Diabetes Care：瑞金医院沈卫峰发现ApoA–I糖基化水平与CAD严重程度有关

为了探讨在2型糖尿病患者，脱辅基蛋白（apo）A–I糖基化水平是否与冠状动脉疾病（CAD）和斑块进展有关，来自上海交通大学附属瑞金医院心内科的沈卫峰教授及其团队进行了一项研究（Glycation of apoprotein a-I is associated with coronary artery plaque progression in type 2 diabetic patients），该研究发现在2型糖尿病患者，脱辅基蛋白A–I糖基化水平与冠状动脉疾病严重程度及冠状动脉斑块进展相关。该研究结果发表在2013年4月的美国《糖尿病治疗》（Diabetes Care）杂志上，该杂志影响因子为8.087。
该研究在375例连续的2型糖尿病患者中间进行定量冠状动脉造影（QCA）和血管内超声（IVUS）检查，对82例无明显狭窄（管腔直径狭窄＜30%[Ⅰ组]）患者，以及190例伴有明显冠状动脉疾病（管腔直径狭窄＞70%[Ⅱ组]）患者分析脱辅基蛋白A–I糖基化水平和血清卵磷脂胆固醇酰基转移酶（LCAT）的活性。对照组为136例健康受试者。在1年随访后，主要在Ⅱ组患者重复血管造影和IVUS，评估斑块进展情况。
该研究结果表明，对照组、Ⅰ组、Ⅱ组光密度法测定糖基化脱辅基蛋白A–I的相对强度逐渐增强，血清卵磷脂胆固醇酰基转移酶活性逐渐下降。在Ⅱ组中，这两种测量值与病变冠状动脉的数量和程度指数相关。在1年随访期间，定量冠状动脉造影在159例受试者中发现45例患者有斑块进展，血管内超声在127例受试者中发现38例患者有斑块进展。与未出现斑块进展的患者相比，有斑块进展的患者基线糖基化脱辅基蛋白A–I相对强度显著增加，其数值与定量冠状动脉造影和血管内超声检测值改变相关。多元回归分析显示，在2型糖尿病患者，基线糖基化脱辅基蛋白A–I相对强度是冠状动脉疾病和斑块进展的独立决定因素。
该研究发现，在2型糖尿病患者，脱辅基蛋白A–I糖基化水平与冠状动脉疾病严重程度及冠状动脉斑块进展相关。
与糖尿病相关的拓展阅读：

• GLP-1类糖尿病药物的胰腺炎风险引起监管机构重视
• Diabetes Care：糖尿病视网膜病和微量白蛋白尿可预测T2DM患者大量白蛋白尿和肾功能减退
• NEJM：糖尿病治疗领域的进展与不足
• JAMA：研究支持对糖尿病患者进行更强力的抗血小板治疗
• Obes Surg：减重手术可能不能“治愈”糖尿病
• Cell Metab:新的血清标志物提前数年预测糖尿病风险
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Glycation of apoprotein a-I is associated with coronary artery plaque progression in type 2 diabetic patients.
Abstract
OBJECTIVE To investigate whether glycation level of apoprotein (apo)A-I is associated with coronary artery disease (CAD) and plaque progression in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Among 375 consecutive type 2 diabetic patients undergoing quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS), 82 patients with nonsignificant stenosis (luminal diameter narrowing <30% [group I]) and 190 patients with significant CAD (luminal diameter stenosis ≥70% [group II]) were included for analysis of apoA-I glycation level and serum activity of lecithin: cholesterol acyltransferase (LCAT). The control group had 136 healthy subjects. At the 1-year follow-up, angiography and IVUS were repeated mainly in group II patients for plaque progression assessment. RESULTS Relative intensity of apoA-I glycation by densitometry was increased, and serum LCAT activity was decreased stepwise across groups control, I, and II. These two measurements were associated with the number of diseased coronary arteries and extent index in group II. During 1-year follow-up, QCA detected 45 patients with plaque progression in 159 subjects, and IVUS found 38 patients with plaque progression in 127 subjects. Baseline relative intensity of apoA-I glycation was significantly increased in patients with plaque progression compared with those without, with values associated with changes in QCA and IVUS measurements. Multivariable regression analysis revealed that baseline relative intensity of apoA-I glycation was an independent determinant of CAD and plaque progression in type 2 diabetic patients. CONCLUSIONS ApoA-I glycation level is associated with the severity of CAD and coronary artery plaque progression in type 2 diabetic patients.