Pu Li Jin, Lu Lin, Shen Wei Feng, Zhang Qi, Zhang Rui Yan, Zhang Jian Sheng, Hu Jian, Yang Zheng Kun, Ding Feng Hua, Chen Qiu Jin, Shen Jie, Fang Dan Hong, Lou Sheng
Department of Cardiology, Rui Jin Hospital, Institute of Cardiovascular Diseases, Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Circ J. 2007 Jul;71(7):1067-73. doi: 10.1253/circj.71.1067.
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).
In a total of 320 consecutive patients with T2DM, coronary angiography revealed normal coronary arteries in 83 patients (control group) and significant coronary stenosis (> or = 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 A(1c) (HbA(1c)) 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 HbA(1c) (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 > or = 19% (odds ratio (OR) 2.9, p<0.001) was an independent predictor for CAD and glycated albumin > or = 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 HbA(1c) (0.543, 95% CI 0.473 to 0.613, p=0.243).
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.
糖化白蛋白是体内主要的循环阿马多里型糖化蛋白，在糖尿病血管并发症的发生发展中起主要作用。本研究旨在评估2型糖尿病（T2DM）患者血清糖化白蛋白水平升高与冠状动脉疾病（CAD）的存在及严重程度之间的关系。
连续纳入320例T2DM患者，冠状动脉造影显示83例患者冠状动脉正常（对照组），237例患者存在显著冠状动脉狭窄（管腔直径狭窄≥70%），其中51例患者为单支血管病变（I组），80例为双支血管病变（II组），106例为三支血管病变（III组）。检测血清糖化白蛋白、糖化血红蛋白A1c（HbA1c）、肿瘤坏死因子（TNF）-α水平、血脂谱及肾功能。进行逻辑回归分析以确定血清糖化白蛋白水平与CAD存在及严重程度的相对风险。进行多变量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。CAD患者血清糖化白蛋白（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）显著高于对照组，但两组间血清HbAlc水平无显著差异（7.6±1.3% vs 7.4±1.2%，p=0.19）。I组和III组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血管数量相关（Spearman r=0.205，p<0.001），且与入院时血糖（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）及HbA1c（r=0.795，p<0.001）水平密切相关。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。逻辑回归分析显示，糖化白蛋白≥19%（比值比（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）是三支血管病变预测的独立预测因子。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HbA1c（0.543，95%CI 0.473至0.613，p=0.243）。
血清糖化白蛋白水平升高与CAD的存在及严重程度相关，可能有助于筛查T2DM患者。
