基线脂代谢谱特征对降糖药物干预再发心血管事件影响的预测研究

发布时间：2018-12-14 20:01

【摘要】：目的·探讨基线脂代谢谱与降糖药物格列吡嗪和二甲双胍干预后心血管结局的关系,寻找能够预测格列吡嗪和二甲双胍长期心血管效应的脂质组分。方法·选取116例分别接受格列吡嗪(56例)和二甲双胍(60例)治疗3年的2型糖尿病(T2DM)合并冠状动脉粥样硬化性心脏病(CHD)患者,运用液相色谱-四级杆飞行时间质谱联用技术(LC-QTOF/MS)测定基线血清中的119种脂质组分。随访所有患者心血管复合终点(包括心血管死亡、全因死亡、非致命性心肌梗死、非致命性脑卒中及冠脉血运重建)的发生情况。通过Logistic回归分析脂质组分与患者心血管复合终点的关系。采用连续净重新分类指数(cf NRI)和整体鉴别指数(IDI)评价基线脂质组分是否有助于提高对再发心血管事件的预测能力。结果·除利尿剂使用率和PC(O-34:2)及SM(d18:0-24:0)水平外,2组间基线药物分布及临床特征和生化指标的差异均无统计学意义。Logistic回归分析结果显示:基线ChE(20:4)是格列吡嗪组患者再发心血管事件的保护性因素(OR=0.87,P=0.039);ChE(20:4)显著提高了心血管复合终点的cf NRI和IDI,分别为69%和0.07(P=0.011,P=0.028)。基线SM(d18:1-22:0)是二甲双胍组患者和全部受试者再发心血管事件的危险因素(OR=1.65,P=0.039;OR=1.64,P=0.014);SM(d18:1-22:0)显著提高了二甲双胍组和全部受试者的心血管复合终点的cf NRI,分别为74%和55%(P=0.012,P=0.005)。结论·在由LC-QTOF/MS方法测得的119种脂质组分中,基线ChE(20:4)和SM(d18:1-22:0)可分别为T2DM合并CHD患者接受格列吡嗪和二甲双胍长期治疗后出现心血管复合终点的保护性和危险因素,且均有助于提高预测再发心血管事件风险的准确性。
[Abstract]:Objective to investigate the relationship between baseline lipid metabolism spectrum and cardiovascular outcome after intervention of hypoglycemic drugs glipizide and metformin, and to find out the lipid components that can predict the long-term cardiovascular effects of glipizide and metformin. Methods 116 patients with type 2 diabetes mellitus (T2DM) complicated with coronary atherosclerotic heart disease (CHD) were treated with glipizide (56 cases) and metformin (60 cases) for 3 years. A total of 119 lipid components in baseline serum were determined by liquid chromatography-quadrupole time of flight mass spectrometry (LC-QTOF/MS). All patients were followed up for cardiovascular complex endpoints (including cardiovascular death, all-cause death, non-fatal myocardial infarction, non-fatal stroke, and coronary revascularization). The relationship between lipid components and cardiovascular complex endpoints was analyzed by Logistic regression analysis. Continuous net recategorization index (cf NRI) and global discriminant index (IDI) were used to evaluate whether baseline lipid components could improve the ability of predicting recurrent cardiovascular events. Results except for the diuretic usage rate and the levels of PC (O-34: 2) and SM (d18: 0-24: 0), The results of Logistic regression analysis showed that baseline ChE (20:4) was the protective factor of recurrent cardiovascular events (OR=0.87,) in glipizide group. (P0. 039); ChE (20:4) significantly increased the cf NRI and IDI, of cardiovascular complex endpoints by 69% and 0.07, respectively. Baseline SM (d18: 1-22: 0) was a risk factor for recurrent cardiovascular events (OR=1.65,P=0.039;OR=1.64,P=0.014) in metformin patients and all subjects. SM (d18: 1-22: 0) significantly increased the cf NRI, of cardiovascular complex endpoints in metformin group and all subjects by 74% and 55% (P < 0.012). Conclusion among the 119 lipid components determined by LC-QTOF/MS method, Baseline ChE (20:4) and SM (d18: 1-22: 0) were protective and risk factors for cardiovascular complex endpoints in T2DM patients with CHD after long-term treatment with glipizide and metformin, respectively. It is helpful to improve the accuracy of predicting the risk of recurrent cardiovascular events.
【作者单位】：上海交通大学医学院附属瑞金医院内分泌代谢病科上海市内分泌代谢病研究所上海市内分泌代谢病临床医学中心;中国科学院大连化学物理研究所分离分析化学重点实验室;SPREAD-DIMCAD研究组;
【基金】：国家自然科学基金项目(81471074,81670797) 上海市科学技术发展基金(14411964700) 上海市教育委员会高峰高原学科建设计划(20161411);上海市教育委员会“曙光计划”项目(14SG17) 国家重点研发计划项目(2016YFC0901200)~~
【分类号】：R54;R587.1

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