CAJ | 학술논문

目的检测2型糖尿病(T2DM)下肢缺血患者(LLI)和非下肢缺血患者(NLLI)的血清视黄醇结合蛋白4(RBP4)水平,探讨RBP4与T2DM下肢缺血的相关性.方法选取2011年7月至2012年6月在上海市糖尿病临床医学中心门诊就诊和住院的T2DM患者共755例为研究对象,踝肱指数(ABI) ＜0.9和下肢血管超声提示动脉狭窄>50％诊断为LLI,参照此标准将患者分为两组:LLI组(n=105)和NLLI组(n=650).检测所有患者体质指数(BMI)、腰围、血压、RBP4、血糖、血脂、预估肾小球滤过率(eGFR)、下肢动脉内膜厚度(IMT)等,比较两组间临床特征及RBP4水平差异.按照RBP4四分位数分组,比较各组问临床特征的差异及LLI的发生率.两两比较采用t检验,多组间比较采用单因素方差分析,采用Spearman进行相关性分析.结果 LLI组和NLLI组两组间年龄、糖尿病病程、收缩压(SBP)、总胆固醇(TC)、血清RBP4水平以及高血压、冠心病和脑梗死的发生率差异有统计学意义[分别为(72±9)比(57±12)岁,13(8～20)比8(4～13)年,(140±20)比(130±18) mmHg(1 mmHg=0.133 kPa),(4.7±1.0)比(4.5±1.1) mmol/L,47(37～54)比43(37～51) mg/L,80％比50.7％,24.8％比10.9％,22.9％比6.8％,t=16.48、5.84、3.45、-2.07、2.16,x2=31.40、15.40、28.29;均P＜0.05].Spearman相关分析表明,校正了年龄、病程、eGFR、高血压后,血清RBP4与TC、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹C肽、餐后2 hC肽、IMT呈正相关(r=0.27、0.37、0.12、0.17、0.24、0.10,均P＜0.05).Logistic回归分析表明年龄、高血压和RBP4是下肢缺血的独立影响因素(OR=1.166、2.297、1.023,均P＜0.05).按照RBP4四分位数分组,结果看到随着RBP4水平升高,BMI、腰围、SBP、IMT、TC、TG和LDL-C增加(F=4.31、7.44、8.01、2.99、15.81、28.27、3.99,均P＜0.05).四组间LLI发生率差异具有统计学意义(x2=11.661,P＜0.05).结论 RBP4和T2DM下肢缺血相关,T2DM患者高血清RBP4水平提示下肢缺血患病风险增加. 目的檢測2型糖尿病(T2DM)下肢缺血患者(LLI)和非下肢缺血患者(NLLI)的血清視黃醇結閤蛋白4(RBP4)水平,探討RBP4與T2DM下肢缺血的相關性.方法選取2011年7月至2012年6月在上海市糖尿病臨床醫學中心門診就診和住院的T2DM患者共755例為研究對象,踝肱指數(ABI) ＜0.9和下肢血管超聲提示動脈狹窄>50％診斷為LLI,參照此標準將患者分為兩組:LLI組(n=105)和NLLI組(n=650).檢測所有患者體質指數(BMI)、腰圍、血壓、RBP4、血糖、血脂、預估腎小毬濾過率(eGFR)、下肢動脈內膜厚度(IMT)等,比較兩組間臨床特徵及RBP4水平差異.按照RBP4四分位數分組,比較各組問臨床特徵的差異及LLI的髮生率.兩兩比較採用t檢驗,多組間比較採用單因素方差分析,採用Spearman進行相關性分析.結果 LLI組和NLLI組兩組間年齡、糖尿病病程、收縮壓(SBP)、總膽固醇(TC)、血清RBP4水平以及高血壓、冠心病和腦梗死的髮生率差異有統計學意義[分彆為(72±9)比(57±12)歲,13(8～20)比8(4～13)年,(140±20)比(130±18) mmHg(1 mmHg=0.133 kPa),(4.7±1.0)比(4.5±1.1) mmol/L,47(37～54)比43(37～51) mg/L,80％比50.7％,24.8％比10.9％,22.9％比6.8％,t=16.48、5.84、3.45、-2.07、2.16,x2=31.40、15.40、28.29;均P＜0.05].Spearman相關分析錶明,校正瞭年齡、病程、eGFR、高血壓後,血清RBP4與TC、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)、空腹C肽、餐後2 hC肽、IMT呈正相關(r=0.27、0.37、0.12、0.17、0.24、0.10,均P＜0.05).Logistic迴歸分析錶明年齡、高血壓和RBP4是下肢缺血的獨立影響因素(OR=1.166、2.297、1.023,均P＜0.05).按照RBP4四分位數分組,結果看到隨著RBP4水平升高,BMI、腰圍、SBP、IMT、TC、TG和LDL-C增加(F=4.31、7.44、8.01、2.99、15.81、28.27、3.99,均P＜0.05).四組間LLI髮生率差異具有統計學意義(x2=11.661,P＜0.05).結論 RBP4和T2DM下肢缺血相關,T2DM患者高血清RBP4水平提示下肢缺血患病風險增加.
