天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (4): 390-395.doi: 10.11958/20203430

• 临床研究 • 上一篇    下一篇

糖尿病无症状性心肌缺血患者血清孤啡肽与脂蛋白相关磷脂酶A2水平变化的研究

解梦莉1，苏敬2，李静2，韩毅3△   

  1. 1山西医科大学麻醉学院（邮编030001）；2中铁十二局集团中心医院内分泌科；3山西医科大学第二医院麻醉科
  • 收稿日期:2020-12-11 修回日期:2021-01-03 出版日期:2021-04-15 发布日期:2021-04-16
  • 通讯作者: 韩毅 E-mail:13753171979@163.com
  • 作者简介:解梦莉（1995），女，硕士在读，主要从事麻醉学临床研究。E-mail：xiemengli2020@163.com
  • 基金资助:
    国家自然科学基金资助项目（81400260）；山西省青年科技研究基金（201701D12111145）

Changes of serum nociceptin/orphanin FQ and lipoprotein‐associated phospholipase A2 levels in diabetic patients with silent myocardial ischemia

XIE Meng-li1, SU Jing2, LI Jing2, HAN Yi3△   

  1. 1 School of Anesthesiology, Shanxi Medical University, Taiyuan 030001, China; 2 Department of Endocrinology,
     the Central Hospital of China Railway 12th Bureau Group; 3 Department of Anesthesiology, 
    the Second Hospital of Shanxi Medical University
  • Received:2020-12-11 Revised:2021-01-03 Published:2021-04-15 Online:2021-04-16
  • Contact: HAN Yi E-mail:13753171979@163.com

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摘要： 目的　观察糖尿病合并无症状性心肌缺血（SMI）患者血清内源性孤啡肽（N/OFQ）、脂蛋白相关磷脂酶A2（Lp-PLA2）水平变化并探讨其意义。方法　纳入行冠状动脉造影术的糖尿病患者120例。根据是否合并SMI分为单纯2型糖尿病患者60例（D组）和2型糖尿病合并SMI的患者60例（DS组）。收集2组临床资料，检测空腹血糖（FBG）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、血清N/OFQ、Lp-PLA2水平，比较2组血清N/OFQ、Lp-PLA2水平的差异，分析2型糖尿病合并SMI的危险因素，分析N/OFQ、Lp-PLA2与各项指标的相关性，受试者工作特征（ROC）曲线分析N/OFQ、Lp-PLA2及两者联合预测因子对2型糖尿病合并SMI的预测价值。结果　DS组糖尿病病程、FBG、TG、LDL-C、血清N/OFQ、Lp-PLA2水平高于D组，HDL-C水平低于D组（P＜0.01）。Logistic回归分析结果显示血清FBG、TG、LDL-C、N/OFQ、Lp-PLA2水平升高是糖尿病患者合并SMI的危险因素（P＜0.05）。DS组FBG、LDL-C、Gensini积分与血清N/OFQ、Lp-PLA2水平呈正相关；糖尿病病程、HbA1c与血清N/OFQ水平呈正相关，而与血清Lp-PLA2水平无显著相关；血清N/OFQ与Lp-PLA2水平呈正相关。ROC曲线分析结果显示，N/OFQ、Lp-PLA2、联合预测因子预测糖尿病合并SMI发生的曲线下面积分别为0.949、0.899、0.956（P＜0.01）。结论　糖尿病合并SMI患者血清N/OFQ、Lp-PLA2水平较高，N/OFQ、Lp-PLA2与糖尿病合并SMI的发生密切相关。

关键词: 糖尿病, 2型, 冠心病, 磷脂酶类A2, 脂蛋白类, 无症状性心肌缺血, 孤啡肽

Abstract: Objective　To observe the changes of serum endogenous nociceptin/orphanin FQ (N/OFQ) and serum lipoprotein-associated phospholipase A2 (Lp-PLA2) levels in diabetic patients with silent myocardial ischemia (SMI), and to explore its significance. Methods　A total of 120 diabetes patients underwent coronary angiography were included in this study. Patients were divided into simple type 2 diabetes group (D group, n=60) and type 2 diabetes with SMI group (DS group, n=60). Clinical data of both groups were collected. The levels of fasting blood glucose (FBG), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum N/OFQ and Lp-PLA2 were detected. The differences of serum N/OFQ and Lp-PLA2 levels were compared between the two groups. The risk factors of type 2 diabetes with SMI and the correlation between     N/OFQ, Lp-PLA2 and various indicators were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive values of N/OFQ and Lp-PLA2 for type 2 diabetes with SMI. Results　The diabetes course, FBG, TG, LDL-C, serum N/OFQ and Lp-PLA2 levels were significantly higher in DS group than those in D group, and the HDL-C level was significantly lower in DS group than that in D group (P＜0.01). Multiple Logistic regression analysis showed that the increased serum levels of FBG, TG, LDL- C, N/OFQ and Lp-PLA2 were the risk factors of diabetic patients with SMI (P＜0.05). The serum levels of N/OFQ and Lp-PLA2 were positively correlated with FBG, LDL-C, and Gensini score in DS group. The diabetes course, HbA1c and serum N/OFQ levels were positively correlated. There was no significant correlation between diabetes course, HbA1c and serum Lp-PLA2 levels. The serum N/OFQ and Lp-PLA2 levels were positively correlated. ROC curve analysis results showed that the areas under the curves of N/OFQ, Lp-PLA2 and combined predictors predicting the occurrence of diabetes with SMI were 0.949, 0.899 and 0.956 (P＜0.01). Conclusion　The serum levels of    N/OFQ and Lp-PLA2 are higher in patients with diabetes and SMI. N/OFQ and Lp-PLA2 are closely related to the occurrence of diabetes and SMI.

Key words: diabetes mellitus, type 2, coronary disease, phospholipases A2, lipoproteins, silent myocardial ischemia, orphanin FQ

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