血清脂蛋白(a)与汉族 2 型糖尿病患者糖尿病视网膜病变的关系。

Association Between Serum Lipoprotein(a) and Diabetic Retinopathy in Han Chinese Patients With Type 2 Diabetes.

机构信息

Institute of Radiation Medicine, China Academy of Medical Science & Peking Union Medical College, Tianjin 300192, China.

Department of Laboratory, China Rehabilitation Research Center, Beijing 100068, China.

出版信息

J Clin Endocrinol Metab. 2017 Jul 1;102(7):2525-2532. doi: 10.1210/jc.2016-4015.

DOI:10.1210/jc.2016-4015

PMID:28472352

Abstract

CONTEXT

Contrasting observations have been made on the relationship between lipoprotein(a) [Lp(a)] concentration and diabetic retinopathy (DR) in patients with type 2 diabetes (T2D).

OBJECTIVE

To measure serum Lp(a) concentrations in patients with T2D to investigate whether Lp(a) affects risk for DR.

DESIGN AND PATIENTS

Serum Lp(a) was determined in 377 Han Chinese patients with T2D. Demographic and clinical information, including presence of DR and vision-threatening DR (VTDR), were collected on admission. The relationship between serum Lp(a) and DR or VTDR was evaluated using univariate and multivariate regression analyses.

RESULTS

Patients with DR or VTDR had significantly higher serum Lp(a) concentrations on admission (P < 0.001). The distribution across Lp(a) quartiles ranged from 11.7% (DR) and 4.3% (VTDR) in the first quartile to 47.9% (DR) and 19.1% (VTDR) in the fourth quartile (P for trend < 0.001). Multivariate logistic regression analysis adjusted for common DR and VTDR risk factors showed that the third and fourth Lp(a) quartiles were significantly associated with DR and VTDR compared with the first Lp(a) quartile (P < 0.001). The patient group with highest concentrations of both Lp(a) (fourth quartile) and hemoglobin A1c (≥7%) had an odds ratio for DR of 5.15 [95% confidence interval (CI), 2.78 to 9.55; P < 0.001] and for VTDR of 5.32 (95% CI, 2.92 to 10.15; P < 0.001) compared with patients with lower concentrations of both factors.

CONCLUSIONS

Lp(a) concentration was independently associated with DR in patients with T2D. More frequent retinal examinations should be recommended for patients with T2D and high Lp(a) concentrations.

摘要

背景

在 2 型糖尿病（T2D）患者中，脂蛋白（a）[Lp(a)]浓度与糖尿病视网膜病变（DR）之间的关系存在相互矛盾的观察结果。

目的

测量 T2D 患者的血清 Lp(a)浓度，以研究 Lp(a)是否影响 DR 的风险。

设计和患者

共纳入 377 例汉族 T2D 患者，测定其血清 Lp(a)。入院时收集人口统计学和临床信息，包括 DR 和威胁视力的 DR（VTDR）的存在情况。使用单变量和多变量回归分析评估血清 Lp(a)与 DR 或 VTDR 的关系。

结果

DR 或 VTDR 患者入院时的血清 Lp(a)浓度显著升高（P < 0.001）。Lp(a)四分位数的分布范围从第 1 四分位数的 11.7%（DR）和 4.3%（VTDR）到第 4 四分位数的 47.9%（DR）和 19.1%（VTDR）（趋势 P < 0.001）。调整常见的 DR 和 VTDR 危险因素的多变量逻辑回归分析显示，与第 1 个 Lp(a)四分位数相比，第 3 和第 4 个 Lp(a)四分位数与 DR 和 VTDR 显著相关（P < 0.001）。同时具有最高 Lp(a)（第 4 四分位数）和血红蛋白 A1c（≥7%）浓度的患者组，DR 的比值比为 5.15（95%置信区间[CI]，2.78 至 9.55；P < 0.001），VTDR 的比值比为 5.32（95% CI，2.92 至 10.15；P < 0.001），与两种因素浓度均较低的患者相比。