Lu Chengzhi, Gao Yun, Zhou Hong, Tian Haoming
Department of Endocrinology, West China Hospital of Sichuan University, ChengDu, China.
Coron Artery Dis. 2008 Dec;19(8):565-73. doi: 10.1097/MCA.0b013e3283109206.
Lower paraoxonase (PON1) activity and higher oxidized low-density lipoprotein (oxLDL) levels are main risk factors of coronary heart disease (CHD). The aim of this study is to observe the characteristics of coronary artery lesions in CHD patients with or without hyperglycemia and relationships between coronary artery lesions and oxLDL levels as well as PON1 activity. Two hundred and eighty-four participants were divided into four groups according to their coronary angiographies and fasting plasma glucose levels: CHD+diabetes mellitus (DM) (n=46); CHD+impaired fasting glucose (n=62); CHD+normal fasting glucose (NFG) (n=86); healthy control group (n=90). The CHD+DM group had more diffuse lesions, higher frequency of severe coronary stenoses or total occlusions and more multivessel lesions than those with NFG. PON1 activity in the CHD+NFG group was lower than that in control participants (P<0.05), and much lower in the CHD patients with hyperglycemia (DM and impaired fasting glucose) (P<0.01). OxLDL levels in the CHD+DM group were higher than in the CHD+NFG group (P<0.05). In the CHD patients with hyperglycemia, the patients of multivessel lesions had higher oxLDL levels than those of single-vessel lesions (P<0.05) and the patients of severe stenosed vessels had obviously lower PON1 activity than those of mild and moderate stenosed vessels (P<0.01), whereas oxLDL levels were higher in the patients with diffuse lesions than those with focal lesions(P<0.05). In the multivariate analysis, the patients in the highest quartile of oxLDL level had an increased likelihood of having multivessel lesions or diffuse lesions compared with those in the lowest quartile [odds ratio (OR)=49.46, P=0.001; OR=34.30, P<0.001, respectively] whereas there was a negative correlation between two upper quartiles of serum PON1 activity and the likelihood of severe stenoses or total occlusions among the CHD patients with hyperglycemia (the top quartile, OR=0.14, P=0.008; the third quartile, OR=0.22, P=0.033). Lower PON1 activity and higher oxLDL levels may be predicting factors that denote diffuse, severe or multivessel disease in CHD patients with hyperglycemia.
对氧磷酶（PON1）活性降低和氧化型低密度脂蛋白（oxLDL）水平升高是冠心病（CHD）的主要危险因素。本研究旨在观察合并或不合并高血糖的冠心病患者冠状动脉病变的特征，以及冠状动脉病变与oxLDL水平和PON1活性之间的关系。根据冠状动脉造影和空腹血糖水平，将284名参与者分为四组：冠心病合并糖尿病（DM）组（n = 46）；冠心病合并空腹血糖受损组（n = 62）；冠心病合并空腹血糖正常（NFG）组（n = 86）；健康对照组（n = 90）。与NFG组相比，冠心病合并DM组有更多的弥漫性病变、更高的严重冠状动脉狭窄或完全闭塞发生率以及更多的多支血管病变。冠心病合并NFG组的PON1活性低于对照组参与者（P<0.05），而在合并高血糖（DM和空腹血糖受损）的冠心病患者中则更低（P<0.01）。冠心病合并DM组的oxLDL水平高于冠心病合并NFG组（P<0.05）。在合并高血糖的冠心病患者中，多支血管病变患者的oxLDL水平高于单支血管病变患者（P<0.05），严重狭窄血管患者的PON1活性明显低于轻度和中度狭窄血管患者（P<0.01），而弥漫性病变患者的oxLDL水平高于局灶性病变患者（P<0.05）。在多变量分析中，与最低四分位数相比，oxLDL水平处于最高四分位数的患者发生多支血管病变或弥漫性病变的可能性增加[比值比（OR）=49.46，P = 0.001；OR = 34.30，P<0.001]，而在合并高血糖的冠心病患者中，血清PON1活性的上两个四分位数与严重狭窄或完全闭塞的可能性呈负相关（最高四分位数，OR = 0.14，P = 0.008；第三四分位数，OR = 0.22，P = 0.033）。较低的PON1活性和较高的oxLDL水平可能是合并高血糖的冠心病患者弥漫性、严重或多支血管病变的预测因素。
