Increased serum glycated albumin level is associated with the presence and severity of coronary artery disease in type 2 diabetic patients
Increased serum glycated albumin level is associated with the presence and severity of coronary artery disease in type 2 diabetic patients
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DOI：
10.1253/circj.71.1067
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发表时间：
2007-07-01
影响因子：
3.3
通讯作者：
Sheng Lou
中科院分区：
文献类型：
--
作者：
Li Jin Pu;Lin Lu;Sheng Lou
背景糖化白蛋白是体内循环中主要的Amadori型糖化蛋白，在糖尿病血管并发症的发展中起主要作用。本研究的目的是评估2型糖尿病（T2 DM）患者中血清糖化白蛋白水平升高与冠状动脉疾病（CAD）的存在和严重程度之间的关系。冠状动脉造影显示83例冠状动脉正常（对照组）和显著冠状动脉狭窄（>= 70%管腔直径狭窄），其中51例患者有1支血管病变（I组），80例患者有2支血管病变106例为3支病变（III组）。测定血清糖化白蛋白、血红蛋白Alc（HbAlc）和肿瘤坏死因子（TNF）-α水平、血脂和肾功能。采用Logistic回归分析确定血清糖化白蛋白水平与冠心病的发生和严重程度的相对危险度。多元逐步线性回归分析，以确定糖化白蛋白水平的独立决定因素。血清糖化白蛋白（21.2 ± 5.3% vs 19.4 ± 4.3%，p=0.005）和TNF-α水平（123 +/- 115 pg/ml vs 65 +/- 59 pg/ml，p < 0.001）在CAD患者中显著高于对照组，但血清HbAlc水平在他们之间没有显著差异（7.6 +/-1.3%vs7.4 +/-1.2%，p =0.19）。第I组和第III组之间的血清糖化白蛋白水平存在显著差异（19.5 +/- 3.3% vs 21.8 +/-5.7%，p < 0.001）。血清糖化白蛋白水平与病变动脉支数相关（斯皮尔曼r=0.205，p < 0.001），并与入院时血糖水平密切相关（r=0.495，p < 0.001）、TNF-α（r=0.123，p=0.028）、血尿素氮（r=0.167，p=0.004）、甘油三酯（r=0.129，p=0.021）和HbAlc（r=0.795，p < 0.001）。多变量分析表明，血清葡萄糖（p < 0.0001）、TNF-α（p=0.001）、血尿素氮（p=0.004）和甘油三酯（p=0.035）水平是糖化白蛋白的独立决定因素。Logistic回归分析显示，糖化白蛋白≥ 19%（OR 2.9，p < 0.001）是CAD的独立预测因子，糖化白蛋白≥ 21%（OR 2.3，p=0.032）是3支血管疾病的预测因子。糖化白蛋白的受试者工作特征曲线下面积（0.620，95%置信区间（CI）0.548至0.691，p=0.001）优于HbAlc的水平（上级（0.543，95%CI 0.473 ~ 0.613，p=0.243）。结论血清糖化白蛋白水平升高与冠心病的发生及严重程度相关，并可用于筛查T2 DM患者。
Background Glycated albumin is the predominant circulating Amadori-type glycated protein in vivo and plays a major role in the development of diabetic vascular complications. The aim of this study was to assess the relationship between increased serum glycated albumin level and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM).Methods and Results In a total of 320 consecutive patients with T2DM, coronary angiography revealed normal coronary arteries in 83 patients (control group) and significant coronary stenosis (>= 70% luminal diameter narrowing) in 237, of whom 51 patients had 1-vessel disease (Group I), 80 had 2-vessel disease (Group II), and 106 had 3-vessel disease (Group III). Serum glycated albumin, hemoglobin Alc (HbAlc) and tumor necrosis factor (TNF)-alpha levels, lipid profile, and renal function were measured. Logistic regression analysis was performed to determine the relative risk of serum glycated albumin level for the presence and severity of CAD. Multivariate stepwise linear regression analysis was done to identify independent determinants of the glycated albumin level. Serum glycated albumin (21.2 +/- 5.3% vs 19.4 +/- 4.3%, p=0.005) and TNF-alpha levels (123 +/- 115 pg/ml vs 65 +/- 59 pg/ml, p < 0.001) were significantly higher in patients with CAD than in controls, but serum HbAlc level did not significantly differ between them (7.6 +/- 1.3% vs 7.4 +/- 1.2%, p=0.19). There was a significant difference in serum glycated albumin level between Groups I and III (19.5 +/- 3.3% vs 21.8 +/- 5.7%, p < 0.001). The serum glycated albumin level correlated with the number of diseased arteries (Spearman r=0.205, p < 0.001), and was closely related to serum levels on admission of glucose (r=0.495, p < 0.001), TNF-alpha (r=0.123, p=0.028), blood urea nitrogen (r=0.167, p=0.004), triglycerides (r=0.129, p=0.021), and HbAlc (r=0.795, p < 0.001). Multivariate analysis indicated that serum levels of glucose (p < 0.0001), TNF-alpha (p=0.001), blood urea nitrogen (p=0.004) and triglycerides (p=0.035) were independent determinants for glycated albumin. Logistic regression analysis revealed that glycated albumin >= 19% (odds ratio (OR) 2.9, p < 0.001) was an independent predictor for CAD and glycated albumin >= 21% (OR 2.3, p=0.032) for 3-vessel disease prediction. The area under the receiver-operating characteristic curve for glycated albumin (0.620, 95% confidence interval (CI) 0.548 to 0.691, p=0.001) was superior to that for HbAlc (0.543, 95% CI 0.473 to 0.613, p=0.243).Conclusions An increased serum level of glycated albumin is associated with the presence and severity of CAD, and may be useful in screening patients with T2DM.