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目的:研究冠心病(CHD)伴糖代谢异常患者血浆脂肪细胞因子脂联素和Apelin的水平及临床意义。方法:选择我院心内科87例住院的CHD患者,根据是否伴糖代谢异常分为3组,即单纯CHD组、CHD伴糖耐量异常(IGT)组(CHD+IGT组)和CHD伴糖尿病(DM)组(CHD+DM组),选择健康体检者31例为正常对照者(NC组)。对所有受试者测量身高、体重、腰围、血压;测血糖、胰岛素、血脂、高敏C反应蛋白(hsCRP)、游离脂肪酸(NFFA)和肝肾功能等,酶联免疫法测脂联素和Apelin;计算体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)并进行比较。结果:①CHD+IGT组、CHD+DM组和CHD组的血浆脂联素和Apelin的血浓度均低于NC组(均P<0.05)。②在CHD+DM组,脂联素较CHD+IGT和CHD组低,且各组间差异有统计学意义(均P<0.05);而Apelin的水平介于CHD组和NC组之间(P<0.05),但与CHD+IGT组无显著差异。③相关分析显示,脂联素与HDL-C显著正相关(P<0.01),与hsCRP和餐后2h血糖(PPG)呈负相关(均P<0.05)。在CHD者,Apelin与PPG显著正相关(P<0.01),控制年龄、血压后,与BMI、PPG和HOMA正相关(r=0.804、0.996、0.998,均P<0.05)。结论:CHD+DM的患者血浆脂联素水平显著降低,一定程度上反映了病情严重程度和机体的炎症状态;而Apelin的水平介于单纯CHD和正常人之间,与伴IGT者无明显差异,提示其一定程度上可能参与了DM的发生,但可能仅在糖代谢异常的晚期发挥作用,也不能像脂联素可以较好地反映和评估CHD伴糖代谢异常患者的病情。
Objective: To study the level of plasma adiponectin and Apelin in patients with coronary heart disease (CHD) with abnormal glucose metabolism and its clinical significance. Methods: Eighty-seven CHD patients hospitalized in Department of Cardiology of our hospital were divided into 3 groups according to whether there were abnormal glucose metabolism: CHD group, CHD IGT group, CHD with IGT group, DM group (CHD + DM group). 31 healthy controls were selected as normal control group (NC group). Blood pressure, insulin, blood lipid, hsCRP, free fatty acid (NFFA) and liver and kidney function were measured in all the subjects. The serum levels of adiponectin and Apelin The body mass index (BMI) and insulin resistance index (HOMA-IR) were calculated and compared. Results: ① The plasma concentrations of adiponectin and Apelin in CHD + IGT group, CHD + DM group and CHD group were lower than those in NC group (all P <0.05). ② In CHD + DM group, adiponectin was lower than CHD + IGT and CHD groups, and there was significant difference among groups (all P <0.05); while Apelin level was between CHD group and NC group (P <0.05), but no significant difference with CHD + IGT group. ③ Correlation analysis showed that adiponectin was positively correlated with HDL-C (P <0.01), negatively correlated with hsCRP and PPG (P <0.05). In CHD, Apelin was significantly and positively correlated with PPG (P <0.01). After controlling for age and blood pressure, Apelin positively correlated with BMI, PPG and HOMA (r = 0.804, 0.996, 0.998, all P <0.05). Conclusion: Plasma adiponectin level was significantly decreased in patients with CHD + DM, to a certain extent, reflect the severity of the disease and the body’s inflammatory state; and Apelin levels between simple CHD and normal subjects, with IGT no significant difference , Suggesting that it may be involved in the occurrence of DM to some extent, but it may only play an important role in the late stage of abnormal glucose metabolism. It can not reflect and evaluate the condition of CHD patients with abnormal glucose metabolism as adiponectin well.