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目的探讨下肢股动脉超声检查联合可溶性低密度脂蛋白受体相关蛋白1(s LRP1)、同型半胱氨酸(Hcy)水平检测在2型糖尿病(T2DM)合并心肌梗死(AMI)中的应用价值及其相关性。方法选取秦皇岛市第一医院2013年3月至2015年3月入院的单纯T2DM患者(单纯T2DM组,155例)、T2DM合并急性心肌梗死患者(T2DM合并AMI组,120例)为研究对象,并选取同期健康体检者作为对照(对照组,130例)。全部受试对象均进行下肢股动脉超声检查,测量其股动脉内-中膜厚度(IMT),观察股动脉血管硬化情况,并按照检查结果分为IMT正常组、IMT增厚组、不稳定斑块组(软斑块与混合斑块)、稳定斑块组(硬斑块);全部受试对象均测定血浆中s LRP1、Hcy、甘油三酯(TG)、总胆固醇(TC)及高密度脂蛋白胆固醇(HDL-C)的水平,并进行比较。结果单纯T2DM组、T2DM合并AMI组患者TC、TG、s LRP1、Hcy水平及IMT值较对照组显著升高,HDL-C水平下降,差异均有统计学意义(P均<0.05);单纯T2DM组与T2DM合并AMI组TC、TG、HDL-C水平比较无统计学差异(P均>0.05);T2DM合并AMI组s LRP1、Hcy水平及IMT值较单纯T2DM组升高,差异均有统计学意义(P均<0.05)。根据超声结果对股动脉硬化程度进行分组,其中IMT增厚组、不稳定斑块组、稳定斑块组中Hcy、s LRP1水平均高于IMT正常组(P<0.05),且Hcy水平在四组间呈逐渐升高趋势(P<0.05),s LRP1水平在不稳定斑块组最高(P<0.05)。结论股动脉血管硬化严重程度与s LRP1、Hcy水平升高与T2DM患者并发急性心肌梗死具有相关性,可为T2DM患者发生心血管疾病的早期预防、诊断及治疗提供临床依据。
Objective To investigate the value of sLRP1 and homocysteine (Hcy) in the detection of lower extremity femoral artery ultrasonography in type 2 diabetes mellitus (T2DM) with myocardial infarction (AMI) And their relevance. Methods A total of 120 T2DM patients (T2DM group, 155 patients) admitted to the First Hospital of Qinhuangdao from March 2013 to March 2015 and 120 patients with T2DM complicated with AMI (T2DM combined with AMI group) Select the same period of healthy physical examination as a control (control group, 130 cases). All the subjects underwent ultrasonography of the femoral artery of the lower extremity to measure the IMT of the femoral artery and observe the vascular sclerosis of the femoral artery. According to the results of the examination, they were divided into IMT normal group, IMT thickening group, unstable plaque (Soft plaque and mixed plaque), stable plaque group (hard plaque); all subjects were measured plasma s LRP1, Hcy, triglyceride (TG), total cholesterol (TC) and high density Lipoprotein cholesterol (HDL-C) levels were compared and compared. Results The levels of TC, TG, s LRP1, Hcy and IMT in T2DM group and T2DM with AMI group were significantly higher than those in control group and HDL-C group (all P <0.05) The levels of TC, TG and HDL-C in T2DM combined with AMI had no significant difference (all P> 0.05). The levels of s LRP1, Hcy and IMT in T2DM with AMI were higher than those in T2DM alone Significance (P <0.05). According to the results of ultrasound, the degree of femoral artery sclerosis was grouped. The levels of Hcy, s LRP1 in IMT thickening group, unstable plaque group and stable plaque group were higher than those in IMT normal group (P <0.05) (P <0.05). The level of s LRP1 in the unstable plaque group was the highest (P <0.05). Conclusions The severity of femoral artery sclerosis and the elevated levels of s LRP1 and Hcy correlate with acute myocardial infarction in patients with T2DM. It may provide a clinical basis for early prevention, diagnosis and treatment of cardiovascular disease in patients with T2DM.