【摘要】 目的 研究合并2型糖尿病的冠心病患者冠狀動(dòng)脈病變程度與血清視黃醇結(jié)合蛋白4（retinol-binding protein 4，RBP4）水平的相關(guān)性?！》椒ā?008年10月-2010年4月選擇性冠狀動(dòng)脈造影確診的冠心病患者共120例，分為單純冠心病組（A組）60例和冠心病合并糖尿病組（B組）60例，檢測(cè)血糖、血脂、胰島素以及脂聯(lián)素、RBP4水平；根據(jù)冠狀動(dòng)脈造影結(jié)果，以Gensini評(píng)分評(píng)判冠狀動(dòng)脈病變程度?！〗Y(jié)果 B組空腹血糖、胰島素、RBP4均顯著高于A組（Plt;0.05）；冠狀動(dòng)脈病變程度更重（Plt;0.05）。相關(guān)性分析顯示RBP4水平與低密度脂蛋白膽固醇、胰島素抵抗和冠狀動(dòng)脈病變積分呈正相關(guān)（r=0.312、0.322、0.314，Plt;0.05）。與脂聯(lián)素水平呈負(fù)相關(guān)（r=-0.362，Plt;0.01）?！〗Y(jié)論 冠心病合并2型糖尿病患者RBP4明顯升高，且與冠狀動(dòng)脈狹窄程度呈正相關(guān)。【Abstract】 Objective To explore the relationship between the level of serum retinol-binding protein 4 (RBP4) and the extent of coronary lesions in coronary heart disease (CHD) patients accompanied with type 2 diabetes mellitus (T2DM). Methods A total of 120 patients with CHD diagnosed by coronary arteriongraphy between October 2008 and April 2010 were enrolled. The patients were divided into two groups: CHD group (60 patients); CHD accompanied with T2DM group (60 patients). The levels of serum insulin, adiponectin and RBP4 were measured. All the patients underwent coronary angiography and the extent of coronary lesions was assessed quantitatively based on the Gensini′s scoring system. Results The levels of serum insulin, plasma RBP4 and the extent of coronary artery stenosis in CHD accompanied with T2DM group were significantly higher than those in CHD group (Plt;0.05). Correlation analysis showed that the level of RBP4 was positively correlated with LDL-C, insulin resistance index and the coronary artery narrow degree（r=0.312, 0.322, 0.314; Plt;0.05); and negatively correlated with adiponectin (r=-0.362, Plt;0.01). Conclusion The significant elevated plasma RBP4 in CHD patients accompanied with T2DM is positively correlated with the extent of coronary artery lesion.
【摘要】 目的 探討2型糖尿病（T2DM）胰島素抵抗導(dǎo)致糖尿病性心功能不全的臨床表現(xiàn)特點(diǎn)及相關(guān)激素的改變。 方法 2008年1-4月對(duì)T2DM患者35例（胰島素抵抗指數(shù)HOMA-IRlt;2.69者19例為A1組，HOMA-IR≥2.69者16例為A2組）及健康體檢者20人B組測(cè)體重指數(shù)（BMI）、空腹血糖（FPG）、胰島素、心鈉素（ANP）、腦鈉素（BNP）水平；心臟彩色多普勒超聲分別測(cè)E/A、e/a、S/D、LVEF、DT期。 結(jié)果 A2組BMI較A1、B組均明顯增加（Plt;0.05），A1、B組間差異無(wú)統(tǒng)計(jì)學(xué)意義（Pgt;0.05）。ANP、BNP及DT值在A1、A2組均較B組增高（Plt;0.05），BNP在A2組高于A1組（Plt;0.05），ANP、DT值在A1、A2組間差異均無(wú)統(tǒng)計(jì)學(xué)意義（Pgt;0.05）。E/A、e/a和S/D在A1、A2組均較B組降低（Plt;0.05），A1、A2組間差異均無(wú)統(tǒng)計(jì)學(xué)意義（Pgt;0.05）。A2組患者LVEF較A1、B組均明顯降低（Plt;0.05），A1、B組間差異無(wú)統(tǒng)計(jì)學(xué)意義（Pgt;0.05）?！〗Y(jié)論 隨著胰島素抵抗加重，心肌舒張順應(yīng)性較差和收縮力下降，伴隨相關(guān)激素（心臟利鈉肽）分泌增加，最終產(chǎn)生心功能不全的臨床表現(xiàn)、體征及多普勒超聲心動(dòng)圖表現(xiàn)?！続bstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.