis.