台灣冠狀動脈疾病患者中有無糖尿病其血清中Adiponectin濃度的差異

研究背景與目的: 併發心血管疾病是造成第二型糖尿病患者死亡的最主要原因,但為什麼糖尿病患者易罹患粥狀硬化性心血管疾病,其真正原因及機制尚未清楚。最近許多國外的研究報告指出,有一種由脂肪組織所分泌,而且大量存在於循環當中的蛋白質Adiponectin , 它本身具有抗發炎(Anti-inflammatory), 抗糖尿病 (Antidiabetic), 抗血管粥狀硬化(Antiatherogenic)的特性。而且有研究報告指出,在糖尿病患者當中,合併有冠狀動脈疾病者,其血清中Adiponectin的濃度會比未合併有冠狀動脈疾病者低。因此理論上‚在冠狀動脈疾病患者當中,合併有糖尿病者,其血清中Adiponectin的濃度應該也會比未合併有糖尿病者低。故本人設計此一實驗來研究本土冠狀動脈疾病患者當中第二型糖尿病與非糖尿病患者間其血清中Adiponectin濃度的差異性。 研究方法與結果: 本研究總共收集了106位患者,男性50位,女性56位,平均年齡59歲(23歲至83歲),其中82位患有冠狀動脈疾病或糖尿病,24位為正常控制組。冠狀動脈疾病患者共41位,合併有糖尿病者19位,未合併者22位。糖尿病患者共60位。取自於空腹8小時以上的血液樣本,經離心後以RIA(Radioimmunoassay)的方式來測量血清中Adiponectin的濃度。以t檢定(Students’t test)及皮爾生(Pearson)相關係數來分析其差異性與相關性。研究結果顯示,冠狀動脈疾病患者當中第二型糖尿病患者,其血清中Adiponectin的濃度低於非糖尿病患者,但未達統計顯著水準(12.87±6.39 versus 15.18±9.48 μg/ml, p=0.186)。冠狀動脈疾病患者,其血清中Adiponectin的濃度低於非冠狀動脈疾病患者,但亦未達統計顯著水準(14.11±8.18 versus 15.85±5.70μg/ml, p=0.181)。血清中Adiponectin的濃度,男性明顯低於女性(11.21±6.94 versus 14.09±6.88μg/ml, p=0.0175),第二型糖尿病患者明顯低於非糖尿病患者(10.58±5.68 versus 15.85±5.70μg/ml, p<0.01)。血清中Adiponectin的濃度與BMI(body mass index)呈現負相關性(r=-0.479,p<0.01)。 結論: 冠狀動脈疾病患者當中第二型糖尿病患者與非糖尿病患者間,其血清中Adiponectin 的濃度並無明顯的差異性,但因樣本數較小及血清中Adiponectin的濃度變異性很大,進一步的研究是必須的。

Background: Atherosclerotic cardiovascular complications are the major causes of morbidity and mortality in type 2 diabetes mellitus patients. The precise mechanism underlying the development of atherosclerotic cardiovascular disease is still unclear. Adiponectin, an adipose tissue-specific plasma protein that is abundantly present in the circulation, was recently revealed to have anti-inflammatory, antidiabetic and antiatherogenic properties.1 The plasma level of adiponectin in diabetic patients with coronary artery disease is lower than in diabetic patients without coronary artery disease.1 In this study, we investigated the differences of plasma adiponectin levels between diabetic and non-diabetic patients with coronary artery disease to find out if a relationship exists. Methods and Results: This study includes a total of 106 patients (50 males and 56 females), 82 of whom had coronary artery disease(CAD) or diabetes mellitus(DM). A control group of 24 patients without DM nor CAD were included. All blood samples were drawn after an overnight 8-hour fast. Plasma samples were kept at -70∘C for subsequent assay. The concentration of plasma adiponectin was determined by an RIA (Radioimmunoassay). Data are expressed as mean±SEM. Intergroup differences in the measurements were analyzed by Students’ t test. Linear relationships were tested by Pearson’s correlation coefficient. There was no significant difference in the plasma level of adiponectin between diabetic and non-diabetic patients with coronary artery disease(12.87±6.39 versus 15.18±9.48 μg/ml, p=0.186). There was also no significant difference in the levels between CAD patients with and without diabetes mellitus(41 patients) and non-CAD patients(24 patients)(14.11±8.18 versus 15.85±5.70μg/ml, p=0.181). In contrast, plasma levels of adiponectin were significantly lower in the diabetic subjects with and without coronary artery disease(60 patients)than in the non-diabetic subjects(10.58±5.68 versus 15.85±5.70μg/ml, p<0.01) and were significantly lower in men than in women(11.21±6.94 versus 14.09±6.88μg/ml, p=0.0175). Plasma levels of adiponectin were negatively correlated with BMI (body mass index)(r=-0.479,p<0.01). Conclusions: There was no statically significant difference of plasma adiponectin levels between CAD subjects with DM and CAD subjects without DM.