| Objective: To study the levels of serum lipopolysaccharide (LPS) in patients with type 2 diabetes mellitus and its association with development and regression of macrovascular atherosclerosis in the patients at three years of follow-up.Method: Serum of 80 patients with type 2 diabetes and 57 nondiabetic subjects were analyzed for LPS from the project of the National Eleventh Five-Year "Macrovascular complications prevention: experimental and control model in type 2 diabetes " under taken in the center of The Second Affiliated Hospital of Dalian Medical University. The data collected were age, sex, history of smoking, history of high blood pressure, Fasting plasma glucose (FPG), serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA1C), serum creatinine (Cr), blood urea nitrogen (BUN), serum insulin (Ins), random urine albumin (UA) at the time of enrollment and make a follow-up visit full one year, two years, three years. Ultrasound measurement of the intima-thickness, plaque numbers, size, and echo characteristics of common carotid artery, femoral artery, iliac artery were taken by the same trained doctor. Human lipopolysaccharide/ endotoxin (LPS) was measured with a commercial ELISA Kit.Results:1.The level LgLPS in the second year and the third year were higher in patients with diabetes than that in nondiabetic subjects (1.56±0.27 vs 1.40±0.24, t=﹣3.64, P<0.01, 1.61±0.41 vs 1.40±0.24, t=﹣3.785, P<0.01). The level LgLPS in the fourth year in diabetic patients were not different from that in the nondiabetic subjects (1.37±0.40 vs 1.40±0.24, t=﹣0.514, P>0.05) and was significantly lower than that in the second and third year (1.56±0.27 vs 1.37±0.40, t=3.531, P<0.01,1.61±0.41 vs 1.37±0.40, t=3.730, P<0.01). There was no significance between the second and third year.2. The CCA-IMT was significantly decreased at the fourth year from the baseline (1.27±0.28 vs 1.16±0.29, P<0.05), while there was no significant difference for CIA-IMT, CFA-IMT.3. When subjects were divided into diabetic macrovascular atherosclerosis group (AS group) and non-atherosclerosis group (NAS group). At enrollment, the course of disease (22.15±4.9 vs 18.76±4.43, t=2.487, P<0.05), baseline age (55.48±7.50 vs 49.46±8.78, t=﹣2.575, P<0.05), HbA1C (0.90±0.10 vs 0.82±0.05, t=2.487, P<0.05), SBP (129±16 vs 118±15, t=﹣2.923, P<0.01) and DBP (82±11 vs 77±10, t=﹣2.151, P<0.05) were higher in AS group than that in NAS group. There were no differences between LPS and the metabolic indices.4. Spearman correlation analysis showed LPS level was positively correlated with insulin (r=0.335, P=0.002) at the third year and with smoking (r=0.338, P=0.002) at the second year, the third year (r=0.242, P=0.030), and the fourth year (r=0.336, P=0.002). The LPS was not correlated with other research indices.5. There was no correlation of LPS with the change of carotid artery intima-media thickness (CCA-IMT), the femoral artery intima-media thickness (CFA-IMT), common iliac artery intima-media thickness (CIA- IMT), and no correlation with cases of diabetic macrovascular atheros- clerosis either.6. When subjects were divided into high-LPS group, middle-LPS group and low-LPS group. CCA-IMT in middle-LPS group was significantly thicker than that of the low-LPS group (1.12±0.20 vs 1.10±0.20, P<0.05) and CCA-IMT in high-LPS group was significantly thicker than that in the middle-LPS group (1.31±0.41 vs 1.12±0.20, P<0.05) at the third year. CCA-IMT of the middle-LPS group was significantly thicker than that of the low-LPS group (1.09±0.20 vs 1.07±0.22, P<0.05) and CCA-IMT of high-LPS group was significantly thicker than that of the low-LPS group (1.25±0.33 vs 1.07±0.22, P < 0.05) at the fourth year. The number of macrovascular disease in the three groups was not significantly different after one year, two years and three years (one year later:χ2=2.088, P=0.352; two years later:χ2=5.604, P=0.061; three years later:χ2=3.516, P=0.172).Conclusion: LPS might be associated with development of atherosclerosis. The higher is the LPS, and the thicker is the IMT. |
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