2型糖尿病动脉粥样硬化与血清铁蛋白关系的研究
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摘要
目的:探讨2型糖尿病患者动脉粥样硬化(AS)与血清中铁蛋白(SF)水平之间的关系,为糖尿病动脉粥样硬化的临床防治提供理论依据。方法:测定血清铁蛋白水平及行颈动脉B超,以168例2型糖尿病患者为研究对象,将T2DM中有颈动脉粥样硬化(CA)的无颈动脉粥样硬化的分为两组,分析血清SF与颈动脉粥样硬化的相关性,并分别比较两组间各相关指标有无差异,进行多因素Logistic回归分析。结果:1.颈动脉病变组SF水平显著高于颈动脉正常组(p<0.05)。2.相关分析通过Spearman相关分析,结果表明,T2DM患者血SF水平分别与颈动脉粥样硬化、甘油三酯、糖化血红蛋白、胰岛素抵抗指数等呈显著正相关(p<0.05),与高密度脂蛋白呈显著负相关(p<0.05)。与族别、体重指数、尿酸、总胆固醇、低密度脂蛋白等无显著相关性。对颈动脉粥样硬化的各主要危险因素行Logistic回归分析显示,血清铁蛋白、甘油三酯、高密度脂蛋白、糖化血红蛋白进入回归方程。结论:SF的升高可能预示着2型糖尿病动脉粥样硬化的发展。
Objective:Approach the relationship between type 2 diabetes mellitus artherosclerosis and serum ferritin(SF), to provide clinic prevention theory for type 2 diabetes mellitus artherosclerosis. Methods: Determined SF and consummated type-B ultrasonic of carotid arteries,use 168 type 2 diabetes mellitus patients to study. The 168 patients were allocated into two groups: carotid atherosclerosis and carotid arteries normal. Analyzing the correlation between SF and carotid atherosclerosis, comparised the index between the two groups,then use mu1tiple linear regression. Results:1. SF levels of type 2 diabetic patients with arteria carotis defect were significantly higher than those of patients without arteriaearotis defect(p<0.05).2. Spearman correlation analysis showed that SF levels was significantly positively correlated with CA、TG、HbA1c、HOMA-IR(p<0.05),SF levels was significantly negatively correlated with HDL-C(p<0.05), there was no significantly correlated with series、BMI、UA、TC and LDL-C,mu1tiple linear regression showed SF、TG、HDL-C and HbA1c entered the equation. Conclusions: Elevated SF levels maybe an effective indicator of development in type 2 diabetes artherosclerosis.
Objective:Approach the relationship between type 2 diabetes mellitus artherosclerosis and serum ferritin(SF), to provide clinic prevention theory for type 2 diabetes mellitus artherosclerosis. Methods: Determined SF and consummated type-B ultrasonic of carotid arteries,use 168 type 2 diabetes mellitus patients to study. The 168 patients were allocated into two groups: carotid atherosclerosis and carotid arteries normal. Analyzing the correlation between SF and carotid atherosclerosis, comparised the index between the two groups,then use mu1tiple linear regression. Results:1. SF levels of type 2 diabetic patients with arteria carotis defect were significantly higher than those of patients without arteriaearotis defect(p<0.05).2. Spearman correlation analysis showed that SF levels was significantly positively correlated with CA、TG、HbA1c、HOMA-IR(p<0.05),SF levels was significantly negatively correlated with HDL-C(p<0.05), there was no significantly correlated with series、BMI、UA、TC and LDL-C,mu1tiple linear regression showed SF、TG、HDL-C and HbA1c entered the equation. Conclusions: Elevated SF levels maybe an effective indicator of development in type 2 diabetes artherosclerosis.
引文
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[5] Chambless LE,Heiss G,Folsom AR etal.Association of coronary heart disease incid- ence with carotid arterial wall thickness and major risk factors:the Atherosclerosis Risk in Communities(ARIC)Study,1987-1993.Am J Epidemiol,1997, 146(6):483-494
[6] Swaminathan S, Fonseca VA, Alam MG, Shah SV: The role of iron in diabetes and its complications. Diabetes Care, 2007,30: 1926–1933.
[7] Zeynep Canturk,Berrin Cetinarslan,IIlhan Tarkun and Nuh Zafer Canturk.Serum Ferritin Levels in Poorly- and Well-Controlled Diabetes Mellitus.Endocrine Research,2003,29:299-306.
[8] Faranak Sharifi,Nmousavi Nasab,H Jazebi Zadeh, Elevated serum ferritin concentr- ations in prediabetic subjects.Diabetes Vasc Dises,2008,5:15–18.
[9] Ramakrishnan U, Kuklina E, Stein AD: Iron stores and cardiovascular disease risk factors in women of reproductive age in the United States. Am J Clin Nutr,2002,76 : 1256–1260.
[10] Gillum RF: Association of serum ferritin and cardiovascular risk factors: a cross- sectional analysis of data from the third National Health and Nutrition Examination Survey. Diabetes Care ,2006,29:1077-1082.
[11]王自正.现代医学标记免疫学.北京:人民军医出版社,2000, 58 ,66 ,211
[12] Kang JO.Chronic iron overload and toxicity:clinical chemistry perspective. Clin Lab Sci,2001,14(3):209-219.
