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目的:探讨瘦素(leptin,Lp)在2型糖尿病(T2DM)并发冠心病(CHD)发生发展过程中的作用及其相关性,探讨降糖药对Lp水平的影响。方法:选择正常对照者30例(A组)、T2DM患者60例(B组)、T2DM合并CHD患者60例(C组),收集所有研究对象的一般临床资料如空腹血脂、血糖、Lp,并把C组中的男女分别随机分配到胰岛素治疗组(T1组)、胰岛素加罗格列酮治疗组(T2组)、二甲双胍治疗组(T3组)进行血糖控制,分别对治疗前后进行统计分析。结果:Lp水平在C组较A、B组均显著升高(P<0.05),但在A、B组之间差异无显著性(P>0.05)。相关分析显示,Lp在A组与体质指数、腰臀比(WHR)、空腹胰岛素呈正相关,在B组与甘油三酯、极低密度脂蛋白胆固醇呈正相关,在C组与总胆固醇、低密度脂蛋白胆固醇呈正相关。Logistic逐步回归分析显示,年龄、WHR、脂蛋白(a)、Lp是T2DM并发CHD的独立危险因素。而C组患者经降糖治疗后发现,T2和T3组Lp水平显著降低(P<0.05)。结论:Lp是T2DM并发CHD的独立危险因素之一。罗格列酮和二甲双胍均能降低Lp水平,进而可能降低T2DM并发CHD的发病率。
Objective: To investigate the role and correlation of leptin (Lp) in the development of type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD) and to explore the effect of hypoglycemic agents on Lp level. Methods: Thirty healthy controls (group A), 60 patients with T2DM (group B) and 60 patients with T2DM complicated with CHD (group C) were enrolled. The clinical data of all subjects including fasting blood lipids, blood glucose, Lp and The men and women in group C were randomly assigned to insulin treatment group (T1 group), insulin plus rosiglitazone treatment group (T2 group) and metformin treatment group (T3 group) for blood glucose control, respectively, before and after treatment for statistical analysis. Results: The level of Lp in group C was significantly higher than that in group A and B (P <0.05), but there was no significant difference between group A and group B (P> 0.05). Correlation analysis showed that Lp was positively correlated with body mass index, WHR, fasting insulin in group A, positively correlated with triglyceride and very low density lipoprotein cholesterol in group B. In group C, it was positively correlated with total cholesterol, low density Lipoprotein cholesterol was positively correlated. Logistic stepwise regression analysis showed that age, WHR, lipoprotein (a), Lp were independent risk factors for T2DM complicated with CHD. The C group of patients with hypoglycemic treatment found that T2 and T3 Lp levels were significantly lower (P <0.05). Conclusion: Lp is one of the independent risk factors of T2DM complicated with CHD. Rosiglitazone and metformin both lower the Lp level, which may reduce the incidence of T2DM complicated by CHD.