| BackgroundIn recent years,the incidence of coronary atherosclerotic heart disease(CAD)and type 2 diabetes mellitus(T2DM)has increased year by year,and showed a trend of younger incidence.These two chronic diseases and their common pathological characteristics,such as abnormal lipid metabolism and activation of inflammatory reaction,have been paid more and more attention,the NCEP-ATP III guidelines of the United States regard T2DM as a disease equivalent to CAD.In the guidelines for the Prevention and treatment of dyslipidemia in Chinese Adults(revised 2016),patients with atherosclerotic cardiovascular disease,including CAD,were classified as very high-risk groups,and T2DM patients were classified as high-risk groups.At present,it has been recognized that dyslipidemia,especially the increase of plasma low density lipoprotein cholesterol(LDL-C),is an important risk factor for the occurrence and development of coronary heart disease.At the same time,abnormal lipid metabolism plays an important role in the occurrence and development of diabetes mellitus and its complications.Studies have shown that 43.9%of T2DM patients in China also have dyslipidemia.The decrease of high density lipoprotein cholesterol(HDL-C)is one of the important factors that increase the incidence of cardiovascular complications in patients with T2DM.Previous epidemiological studies have shown that HDL-C levels are negatively correlated with the risk of coronary heart disease,and the incidence of coronary heart disease decreases by 2%?3O%for every 1 mg/dL,increase in HDL-C levels.However,several large recent studies have concluded that simply increasing the concentration of HDL-C does not delay the progression of atherosclerosis.The failure of nicotinic acid clinical research represented by HPS-THRIVE research and CEPT inhibitor research represented by torcetrapid also confirmed the complexity of HDL particles.Because HDL particles are heterogeneous particles composed of a series of different functions,structures and sizes,and HDL particles with different subcomponent characteristics have different functions,more and more researchers focus on the function of HDL particles.The anti-arteriosclerosis ffunction of HDL particles is related not only to the value of HDL-C,but also to the size of HDL particles,in our previous study,it was considered that the larger HDL particles had stronger anti-arteriosclerosis function-Maze et al reported that HDL-C/apoA-I ratio can be used to replace the relative size of HDL particles,which represents that different HDL particle functions have been widely recognized,so that we have a certain quantitative index of HDL particle function.In the current study,there have been a few studies on HDL particle size(HDL-C/apoA-I ratio)and function in CAD patients and T2DM patients,Some of the results are still controversial.According to the results of Kontush et al,small HDL particles are stronger than large HDL particles in cholesterol reversal.However,the current mainstream view still believes that large particles of HDL have a stronger effect on anti-atherosclerosis.For example,Ford MA et al found that the large HDL particles isolated by nuclear magnetic resonance spectroscopy(NMR)can inhibit the dysfunction of coronary artery endothelial cells.Hermans et al.in a study of female patients with type 2 diabetes mellitus showed that the decrease of HDL-C/apoA-I ratio was associated with lower islet ? cell residual function and complications of large and small arteries(mainly coronary artery disease and retinopathy).However,when CAD patients complicated with T2DM,whether HDL particle size(HDL-C/apoA-I ratio)and CRP and other inflammatory indicators changed,whether these changes were related to the degree of coronary artery disease,whether it was related to the clinical classification of patients with coronary heart disease,And whether it's related to blood sugar control,At present,there are few studies on these issues,and no relevant reports have been found in the literature at home and abroad.ObjectivesThe purpose of this study was to investigate the changes of HDL-C/apoA-I ratio and CRP in patients with CAD combined with T2DM,and the relationship between this two and blood sugar control in patients with CAD combined with T2DM,and to compare the relationship between HDL-C/apoA-I ratio and the number of coronary artery lesions in patients with CAD combined with T2DM,so as to determine whether T2DM affects the HDL-C/apoA-I ratio of patients,thus resulting in the difference of HDL particles function.Secondary prevention of CAD patients provides new ideas and targets.MethodsA total of 610 patients who underwent coronary angiography for the first time and were diagnosed as CAD in Nanfang Hospital were collected.Total samples were divided into T2DM group(n = 374)and non-T2DM group(n = 236)according to whether there was a history of T2DM or OGTT results.After confirming that there was no statistical difference in baseline data between the two groups,the differences of blood lipid profile,HDL particle size and CRP value between the two groups were compared respectively.The T2DM group was divided into good glycemia control group(HbA1C<6.5%,n=157)and poor glycemia control group(HbA1C>6.5%,n=217).After confirming that there was no statistical difference in baseline data armong the three groups,the differences of blood lipid profile,HDL particle size and CRP value were compared among the three groups,and the differences of HDL particle size and CRP in different clinical situations were analyzed;the correlation between HDL particle size,CRP and HbAIC and clinical stability of CAD;and the relationship between HDL particle size and coronary artery lesion branch number in patients with T2DM were discussed.The changes of CRP in patients with CAD combined with T2DM were studied to explore the clinical application prospects of HDL particles.Results1.The patients with T2DM showed the characteristics of HDL-C,apoA-I,apolipoprotein ratio(apoA-I/apo-B)decreased(P<0.05)and LDL-C increased.At the same tirme,HDL-C/apoA-I in the patients with T2DM was smaller than that in the non-T2DM group,and CRP in the patients with T2DM was significantly higher than that in the non-T2DM group.2.Among the three groups,HDL-C/apoA-I in the non-T2DM group was larger than that in the other two groups,while HDL-C/apoA-I in the good glycemia control group and the poor glycemia control group had no statistical difference.CRP in the group with poor glycemic control was larger than that in the other two groups.There was no significant difference in CRP between the non-T2DM group and the group with good glycemic control.3.The BMI was higher,HDL-C and apoA-I were lower and HDL-C/apoA-I was smaller in patients with coronary multi-vessel disease(P<0.05).4.CRP and HbA1C were positively correlated in patients with CAD and T2DM(correlation coefficient = 0.211,P<0.05).5.High CRP was a risk factor for clinical instability of coronary heart disease.The incidence of ACS in high CRP group was higher.There was significant difference between the two groups(x2=9.241,P<0.05).ConclusionWhen the CAD population is combined with T2DM,the size of HDL particles is smaller,the CRP is higher,and clinical instability events happen more frequently.The smaller the size of HDL particles,the more the number of coronary lesions in patients;the size of HDL particle is not related to glycemic control but just whether CAD patients are combined with T2DM;CRP is positively correlated with HbA1C.HDL particle size(HDL-C/apoA-I ratio)and CRP are closely related to coronary artery disease and clinical stability in patients with coronary heart disease complicated with type 2 diabetes mellitus.It has certain clinical value. |
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