1型糖尿病患者的总抗氧化状态与冠状动脉钙化

Total antioxidant status and coronary artery calcification in type 1 diabetes.

作者信息

Valabhji J, McColl A J, Richmond W, Schachter M, Rubens M B, Elkeles R S

机构信息

Department of Endocrinology and Metabolic Medicine, Imperial College School of Medicine, St Mary's Hospital, Norfolk Place, London W2 1PG, United Kingdom.

出版信息

Diabetes Care. 2001 Sep;24(9):1608-13. doi: 10.2337/diacare.24.9.1608.

DOI:10.2337/diacare.24.9.1608

PMID:11522707

Abstract

OBJECTIVE

Type 1 diabetes is associated with a high risk of coronary heart disease (CHD), despite the absence of dyslipidemia. Oxidative modification may render LDLs more atherogenic. We aimed to assess antioxidant status in type 1 diabetes and its association with coronary artery calcification (CAC).

RESEARCH DESIGN AND METHODS

Total antioxidant status (TAS) of serum was measured using the Trolox equivalent antioxidant capacity assay in 48 type 1 diabetic and 25 nondiabetic subjects. The presence of CAC was assessed in the diabetic subjects using electron beam computed tomography.

RESULTS

TAS was reduced in type 1 diabetic subjects compared with nondiabetic subjects (Mann-Whitney U test, P < 0.0001). There were associations between TAS and HbA(1c) (r = -0.43; P = 0.0026) and duration of diabetes (r = -0.35; P = 0.0157). Significant CAC was considered present if the Agatston score was >10. The diabetic subjects with significant CAC were older (P < 0.0001); had longer duration of diabetes (P = 0.0002); were more likely to have high blood pressure (P = 0.040); had higher total cholesterol concentration (P = 0.039), serum creatinine concentration (P = 0.003), and urinary albumin-to-creatinine ratio (P = 0.022); and had lower serum TAS (P = 0.018) compared with those without significant calcification. In logistic regression with CAC as the dependent variable, TAS was entered as a predictor, and the effects on its predictive value of adding other explanatory variables in bivariate analyses were assessed. The power of TAS to predict CAC was independent of many of the traditional CHD risk factors. Whereas TAS as a predictor was no longer statistically significant when age or duration of diabetes were entered into the model, the odds ratio for a TAS concentration above the median value predicting significant CAC only increased from 0.19 to 0.26 and 0.32, respectively.

CONCLUSIONS

TAS is reduced in type 1 diabetes and is associated with the presence of CAC.

摘要

目的

1型糖尿病患者患冠心病（CHD）的风险较高，尽管其不存在血脂异常。氧化修饰可能使低密度脂蛋白更具致动脉粥样硬化性。我们旨在评估1型糖尿病患者的抗氧化状态及其与冠状动脉钙化（CAC）的关系。

研究设计与方法

采用特洛克斯等效抗氧化能力测定法，对48例1型糖尿病患者和25例非糖尿病患者的血清总抗氧化状态（TAS）进行了测量。使用电子束计算机断层扫描对糖尿病患者的CAC情况进行评估。

结果

与非糖尿病患者相比，1型糖尿病患者的TAS降低（曼-惠特尼U检验，P<0.0001）。TAS与糖化血红蛋白（HbA1c）（r=-0.43；P=0.0026）及糖尿病病程（r=-0.35；P=0.0157）之间存在相关性。如果阿加斯顿评分>10，则认为存在显著的CAC。与无显著钙化的糖尿病患者相比，有显著CAC的糖尿病患者年龄更大（P<0.0001）；糖尿病病程更长（P=0.0002）；更易患高血压（P=0.040）；总胆固醇浓度更高（P=0.039）、血清肌酐浓度更高（P=0.003）及尿白蛋白与肌酐比值更高（P=0.022）；血清TAS更低（P=0.018）。以CAC作为因变量进行逻辑回归分析，将TAS作为预测因子纳入，并评估在双变量分析中加入其他解释变量对其预测价值的影响。TAS预测CAC的能力独立于许多传统的CHD危险因素。当将年龄或糖尿病病程纳入模型时，TAS作为预测因子不再具有统计学意义，而TAS浓度高于中位数预测显著CAC的比值比仅分别从0.19增至0.26和0.32。