Brădescu O M, Georgescu Maria, Ifrim Silvi, Ioacără S, Ionescu-Tîrgovişte C
Clinic of Diabetes, N. Paulescu Institute of Diabetes, Bucharest, Romania.
Rom J Intern Med. 2005;43(1-2):97-113.
C reactive protein (CRP), a non-specific acute phase reactant, has been associated with multiple patogenic mechanisms involved in chronic illnesses, but up to now the significance of CRP in the postprandial state in diabetes mellitus has not been addressed.
We evaluated 58 type 2 diabetic patients (33F/25 M) with associated metabolic syndrome. The main characteristics of the patients were: age 58.1+/-9.15 years, duration of diabetes 3.9+/-3.07 years, BMI 26.2+/-3.26 kg/m2, waist circumference 97.7+/-9.88 cm and HbA1c 7.2+/-1.2%. Men and women were matched for age, duration of diabetes, BMI and HbA1c. The patients had a 330 kcal standard meal, blood samples were taken in fasting condition and 2 and 4 hours postprandial and the following parameters were obtained: glycemia, total cholesterol, HDL-cholesterol, triglycerides, apolipoprotein A1 and B and also CRP levels. The patients were also evaluated through duplex scan 2D ultrasound for intima-media thickness (IMT) of common carotid artery bilaterally. Data were analysed with Epi Info, SPSS and Statistica Software.
Fasting CRP correlated to BMI and waist circumference (p=0.0068 and p=0.038 respectively). At two hours postprandial, we found a significant nonparametric correlation between CRP level and total cholesterol (p=0.01), which remained significant even after adjusting for age, BMI, HbA1c and blood pressure values (adjusted p=0.018). Patients in the lowest quartile for CRP level compared to those in the highest quartile had lower fasting apolipoprotein B levels (146 vs 197 mg/dl, p=0.042), lower postprandial blood glucose levels (188 vs 241 mg/dl, p=0.035) and lower nonHDL-cholesterol levels (148 vs 192 mg/dl, p=0.005). Common carotid artery IMT correlated with the duration of diabetes (p=0.026) and systolic blood pressure values both in clino and orthostatism (p=0.007 and p=0.006 respectively).
The results confirm that C reactive protein and apolipoprotein B have close relationships with other components of the metabolic syndrome in type 2 diabetic patients. High CRP and apolipoprotein B levels could be a marker for an excessive postprandial response, leading to an increased risk for chronic vascular complications and atherogenesis.
C反应蛋白（CRP）是一种非特异性急性期反应物，与多种慢性疾病的发病机制相关，但迄今为止，CRP在糖尿病餐后状态中的意义尚未得到探讨。
我们评估了58例伴有代谢综合征的2型糖尿病患者（33例女性/25例男性）。患者的主要特征为：年龄58.1±9.15岁，糖尿病病程3.9±3.07年，体重指数（BMI）26.2±3.26kg/m²，腰围97.7±9.88cm，糖化血红蛋白（HbA1c）7.2±1.2%。根据年龄、糖尿病病程、BMI和HbA1c对男性和女性进行匹配。患者进食330千卡标准餐，在空腹状态以及餐后2小时和4小时采集血样，测定以下参数：血糖、总胆固醇、高密度脂蛋白胆固醇、甘油三酯、载脂蛋白A1和B以及CRP水平。还通过双功扫描二维超声评估双侧颈总动脉的内膜中层厚度（IMT）。数据采用Epi Info、SPSS和Statistica软件进行分析。
空腹CRP与BMI和腰围相关（分别为p=0.0068和p=0.038）。餐后2小时，我们发现CRP水平与总胆固醇之间存在显著的非参数相关性（p=0.01），即使在调整年龄、BMI、HbA1c和血压值后，这种相关性仍然显著（调整后p=0.018）。与CRP水平最高四分位数的患者相比，CRP水平最低四分位数的患者空腹载脂蛋白B水平较低（146对197mg/dl，p=0.042），餐后血糖水平较低（188对241mg/dl，p=0.035），非高密度脂蛋白胆固醇水平较低（148对192mg/dl，p=0.005）。双侧颈总动脉IMT与糖尿病病程相关（p=0.026），与临床和直立位时的收缩压值均相关（分别为p=0.007和p=0.006）。
结果证实C反应蛋白和载脂蛋白B与2型糖尿病患者代谢综合征的其他成分密切相关。高CRP和载脂蛋白B水平可能是餐后反应过度的标志物，导致慢性血管并发症和动脉粥样硬化发生风险增加。
