2型糖尿病患者血浆同型半胱氨酸、脂蛋白a与颈动脉粥样硬化的相关性分析

Correlation between plasma levels of homocysteine and lipoprotein (a) and carotid atherosclerosis in patients with type 2 diabetes mellitus

摘要:

目的 探讨2型糖尿病患者血浆同型半胱氨酸（Hcy）、脂蛋白a［LP（a）］与颈动脉粥样硬化的相关性。方法 选取2018年9月—2019年9月在承德医学院附属医院内分泌科就诊的100例2型糖尿病患者作为病例组。另选取同期该院50例健康体检者作为对照组。比较两组颈动脉内-中膜厚度（IMT）。根据IMT测定结果，将病例组患者分为IMT正常组（IMT< 0.9 mm）、IMT增厚组（IMT≥ 0.9 mm），分别有56和44例。比较两组一般资料、糖脂代谢指标以及血浆Hcy、LP（a）水平，并将差异有统计学意义的指标作为自变量，采用多元线性逐步回归分析2型糖尿病患者IMT增厚的影响因素。根据颈动脉内斑块回声性质将病例组分为无斑块组、稳定斑块组、不稳定斑块组，分别有68例、18例和14例。比较3组血浆Hcy、LP（a）水平。采用Pearson法分析血浆Hcy与LP（a）表达水平的相关性。结果 病例组IMT高于对照组（P <0.05）。IMT增厚组患者年龄、吸烟患者占比、SBP及血清TG、血浆Hcy、LP（a）较IMT正常组高（P <0.05），病程较IMT正常组长（P <0.05）。多元线性逐步回归分析显示，年龄、病程、吸烟、TG、Hcy及LP（a）水平是2型糖尿病患者IMT增厚的风险因素（P <0.05）。不稳定斑块组患者血浆Hcy、LP（a）水平高于稳定斑块组和无斑块组（P <0.05），稳定斑块组患者血浆Hcy、LP（a）水平高于无斑块组（P <0.05）。Pearson相关性分析显示，血浆Hcy与LP（a）表达水平呈正相关（r =0.671，P <0.05）。结论 2型糖尿病患者IMT增厚受多种因素影响，其中血浆Hcy、LP（a）水平升高是IMT增厚的危险因素，且与颈动脉内斑块稳定性密切相关；此外，血浆Hcy与LP（a）表达水平密切相关。

Abstract:

Objective To investigate the correlation between plasma levels of homocysteine (Hcy) and lipoprotein (a) [LP (a)] and carotid atherosclerosis in patients with type 2 diabetes mellitus.Methods The clinical data of 100 patients with type 2 diabetes mellitus admitted to the Department of Endocrinology in our hospital from September 2018 to September 2019 (case group) were retrospectively analyzed. In addition, 50 healthy people undergoing physical examination during the same period in our hospital were selected as the control group. The carotid intima-media thickness (IMT) was compared between the two groups, and the case group was further divided into IMT normal group (IMT < 0.9 mm, n = 56) and IMT thickening group (IMT ≥ 0.9 mm, n = 44) according to the carotid IMT. The general data, glycolipid metabolism, and the plasma levels of Hcy and LP (a) were compared between the two groups, and the stepwise multiple linear regression analysis was performed to determine the factors contributing to the increased IMT in type 2 diabetic patients. According to the carotid plaque echogenicity, the 100 patients were divided into non-plaque group (n = 68), stable plaque group (n = 18) and unstable plaque group (n = 14). The plasma levels of Hcy and LP (a) were compared between the three groups, and the correlation between the plasma level of Hcy and that of LP (a) was analyzed with the Pearson correlation method.Results The IMT was greater in the case group than that in the control group (P < 0.05). Compared with the IMT normal group, the IMT thickening group exhibited a greater age, a longer disease duration, a higher proportion of smokers, and higher systolic blood pressure (SBP), serum levels of triglyceride (TG), and plasma levels of Hcy and LP (a) (P < 0.05). The stepwise multiple linear regression analysis revealed that age, disease duration, history of smoking, serum levels of TG, and plasma levels of Hcy and LP (a) were factors contributing to an increase in IMT in type 2 diabetic patients (P < 0.05). The plasma levels of Hcy and LP (a) in the unstable plaque group were higher than those in the stable plaque group and non-plaque group (P < 0.05), while they were even higher in the stable plaque group relative to those in the non-plaque group (P < 0.05). Furthermore, there was a positive correlation between the plasma level of Hcy and that of LP (a) (r = 0.671, P < 0.05).Conclusions The increased IMT in type 2 diabetic patients is affected by many factors, of which the elevated plasma levels of Hcy and LP (a) are risk factors for an increase in IMT and are closely related to carotid plaque stability. In addition, the plasma level of Hcy is strongly associated with that of LP (a).