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目的观察2型糖尿病(T2DM)大血管病变患者血清视黄醇结合蛋白(RBP)水平变化,并探讨其临床意义。方法将106例T2DM患者分为合并大血管病变组58例、未合并大血管病变组48例,选择体检健康者52例作为正常对照组。用免疫比浊法检测三组血清RBP,按血清RBP水平将T2DM患者分为RBP低水平(RBP≤35 mg/L)组53例、RBP高水平(RBP>35 mg/L)组53例;生化分析仪检测空腹血糖(FPG)、尿酸(UA)、TG、TC、HDL-C、LDL-C、载脂蛋白AⅠ(apo AⅠ)、载脂蛋白B(apo B)、脂蛋白(a)[Lp(a)]、同型半胱氨酸(HCY);用高效液相色谱法检测糖化血红白蛋白(Hb A1C);化学发光法检测空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR);Pearson相关分析RBP与其他指标的相关性;Logistic多元回归分析T2DM大血管病变的影响因素;比较调脂前后T2DM合并大血管病变患者血清RBP水平变化。结果合并大血管病变组患者血清RBP水平高于未合并大血管病变组及正常对照组(P均<0.05);RBP高水平组年龄、病程、BMI、SBP、FPG、FINS、HOMA-IR、Hb A1c、TG、apo B、Lp(a)、LDL-C、UA及HCY与低水平组比较均升高(P均<0.05)。Pearson相关分析结果显示:T2DM大血管病变组血清RBP水平与BMI、病程、SBP、FINS、HOMA-IR、apo B、LDL-C、TG、UA、HCY呈正相关(r分别为0.46、0.38、0.41、0.44、0.36、0.40、0.38、0.62、0.80、0.65,P均<0.05)。Logistic多元回归分析结果显示:年龄、RBP、HCY、Lp(a)、LDL-C是T2DM患者大血管病变的影响因素(OR分别为1.086、1.119、1.514、1.178、3.105,P均<0.05)。T2DM大血管病变患者调脂后血清RBP水平低于调脂前(P<0.05)。结论 T2DMA大血管病变患者血清RBP水平升高,其可能通过导致IR、血脂紊乱等引发或加重T2DM患者大血管病变。
Objective To observe the changes of serum retinol binding protein (RBP) in patients with type 2 diabetes mellitus (T2DM) macroangiopathy and to explore its clinical significance. Methods One hundred and sixty patients with T2DM were divided into 58 cases with macrovascular complications, 48 cases without macrovascular complications, and 52 cases with healthy subjects were selected as normal control group. Three groups of serum RBP were detected by immunoturbidimetry. 53 patients with low RBP (RBP≤35 mg / L) and 53 RBP high (RBP> 35 mg / L) Biochemical analyzer was used to detect fasting blood glucose (FPG), uric acid (UA), TG, TC, HDL-C, LDL-C, apo AⅠ, apolipoprotein B, (Hb A1C) were determined by HPLC; fasting insulin (FINS) was detected by chemiluminescence method and insulin resistance index (HOMA-IR ); Pearson correlation analysis of RBP and other indicators of correlation; Logistic multiple regression analysis of T2DM macrovascular disease factors; before and after lipid-lowering treatment of T2DM with macrovascular disease serum RBP levels. Results Serum RBP levels in patients with macrovascular complications were significantly higher than those in non-complicated macroangiopathy groups and normal controls (all P <0.05). The age, course of disease, BMI, SBP, FPG, FINS, HOMA-IR, A1c, TG, apo B, Lp (a), LDL-C, UA and HCY were significantly higher than those in the low-dose group (all P <0.05). Pearson correlation analysis showed that serum RBP level was positively correlated with BMI, duration of disease, SBP, FINS, HOMA-IR, apo B, LDL-C, TG, UA and HCY in T2DM macroangiopathy group (r = 0.46,0.38,0.41 , 0.44,0.36,0.40,0.38,0.62,0.80,0.65, all P <0.05). Logistic multiple regression analysis showed that age, RBP, HCY, Lp (a) and LDL-C were the major risk factors of macrovascular complications in T2DM patients (OR = 1.086,1.119,1.514,1.178,3.105, P <0.05 respectively). Serum RBP levels in patients with T2DM macrovascular disease were lower than those before lipid-lowering therapy (P <0.05). Conclusions Serum levels of RBP are elevated in patients with T2DM, which may lead to or aggravate macrovascular complications in patients with T2DM by causing IR and dyslipidemia.