Relationship Between Serum Pregnancy-associated Plasma Protein-A Level And Carotid Plaque In Patients With Type 2 Diabetes Mellitus

Objective : To explore the relationship between pregnancy-associated plasma protein-A(PAPP-A) and carotid plaque in patients with type 2 diabetes,and the association of serum PAPP-A levels with anthropometric parameters, glucose-lipid metabolism parameters, insulin sensitivity index, and inflammatory factors(TNF-α,hs-CRP), in order to provide some theoretical foundation for the occurrence of T2DM and its macrovascular complications .Methods: We detected the carotid intima-media thicknes(sIMT) of all subjects by color doppler ultrasonography. According to the results,the patient group was divided into atherosclerosis group(T2DM+CP) and nonatherosclerosis group(T2DM). The normal control group had neither intimal thickening nor plaque. Serum PAPP-A levels were measured by ELISA in 60 patients with type 2 diabetes (30 diabetic patients without carotid plaque and 30 diabetic patients with it) and 28 healthy controls.TNF-α,hs-CRP,HbA1c,fasting plasma glucose (FPG),fasting insulin (FINS) and some other metabolic variables were also determined.Body mass index (BMI) was evaluated and insulin sensitivity was assessed by HOMA-IR.Results:①The serum PAPP-A levels in type 2 diabetes with and without carotid plaque were significantly higher than those in control group (P<0.05 respectively). Furthermore, among type 2 diabetes,serum PAPP-A level was higher in patients with carotid plaque than those without, (4.97±1.63)μg/mL. VS. (3.42±1.96)μg/mL (P<0.05).②A multivariate correlation analysis showed that serum PAPP-A level positively correlates with TNF-αin patients with carotid plaque (β=0.61,P<0.05).③No gender difference was found in serum PAPP-A level between the two DM groups.④Stepwise linear multiple regression revealed that in the patients group without carotid plaque ,HDL-C (r = 0.27, P= 0.008) and LDL-C (r = 0.24, P = 0.007 ) were significant determinants of PAPP-A level; in patients with carotid plaque,BMI (r = 0.18, P = 0.030) and FPG(r = 0.24, P = 0.014) were significant determinants of PAPP-A level.Conclusion:①Serum PAPP-A level was higher in patients with carotid plaque than those without,thus monitoring the serum PAPP-A levels may have a very significant value for understanding the degree of diabetic macrovascular complications.②P APP-A is positively related with chronic inflammation factors in diabetic patients with carotid plaque and it may play an important role in the process of developing a complication of great vessels in diabetes patients.③Better glycemic control may contribute to the decrease in serum PAPP-A concentrations,thus delay or even reduce the occurrence of macrovascular complications of diabetes.