목적 검측2형당뇨병(T2DM)하지결혈환자(LLI)화비하지결혈환자(NLLI)적혈청시황순결합단백4(RBP4)수평,탐토RBP4여T2DM하지결혈적상관성.방법 선취2011년7월지2012년6월재상해시당뇨병림상의학중심문진취진화주원적T2DM환자공755례위연구대상,과굉지수(ABI) ＜0.9화하지혈관초성제시동맥협착>50％진단위LLI,삼조차표준장환자분위량조:LLI조(n=105)화NLLI조(n=650).검측소유환자체질지수(BMI)、요위、혈압、RBP4、혈당、혈지、예고신소구려과솔(eGFR)、하지동맥내막후도(IMT)등,비교량조간림상특정급RBP4수평차이.안조RBP4사분위수분조,비교각조문림상특정적차이급LLI적발생솔.량량비교채용t검험,다조간비교채용단인소방차분석,채용Spearman진행상관성분석.결과 LLI조화NLLI조량조간년령、당뇨병병정、수축압(SBP)、총담고순(TC)、혈청RBP4수평이급고혈압、관심병화뇌경사적발생솔차이유통계학의의[분별위(72±9)비(57±12)세,13(8～20)비8(4～13)년,(140±20)비(130±18) mmHg(1 mmHg=0.133 kPa),(4.7±1.0)비(4.5±1.1) mmol/L,47(37～54)비43(37～51) mg/L,80％비50.7％,24.8％비10.9％,22.9％비6.8％,t=16.48、5.84、3.45、-2.07、2.16,x2=31.40、15.40、28.29;균P＜0.05].Spearman상관분석표명,교정료년령、병정、eGFR、고혈압후,혈청RBP4여TC、감유삼지(TG)、저밀도지단백담고순(LDL-C)、공복C태、찬후2 hC태、IMT정정상관(r=0.27、0.37、0.12、0.17、0.24、0.10,균P＜0.05).Logistic회귀분석표명년령、고혈압화RBP4시하지결혈적독립영향인소(OR=1.166、2.297、1.023,균P＜0.05).안조RBP4사분위수분조,결과간도수착RBP4수평승고,BMI、요위、SBP、IMT、TC、TG화LDL-C증가(F=4.31、7.44、8.01、2.99、15.81、28.27、3.99,균P＜0.05).사조간LLI발생솔차이구유통계학의의(x2=11.661,P＜0.05).결론 RBP4화T2DM하지결혈상관,T2DM환자고혈청RBP4수평제시하지결혈환병풍험증가.
Objective This study tested serum retinol-binding protein 4 (RBP4) level in type 2 diabetic mellitus (T2DM) patients with lower limb ischemia (LLI) and non-lower limb ischemia (NLLI) to investigate the relationship between serum retinol-binding protein 4 levels and lower limb ischemia in type 2 diabetic population.Methods A total of 755 type 2 diabetic in-patients and out-patients in Shanghai Clinical Medical Center from Jul 2011 to Jun 2012 were included in this cross-sectional study.Their clinical and biochemical characteristics,ankle-brachial index (ABI),lower extremity arterial ultrasound were detected.LLI was defined by ABI＜ 0.9 and lower extremity arterial stenosis＞50％ by ultrasound examination.According this standard,patients were divided to two groups:LLI group (n=105) and NLLI group (n=650).Body mass index (BMI),waist circumference,blood pressure,RBP4,blood glucose,serum lipid,estimated glomerular filtration rate (eGFR),intima-meida thickness (IMT) were measured to compare the difference of clinical character and RBP4 level between two groups.The patients were grouped by the quartiles of RBP4 to compare the difference of clinical character and the incidence of LLI.Two groups of continuous variables were compared by the t test.Multiple groups of continuous variables were compared by ANOVA test.The association between RBP4 and other variables were evaluated with Spearman correlation.Results There were significant differences in age ((72 ±9) vs (57 ± 12) yrs,t=16.48,P＜0.05),duration of diabetes ((13 (8-20) vs 8 (4-13) yrs,t=5.84,P＜0.05),systolic blood pressure (SBP (140±20) vs (130± 18) mmHg,t=3.45 P＜0.05),total cholesterol (TC (4.7±1.0) vs (4.5± 1.1) mmol/L,t=-2.07,P＜0.05),serum RBP4 ((47(37-54) vs 43(37-51) mg/L,t=2.16,P＜0.05) and incidence of hypertension (80.0％ vs 50.7％,x2=31.40,P＜0.05),coronary artery disease (24.8％ vs 10.9％,x2=15.40,P＜0.05),cerebral infarction (22.9％ vs 6.8％,x2=28.29,P＜0.05) between LLI group and NLLI group.After adjusting for age,duration,eGFR and hypertension,Spearman correlation analysis showed that serum RBP4 level was positively correlated with TC,triglyceride (TG),low density lipoprotein-cholesterol (LDL-C),fasting C-peptide,2 h-postprandial C-peptide,IMT (r=0.27,0.37,0.12,0.17,0.24,0.10,respectively,P＜0.05).Logistic regression analysis showed that age,hypertension,RBP4 were independent associated factors for LLI (OR=1.166,2.297,1.023,P＜0.05 all above).Comparisons of patients with quartiles of RBP4 revealed that the levels of BMI,waist circumference,SBP,IMT,TC,TG,LDL-C level increased with the increasing of serum RBP4 concentration (F=4.31,7.44,8.01,2.99,15.81,28.27,3.99,P＜0.05).There was significant difference in the incidence of LLI between four groups (x2=11.66 P＜0.05).Conclusions RBP4 was associated with lower limb ischemia in type 2 diabetic patients.High serum RBP4 concentration predicts the increasing risk of lower limb ischemia in type 2 diabetic patients.