ApoB、apoAⅠ及apoB/apoAⅠ比值与2型糖尿病肾病的关系
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摘要
目的:研究apoB、apoAⅠ及其比值与2型糖尿病患者并发糖尿病肾病的关系。
方法:本研究共纳入了192个对象,这些研究对象的选择,根据严格的纳入以及排除标准以控制混杂因素,其中男性104个,女性88个。2型糖尿病并糖尿病肾病(DN)及单纯2型糖尿病(DM)分别定义为尿白蛋白/尿肌酐比值(ACR)≥30mg/g或者<30mg/g。所入选的对象,DN组及DM组分别为83及109个。分别测定血总胆固醇(TCHO)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)以及载脂蛋白B(apoB)、载脂蛋白AⅠ(apoAⅠ),并计算apoB/apoAⅠ比值及非高密度脂蛋白胆固醇(非HDL-C),对两组病人进行分析、比较。
结果:DN组的TCHO、TG、非HDL-C、apoB以及apoB/apoAⅠ比值高于DM组(p<0.05)。相关统计分析显示,性别和DN相关,以性别作为分层因素,分别对男性组及女性组进行分析。在男性组中,病程、收缩压(SBP)和男性糖尿病肾病发生有关,调整混杂因素后统计分析显示在男性组, TCHO、非HDL-C、apoB以及apoB/apoAⅠ比值和糖尿病肾病有关,其OR值及95%可信区间分别为1.49(91.022～2.198)、1.591(1.044～2.425)、6.744(1.568～29.010)及5.604(1.666～18.854),p值分别为0.038、0.031、0.010、0.005,相关系数r值分别为0.210、0.218、0.269、0.292,p值分别为0.034、0.027、0.006、0.003;而在女性组,收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)和DN发生有关,但由于年龄p=0.074、病程p=0.078,故两者同时也作为混杂因素加以调整,在调整危险因素后,只有apoB/apoAⅠ比值和糖尿病肾病有关,其OR值为9.772(95%可信区间1.386～68.899),p值为0.022,相关系数r值为0.241,p值为0.028。在所有研究对象中,pearson分析显示apoB/apoAⅠ比值与TCHO、TG、LDL-C、HDL-C、非HDL-C均相关,其相关系数r值分别为0.252、0.356、0.332、-0.386、0.390,p值均<0.05。以apoB/apoAⅠ比值0.9作为分层,在apoB/apoAⅠ≥0.9以及<0.9组,其糖尿病肾病发生率分别为57.65%、31.76%,差别具有统计学意义(p<0.05),而两组病人在性别、年龄、体重指数、病程、收缩压、舒张压以及糖化血红蛋白方面无差别(p>0.10)。
结论:1、apoB/apoAⅠ比值与男性及女性2型糖尿病患者并发糖尿病肾病均有关。
2、apoB/apoA1≥0.9时2型糖尿病肾病发病率明显增高。
Objective:To investigate the association between apoB,apoAⅠ,apoB/apoAⅠratio and diabetic nephropathy in type 2 diabetes mellitus.
Methods:A total of 192 (108 men,84 women) patients were selected with strict criteria to prevent confounders.Diabetic nephropathy and non-diabetic nephropathy were defined as urinary albumin-to-creatinine ratio(ACR) of≥30mg/g and < 30 mg/g,respectively. To explore the differences between the two groups,TCHO,TG,LDL and HDL cholesterol, apolipoprotein AⅠand B were measured,and apoB/apoAⅠratio and non-HDL cholesterol were calculated,then the two groups were compared.
