Study Of The Correlation Between Plasma Lipoprotein-associated Phospholipase A2and Subclinical Atherosclerosis In Type2Diabetes Mellitus

BackgroundDiabetes has become the increasingly serious social public health problem in the21st century. There are more and more diabetes mellicus patients around the world in recent decades, and its morbidity is increasing year by year. Diabetes not only make a big influence on the human being’s health, but also bring such a huge economic burden to every patient’s family and the whole society.to. At present, there are92.4million patients with diabetes in China, which take the first place of the world, in addition, there are148million pre-diabetes, which is an important risk factor for the development of overt diabetes and cardiovascular disease[1]. Diabetes chronic vascular pathy, especially macrovascular complication is the first cause of disability and death of the diabetes patients, as we all known, atherosclerosis is the pathologic basis of the vascular pathy,so how to identify early atherosclerosis and intervent its process has become the hotspot. Large amount of basic and clinical studies support the conclusion that inflammation plays a very important role in the whole process of atherosclerosis, and the plasma inflammatory markers are the important part of the risk factors, plasma lipoproteins-associated phospholipase A2(LP-PLA2) is one of those important inflammatory markers, it has drawn so many attentions in recent years for it can strengthen the blood vessel inflammation and atherosclerosis. Meanwhile, a variety of epidemiological studies support the standpoint using the measurement of Lp-PLA2to assess the risk of cardioascular disease. ObjectiveTo explore the correlation between the concentration of plasma Lp-PLA2and Subclinical atherosclerosis in new-diagnosed type2diabetes mellitus patients.MethodsA total of120new-diagnosed type2diabetes mellitus patients(aged27-77year,course≤1year)were enrolled in the study,and divided into60patients with subclinical artherosclerosis (subAS group) and60patients without subclinical artherosclerosis(NsubAS group)by ultrasonography, and then compare the difference of the clinical feature and plasma Lp-PLA2(measured by enzyme-linked immunosorbent assay(ELISA)) in the two group. According to gender these subjects were divided into two subgroups,to explore the relations to the concentration of plasma Lp-PLA2and subclinical atherosclerosis in two subgroups.and then based on atherosclerosis plaque these patients were dived into two groups,and compare the concentration of plasma Lp-PLA2in two group.Results1. Age[(52±12) vs(49±11) year]、waist-to-hip ratio (WHR)[(0.77±0.17)vs (0.68±0.16)]、systolic blood pressure (SBP)[(133.5±14.1)vs(126.1±11.1)mmHg]、 diastolic blood pressure (DBP)[(81.5±11.4)vs(76.5±10.2)mmHg]、fasting plasma glucose (FPG)[(8.27±2.18)vs(7.46±2.17)mmol/L]、2h postload plasma glucose (2hPPG)[(15.80±5.44)vs(13.51±4.72)mmol/L]、low-density lipoprotein cholesterol (LDL-c)[(3.62±1.26)vs(2.42±1.01)mmol/L]、high-density lipoprotein cholesterol (HDL-c)[(1.79±0.92)vs(1.10±0.39)mmol/L]、high-sensitivity C-reactive protein (hs-CRP)[6.52(0.30-60.82)vs1.40(0.16-4.34)mg/L]、lipoprotein-associsted phospholi-pase A2(Lp-PLA2)[(272.82±90.66)vs(38.13±77.37)μg/], common carotid artery intima-media thickness(CCA-IMT)[(1.0±0.34)vs(0.68±0.18)mm]、triglycerides (TG)[(2.78±1.47)vs(1.49±0.77)mmol/L]were significantly higher(P<0.05) in subAS group as compared to NsubAS group. 2. Based on gender (man/woman) all subjects were divided into two groups,the concentration of plasma Lp-PLA2was higher in man group as compare to woman group(P<0.05).But in subgroups(subAS group/NsubAS group) the concentration of plasma Lp-PLA2is not significant different between man group and woman group(P>0.05).3. Based on atherosclerosis plaques all subjects were divided into two groups, the concentration of plasma Lp-PLA2was higher in atherosclerosis plaques as compare to no atherosclerosis plaques[(275.25±88.67)vs(155.62±90.97)μg/L](P<0.01).4. Spearman and partial correlation analysis is showed:new-diagnosed in type2diabetes Lp-PLA2is correlative positively with TG (r=0.803, P<0.001), LDL (r=0.863, P<0.001), SBP (r=0.297, P<0.01), DBP (r=0.252, P<0.01), age (r=0.403, P<0.001), CCA-IMT (r=0.830, P<0.01), control confounding factors for partial correlation, although the correlation betweenLp-PLA2and age、TG、LDL-c、 CCA-IMT, but Lp-PLA2is still correlative positively with age (r=0.192, P<0.05), TG (0.471, P<0.001), LDL (r=0.535, P<0.001), CCA-IMT (r=0.550, P<0.001), and there are no correlation between Lp-PLA2and DBP, SBP.5. Logistic regression analysis showed that LDL、HDL、WHR、hsCRP and Lp-PLA2contributed to subclinical atherosclerosis in newly diagnosed type2diabetes patients.Conclusions1. Plasma Lp-PLA2level is related positively with TG, LDL, IMT and age in new-diagnosed type2diabetes patients and highly isexpessed in the atherosclerotic plaques,but such expression is different in man and woman.2. Lp-PLA2has the predictional significance for early macrovascular pathy in new-diagnosed type2diabetes patients and give a new way to early intervene the subclinical atherosclerosis.