摘要
背景血浆致动脉粥样硬化指数(AIP)与低密度脂蛋白胆固醇(LDL-C)颗粒直径及胰岛素抵抗密切相关,但其与2型糖尿病患者冠心病发生情况及其冠状动脉病变关系的研究报道较少。目的探讨AIP与2型糖尿病患者并发冠心病及其冠状动脉狭窄程度的关系。方法选取2016年1月—2018年10月汉中市中心医院收治的2型糖尿病患者501例,根据冠状动脉狭窄程度分为对照组114例(未合并冠心病)、低危狭窄组203例(合并冠心病且syntax积分≤22分)和高危狭窄组184例(合并冠心病且syntax积分>22分)。比较三组患者性别、年龄、体质指数(BMI)、高血压发生情况、吸烟史、实验室检查指标〔包括总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、LDL-C、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、AIP〕及syntax积分;2型糖尿病患者并发冠心病、2型糖尿病并发冠心病患者冠状动脉狭窄程度影响因素分析采用单因素及多因素Logistic回归分析,并绘制受试者工作特征(ROC)曲线分析AIP对2型糖尿病患者并发冠心病及其冠状动脉狭窄程度的预测价值。结果三组患者性别、年龄、高血压发生率、吸烟史、FBG比较,差异无统计学意义(P>0.05)。高危狭窄组患者BMI、TC、TG、non-HDL-D、LDL-C、ApoB、HbA1c、AIP高于对照组,HDL-C、ApoA1低于对照组,BMI、TG、non-HDL-D、LDL-C、ApoB、AIP高于低危狭窄组(P<0.05);低危狭窄组患者TC、HbA1c、AIP高于对照组,HDL-C、ApoA1低于对照组(P<0.05)。多因素Logistic回归分析结果显示,HDL-C〔OR=0.35,95%CI(0.15,0.83)〕、non-HDL-C〔OR=1.47,95%CI(1.16,1.86)〕、LDL-C〔OR=1.32,95%CI(1.03,1.74)〕、ApoA1〔OR=0.31,95%CI(0.11,0.80)〕、HbA1c〔OR=1.56,95%CI(1.25,1.95)〕、AIP〔OR=3.29,95%CI(1.27,8.50)〕是2型糖尿病患者并发冠心病的独立影响因素(P<0.05);TG〔OR=1.29,95%CI(1.05,1.59)〕、non-HDL-C〔OR=2.11,95%CI(1.60,2.78)〕、LDL-C〔OR=1.85,95%CI(1.43,2.38)〕、ApoB〔OR=5.03,95%CI(2.09,12.01)〕、HbA1c〔OR=1.32,95%CI(1.13,1.54)〕、AIP〔OR=2.74,95%CI(1.03,5.93)〕是2型糖尿病并冠心病患者冠状动脉狭窄程度的独立影响因素(P<0.05)。ROC曲线显示,AIP预测2型糖尿病患者并发冠心病及其冠状动脉狭窄程度的ROC曲线下面积(AUC)均大于non-HDL-C及LDL-C(P<0.05)。结论AIP是2型糖尿病患者并发冠心病的独立影响因素,同时也是2型糖尿病并发冠心病患者冠状动脉狭窄程度的独立影响因素,且具有较高的预测价值。
Background The atherogenic index of plasma(AIP)is closely related to the diameter of low density lipoprotein cholesterol(LDL-C)particlesand insulin resistance,but there are few reports about the relationship between AIP and coronary heart disease and coronary artery disease in patients with type 2 diabetes mellitus.Objective To discuss the relationship between AIP and coronary heart disease and degree of coronary artery stenosis in type 2 diabetes mellitus patients.Methods From January 2016 to October 2018,a total of 501 patients with type 2 diabetes mellitus were selected in Hanzhong Central Hospital,and they were divided into control group(114 patients without coronary heart disease),low risk stenosis group(203 patients complicated with coronary heart disease and syntax score≤22)and high risk stenosis group(184 patients complicated with coronary heart disease and syntax score>22).Gender,age,body mass index(BMI),incidence of hypertension,smoking history,laboratory indicators〔including total cholesterol(TC),triacylglycerol(TG),high density lipoprotein cholesterol(HDL-C),non-HDL-C,LDL-C,apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),AIP〕and syntax score were comapred in the three groups.The influencing factors of coronary heart disease of type 2 diabetes mellitus patients and the degree of coronary artery stenosis in patients with type 2 diabetes mellitus complicated with coronary heart disease were analysed by univariate and multivariate Logistic regression analysis,ROC curve were drawn to analyse the value of AIP in predicting coronary heart disease and the degree of coronary artery stenosis in patients with type 2 diabetes mellitus.Results There was no significant difference in gender,age,incidence of hypertension,smoking rate and FBG in the three groups(P>0.05).In high risk stenosis group,BMI,TC,TG,non-HDL-D,LDL-C,ApoB,HbA1c,AIP were higher than those in control group,HDL-C and ApoA1 were lower than those in control group,BMI,TG,non-HDL-D,LDL-C,ApoB and AIP were higher than those in low risk stenosis group(P<0.05);while in low risk stenosis group,TC,HbA1c and AIP were higher than those in control group,HDL-C and ApoA1 were lower than those in control group(P<0.05).Multivariate Logistic regression analysis showed that,HDL-C〔OR=0.35,95%CI(0.15,0.83)〕,non-HDL-C〔OR=1.47,95%CI(1.16,1.86)〕,LDL-C〔OR=1.32,95%CI(1.03,1.74)〕,ApoA1〔OR=0.31,95%CI(0.11,0.80)〕,HbA1c〔OR=1.56,95%CI(1.25,1.95)〕and AIP〔OR=3.29,95%CI(1.27,8.50)〕were indenpent influencing factors of coronary heart disease in patients with type 2 diabetes mellitus(P<0.05);TG〔OR=1.29,95%CI(1.05,1.59)〕,non-HDL-C〔OR=2.11,95%CI(1.60,2.78)〕,LDL-C〔OR=1.85,95%CI(1.43,2.38)〕,ApoB〔OR=5.03,95%CI(2.09,12.01)〕,HbA1c〔OR=1.32,95%CI(1.13,1.54)〕and AIP〔OR=2.74,95%CI(1.03,5.93)〕were indenpent influencing factors of the degree of coronary artery stenosis in patients with type 2 diabetes mellitus complicated with coronary heart disease(P<0.05).ROC curve analysis showed that,the AUC of AIP in predicting coronary artery severityand the degree of coronary artery stenosis in type 2 diabetes mellitus patients was larger than that in non-HDL-C and LDL-C(P<0.05).Conclusion AIP is not only an independent influencing factor of coronary heart disease in patients with type 2 diabetes mellitus,but also an independent influencing factor of the degree of coronary artery stenosis in type 2 diabetes mellitus patients complicated with coronary heart disease,and has high predictive value for them.
作者
王露朝
柴小奇
陈玉军
李子杰
WANG Luzhao;CHAI Xiaoqi;CHEN Yujun;LI Zijie(Department of Cardiovascular Medicine,Hanzhong Central Hospital,Hanzhong 723000,China)
出处
《实用心脑肺血管病杂志》
2020年第6期22-27,35,共7页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
陕西省卫生健康科研基金(2018D013)。