Results:TCHO,TG,non-HDL cholesterol,apoB and apo B/apoAⅠratio were significantly(p<0.05) higher in patients with diabetic nephropathy.Data showed that gender was associated with DN,so the subjects were divided into two groups based on gender.In male group,after adjusting for diabetic duration years and SBP, the result indicated that odds ratio and 95%CI for diabetic nephropathy for TCHO,non-HDL cholesterol,apoB and apoB/apoAⅠratio in men was 1.499(1.022～2.198),1.591(1.044～2.425),6.744(1.568～29.010),5.604(1.666～18.854),with p value 0.038,0.031,0.010 , 0.005 , and correlation coefficient for DN for TCHO,non-HDL cholesterol,apoB and apoB/apoAⅠratio in men was 0.210, 0.218, 0.269, 0.292,with p value 0.034,0.027, 0.006, 0.003 ; but in female group,SBP,DBP and HbA1c were associated with DN,as p value for age and diabetic duration years between the two groups was 0.074, 0.078,so SBP,DBP,HbA1c,age and diabetic duration years were adjusted in further statistic analysis,the result indicated that odds ratio for DN for apoB /apoAⅠratio was 9.772(95%CI 1.386～68.899),with p value 0.022,and correlation coefficient for DN for apoB/apoAⅠratio was 0.241,with p value 0.028. In the subjects,pearson analysis showed that correlation coefficient between apoB/apoAⅠratio and lipid parameters of TCHO,TG, LDL-C,HDL-C,non-HDL-C was 0.252, 0.356, 0.332, -0.386, 0.390, with all p value<0.05.All subjects were divided into two groups according to apoB/apoAⅠratio above or below 0.9.The incidence of DN was significantly(p<0.05) higher in patients with apoB/apoAⅠratio above 0.9 than those below 0.9,which was 57.65%,31.76%,respective, but gender, age,BMI, diabetic duration years, HbA1c between the two groups were comparable.
Conclusions: 1.ApoB/apoAⅠratio is associated with diabetic nephropathy both in men and women with type 2 diabetes mellitus.
2. When apoB/apoAⅠratio≥0.9,the incidence of DN was markly higher.
方法:本研究共纳入了192个对象,这些研究对象的选择,根据严格的纳入以及排除标准以控制混杂因素,其中男性104个,女性88个。2型糖尿病并糖尿病肾病(DN)及单纯2型糖尿病(DM)分别定义为尿白蛋白/尿肌酐比值(ACR)≥30mg/g或者<30mg/g。所入选的对象,DN组及DM组分别为83及109个。分别测定血总胆固醇(TCHO)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)以及载脂蛋白B(apoB)、载脂蛋白AⅠ(apoAⅠ),并计算apoB/apoAⅠ比值及非高密度脂蛋白胆固醇(非HDL-C),对两组病人进行分析、比较。
结果:DN组的TCHO、TG、非HDL-C、apoB以及apoB/apoAⅠ比值高于DM组(p<0.05)。相关统计分析显示,性别和DN相关,以性别作为分层因素,分别对男性组及女性组进行分析。在男性组中,病程、收缩压(SBP)和男性糖尿病肾病发生有关,调整混杂因素后统计分析显示在男性组, TCHO、非HDL-C、apoB以及apoB/apoAⅠ比值和糖尿病肾病有关,其OR值及95%可信区间分别为1.49(91.022～2.198)、1.591(1.044～2.425)、6.744(1.568～29.010)及5.604(1.666～18.854),p值分别为0.038、0.031、0.010、0.005,相关系数r值分别为0.210、0.218、0.269、0.292,p值分别为0.034、0.027、0.006、0.003;而在女性组,收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)和DN发生有关,但由于年龄p=0.074、病程p=0.078,故两者同时也作为混杂因素加以调整,在调整危险因素后,只有apoB/apoAⅠ比值和糖尿病肾病有关,其OR值为9.772(95%可信区间1.386～68.899),p值为0.022,相关系数r值为0.241,p值为0.028。在所有研究对象中,pearson分析显示apoB/apoAⅠ比值与TCHO、TG、LDL-C、HDL-C、非HDL-C均相关,其相关系数r值分别为0.252、0.356、0.332、-0.386、0.390,p值均<0.05。以apoB/apoAⅠ比值0.9作为分层,在apoB/apoAⅠ≥0.9以及<0.9组,其糖尿病肾病发生率分别为57.65%、31.76%,差别具有统计学意义(p<0.05),而两组病人在性别、年龄、体重指数、病程、收缩压、舒张压以及糖化血红蛋白方面无差别(p>0.10)。
结论:1、apoB/apoAⅠ比值与男性及女性2型糖尿病患者并发糖尿病肾病均有关。
2、apoB/apoA1≥0.9时2型糖尿病肾病发病率明显增高。
Objective:To investigate the association between apoB,apoAⅠ,apoB/apoAⅠratio and diabetic nephropathy in type 2 diabetes mellitus.