[13] Guillen C,McInnes IB,Kruger H,et al.Iron,lactoferrin and iron regulatory protein activity in the synovium:relative importance of iron loading and the inflammatory response.Ann Rheum Dis,1998,57:309-314.
[14] Salonen JT,Tuomainen TP,Nyssonen K,et al.Relation between iron stores and nonin- sul in dependent diabetes in men:acase control study.BMJ,1998,317(7160): 727-730.
[15] Mannami T, Konishi M, Baba S , Nishi N , Terao A. Prevalence ofasym ptomatic caro-tid atherosclerotic lesions detected by high resclution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city : the suita study . Stroke , 1997 , 28 (3) : 518-525.
[16] Yamasaki Y, Kawamori R , Matsushima H, Nishizawa H, Kodama M, Kubota M, et al. Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid artery . Diabetologia , 1995 , 38 (5) : 585-591.
[17]李玉红,李福旺,孙鹏.高铁蛋白血症与糖尿病血管并发症关系的研究.天津医科大学学报.2006,12(2):232-249.
[18] Himsworth H.Diabetes mellitus:a differential into insulin sensitive and insulin- insensitive types.Lancet,1936,1:127-130.
[19] Fernandez-Real JM,Penarroja G,Castro A,et al.Blood letting in high-ferritin type 2 diabetes:effects on insulin sensitivity andβ-cell function[J].Diabetes,2002,51:1000- 1004.
[20] Bains K,Kaur J.Food and nutrient intake in relation to cardiovascular disease among rural males of Punjob,Insia.Asia Pac J Clin Nutr,2004,13 (suppl):S95.
[21] Puntarulo S: Iron, oxidative stress and human health.Mol Aspects Med, 2005,26: 299–312.
[22]李辉王炳元.铁超负荷与脂肪肝.现代医药卫生,2004,20(8):630-631.
[23] HSIAO T J,CHEN JC,WANG JD.Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease apparently healthy obese patients.Int J Obese Re lat Metab Disord,2004,28:167-172
[24] MacDonald MJ,Cook JD,Epstein ML,et al.Large amount of(apo)ferritin in the pancreatic insulin cell and its by glucose.FASEB J,1994,8:777-781.
[25] Andrews NC:The iron transporter DMT1.Int J Biochem Cell Biol, 1999,31:991-994.
[26] Cooksey RC,Jouinhan HA,Ajioka RS, Hazel MW, Jones DL,Kushner JP,McClain DA:Oxidative stress,beta-cell apoptosis,and decreased insulin secretory capacity in mouse models of hemochromatosis. Endocrinology, 2004,145:5305-5312.
[27] Papanikolaou G, Pantopoulos K: Iron metabolism and toxicity.Toxicol ApplPharmacol,2005,202: 199–211.
[28] Ren Y, Tian H, Liang J, Zhao G. Elevated serum ferritin concentration in a glucose impaired population and in normal glucose tolerance first degree relatives in familial type 2 diabetic pedigrees.Diabetes Care,2004;27:622-623.
[29] Marchesini G,Brizi M,Bianchi G,et al.Nonalcoholic fatty liver disease:a feature of the metabolic syndrome.Diabetes,2001,50:1844-1850.
[30] Tuomainen TP,Nyysonen K,Salonen R,et al.Body iron stores are associated with serum insulin and blood glucose concentrations.Diabetes Care,1997,20:426-428.
[31] Fernandez-Rea1 JM,Ricart W,Arroyo E,et al.Serum ferritin as a component of the insulin resistance syndrome.Diabetescare,1998, 21:62-68.
[32] Lao TT CP,Tam KF.Gestational diabetes mellitus in the last trimester:A feature of maternal iron excess?Diabet Med,2001,18:218-223.
[33] Chen X,Scholl TO,Stein TP.Association of elevated serum ferritin Levels and the risk of gestational diabetes mellitus in pregnant women:The Camden study.Diabetes Care,2006,29(5):1077-1082.
[34] Randle PJ.Regulatory interactions between lipids and carbohydrates:the glucose fatty acid cycle after 35 years. Diabetes Metab Rev,1998,14: 263-283.
[35] Arner P.Insulin resistance in type 2 diabetes:role of fatty acids.Diabetes Metab Res Rev,2002,18:S5-S9.
[36] Rumberger JM,Peters TJr,Burrington C,etal.Transferrin and iron contribute to the lipolytic effec to serum in isolate dadipocytes.Diabetes,2004,53:2535-2641.
[37] Van Jaarsveld H,Pool GF,Barnard HC.Dietary iron concen tration alters LDL oxidatively , The effect of antioxidants.Res Commun Molp athol Pharmacol, 1998,99(1):69-80.
[38] FordES,GilesWH,Dietz WH,Prevalence of the metabolic syndrome among Rs adults:findings from the Third National Health and Nutrition Examination Survey. JAMA,2002,287:356-359.
[39]肖创清,何云南.血清铁蛋白放射免疫分析的临床应用价值.放射免疫学杂志,2005,18(1):60-64.
[40] Qayyum R,SchulmanP.Iron andathero sclerosis.Clin Cardiol,2005, 28:119-122.
[41] You SA,Wang Q.Ferritin in atherosclerosis. Clin Chim Acta,2005,357:1-16.
[42] Spiteller G.Is atherosclerosis a multifactorial disease or is it induced by a sequence of lipid peroxidation reaction. Ann N Y Acad Sci,2005,1043:355-366.
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