Department of Endocrinology Department of Cardiology Laboratory Center, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
Eur J Clin Invest. 2011 Aug;41(8):820-7. doi: 10.1111/j.1365-2362.2011.02471.x. Epub 2011 Jan 31.
A recent meta-analysis showed that both plasma lipoprotein-associated phospholipase A(2) (Lp-PLA(2) ) mass and activity independently predict cardiovascular events. Notably, Lp-PLA(2) activity but not mass was found to be a determinant of cardiovascular outcome in type 2 diabetes mellitus. We questioned whether relationships of carotid intima media thickness (IMT), a measure of subclinical atherosclerosis, with Lp-PLA(2) mass differ between diabetic and nondiabetic subjects.
Relationships of IMT with plasma Lp-PLA(2) mass (turbidimetric immunoassay) were compared in 74 patients with type 2 diabetes and in 64 nondiabetic subjects.
IMT was increased (P=0·016), but plasma Lp-PLA(2) mass was decreased in patients with diabetes compared to nondiabetic subjects (277±66 vs. 327±62μgL(-1) , P<0·001). In nondiabetic subjects, IMT was correlated positively with Lp-PLA(2) (r=0·325, P<0·009); multiple linear regression analysis confirmed an independent association of IMT with Lp-PLA(2) (ß=0·192, P=0·048). In contrast, IMT was unrelated to Lp-PLA(2) in patients with diabetes (r=0·021, P=0·86), and the relationship of IMT with Lp-PLA(2) was different in diabetic and control subjects (P<0·001). The relationship of Lp-PLA(2) with the total cholesterol/high-density lipoprotein (HDL) cholesterol ratio also differed between diabetic and nondiabetic subjects (P<0·001).
Plasma Lp-PLA(2) may relate to early stages of atherosclerosis development. In diabetes mellitus, in contrast, the association of IMT with plasma Lp-PLA(2) mass is abolished, which could be partly ascribed to redistribution of Lp-PLA(2) mass from apolipoprotein B-containing lipoproteins towards HDL. These findings raise questions about the usefulness of plasma Lp-PLA(2) mass measurement as a marker of subclinical atherosclerosis in type 2 diabetes mellitus.
最近的一项荟萃分析表明，血浆脂蛋白相关磷脂酶 A2（Lp-PLA2）的质量和活性均可独立预测心血管事件。值得注意的是，在 2 型糖尿病患者中，Lp-PLA2 的活性而非质量是心血管结局的决定因素。我们质疑颈动脉内膜中层厚度（IMT）与脂蛋白相关磷脂酶 A2（Lp-PLA2）质量之间的关系是否在糖尿病患者和非糖尿病患者之间存在差异。
我们比较了 74 例 2 型糖尿病患者和 64 例非糖尿病患者的 IMT 与血浆 Lp-PLA2 质量（比浊免疫测定法）之间的关系。
与非糖尿病患者相比，糖尿病患者的 IMT 升高（P=0.016），而血浆 Lp-PLA2 质量降低（277±66 与 327±62μg/L，P＜0.001）。在非糖尿病患者中，IMT 与 Lp-PLA2 呈正相关（r=0.325，P＜0.009）；多元线性回归分析证实 IMT 与 Lp-PLA2 独立相关（β=0.192，P=0.048）。相比之下，糖尿病患者的 IMT 与 Lp-PLA2 无关（r=0.021，P=0.86），糖尿病患者和对照组之间 IMT 与 Lp-PLA2 的关系不同（P＜0.001）。Lp-PLA2 与总胆固醇/高密度脂蛋白（HDL）胆固醇比值的关系在糖尿病患者和非糖尿病患者之间也不同（P＜0.001）。
血浆 Lp-PLA2 可能与动脉粥样硬化早期发展有关。相比之下，在 2 型糖尿病中，IMT 与血浆 Lp-PLA2 质量的关联被消除，这可能部分归因于 Lp-PLA2 质量从载脂蛋白 B 脂蛋白向 HDL 的重新分布。这些发现引发了关于血浆 Lp-PLA2 质量测量作为 2 型糖尿病患者亚临床动脉粥样硬化标志物的有用性的问题。