Methods:A total of 192 (108 men,84 women) patients were selected with strict criteria to prevent confounders.Diabetic nephropathy and non-diabetic nephropathy were defined as urinary albumin-to-creatinine ratio(ACR) of≥30mg/g and < 30 mg/g,respectively. To explore the differences between the two groups,TCHO,TG,LDL and HDL cholesterol, apolipoprotein AⅠand B were measured,and apoB/apoAⅠratio and non-HDL cholesterol were calculated,then the two groups were compared.
Results:TCHO,TG,non-HDL cholesterol,apoB and apo B/apoAⅠratio were significantly(p<0.05) higher in patients with diabetic nephropathy.Data showed that gender was associated with DN,so the subjects were divided into two groups based on gender.In male group,after adjusting for diabetic duration years and SBP, the result indicated that odds ratio and 95%CI for diabetic nephropathy for TCHO,non-HDL cholesterol,apoB and apoB/apoAⅠratio in men was 1.499(1.022～2.198),1.591(1.044～2.425),6.744(1.568～29.010),5.604(1.666～18.854),with p value 0.038,0.031,0.010 , 0.005 , and correlation coefficient for DN for TCHO,non-HDL cholesterol,apoB and apoB/apoAⅠratio in men was 0.210, 0.218, 0.269, 0.292,with p value 0.034,0.027, 0.006, 0.003 ; but in female group,SBP,DBP and HbA1c were associated with DN,as p value for age and diabetic duration years between the two groups was 0.074, 0.078,so SBP,DBP,HbA1c,age and diabetic duration years were adjusted in further statistic analysis,the result indicated that odds ratio for DN for apoB /apoAⅠratio was 9.772(95%CI 1.386～68.899),with p value 0.022,and correlation coefficient for DN for apoB/apoAⅠratio was 0.241,with p value 0.028. In the subjects,pearson analysis showed that correlation coefficient between apoB/apoAⅠratio and lipid parameters of TCHO,TG, LDL-C,HDL-C,non-HDL-C was 0.252, 0.356, 0.332, -0.386, 0.390, with all p value<0.05.All subjects were divided into two groups according to apoB/apoAⅠratio above or below 0.9.The incidence of DN was significantly(p<0.05) higher in patients with apoB/apoAⅠratio above 0.9 than those below 0.9,which was 57.65%,31.76%,respective, but gender, age,BMI, diabetic duration years, HbA1c between the two groups were comparable.
Conclusions: 1.ApoB/apoAⅠratio is associated with diabetic nephropathy both in men and women with type 2 diabetes mellitus.
2. When apoB/apoAⅠratio≥0.9,the incidence of DN was markly higher.
引文
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29.Walldius G,Jungner I,Aastveit AH,et al. The apoB/ apoAⅠ ratio is better than the cholesterol ratios to estimate the balance between plasma proatherogenic and antiatherogenic lipoproteins and to predict coronary risk. Clin Chem Lab Med ,2004 ,42 : 1355.
[2] Walldius G,Junger I,Hgolme I.High apolipoprotein B,low apolipopro- tein AⅠ,and improvement in the prediction of fatal myocardial infarction (AMORIS Study):a prospective study.Lancet,2001,358(12):2026-33.
[3]Gotto JA,Whitney E,Stein EA,Shapiro DR, et al.Relation between baseline and coronary events in the Air Force/Texas Cornary Atherosc- lerosis Prevention Study (TexCAPS/Texas). Circulation,2000,101:477-84.
[4] Miremadt S,Sniderman A,Frohlich J.Can measurement of serum apolipo- protein B replace the lipid profile monitoring or patients with lipoprotein disorders? Clin Chem,2002,48:484-848.
[5] World Health Organization Definition.Diagnosis and clssification of diabetes mellitus and its complication:report of a WHO Consultation.PartⅠ:Diagnosis and Classification of diabetes mellitus.Geneva, Switzerl- and:World Health Orgination,1999,1(2):50.
[6] Hara H,Yokoyama S.Interaction of free apolipoprotein with macroph- ages: Formation of high density lipoprotein like lipoprotein sand reduction of cellular cholescerol.Biol Chem,1991,266:3080.
[7] Austin MA,Breslon JL,Hennekens CH,et al.Low density lipoprotein subclass patterns and risk of myocardial infarction.JAMA,1988,82:495-506.
[8] Lamarche B,Uffelman KD,Carpentier A,et al.Triglyceride enrichment of HDL enhances in vivo metabolism clearance of HDL in healthy men.J clin Invest,1999,103:1191.
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