·神经科疾病临床观察研究·

2型糖尿病合并脑梗死患者血清对氧磷脂酶-1的活性变化及临床意义

朱卫香1，刘彦敏2，张砚卿2，杜国辉2，张琳琳2

摘要：目的探讨2型糖尿病合并脑梗死患者血清对氧磷脂酶-1(PON-1)活性变化的临床意义。方法采用对硝基苯酚为底物的速率法测定正常对照组(n=50)、单纯2型糖尿病组(n=56)及糖尿病合并脑梗死组(n=48)观察者血清PON-1活性，同时检测3组的体重指数、血糖、氧化低密度脂蛋白胆固醇(ox-LDL)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平等指标。结果2型糖尿病组血清PON-1、HDL-C明显低于正常对照组(P<0.001)，ox-LDL、LDL-C、TC、TG明显高于正常对照组，差异有统计学意义(P<0.05)；糖尿病合并脑梗死组PON-1活性又明显低于单纯糖尿病组(P<0.05)，糖尿病合并脑梗死组ox-LDL水平又明显高于单纯糖尿病组(P<0.05)；相关分析显示血清PON-1与ox-LDL呈显著负相关(r=-0.565，P<0.001)，与HDL呈正相关(r=0.179，P<0.05)。结论PON-1活性降低导致抗氧化能力的减弱，这种改变对预测2型糖尿病并发脑梗死风险有重要意义。

关键词：2型糖尿病； 脑梗死； 血清对氧磷脂酶-1

中图分类号：R743R255

收稿日期：(2014-09-27)

Serum Paraoxonase-1 Activity in Patients with Cerebral Infarction with Diabetes and Its Clinical Significance

Zhu Weixiang,Liu Yanmin,Zhang Yanqing，Du Guohui，Zhang Linlin

Tangshan Xiehe Hospital，Tangshan 063004，Hebei，China

Abstract：ObjectiveTo investigate the serum paraoxonase-1(PON-1) activity in patients with cerebral infarction with diabetes and its clinical significance.MethodsFifty health subjects，56 simple type 2 diabetes and 48 cerebral infarction with diabetes were selected.Serum PON-1 activity was measured by paroxon as substrate.The levels of body mass index (BMI)，oxidized low-density lipoprotein(ox-LDL)，total cholesterol(TC)，triglyceride(TG)，high density lipoprotein-cholesterol(HDL-C) and low density lipoprotein-cholesterol (LDL-C) were measured.ResultsThe levels of serum PON-1 activity，HDL-C in the type 2 diabetes group were significantly lower than that in the control group(P<0.05).The levels of serum ox-LDL，TC，TG，LDL-C in the type 2 diabetes group was significantly higher than that in the control group(P<0.001).Serum PON-1 activity was significantly lower in the cerebral infarction with diabetes than that simple type 2 diabetes(P<0.05).Serum ox-LDL level was significantly higher in the cerebral infarction with diabetes than that simple type 2 diabetes(P<0.05).Based on person correlation analysis，PON-1 activity was correlated negatively with ox-LDL and positively with HDL-C. ConciusionSerum PON-1 activity decreas may be an important risk factor of cerebral infarction.and have an important meaning to forecast risk of cerebral infarction with diabetes.

Key words：type 2 diabetes；cerebral infarction；serum paraoxonase-1

近年来，糖尿病患者合并脑梗死方面的研究越来越多。有研究发现，与非糖尿病相比，糖尿病脑梗死危险性增加(2～5)倍[1]。血清对氧磷脂酶-1(PON-1)又称副氧化酶，与高密度酯蛋白(HDL-C)紧密结合，通过水解脂质过氧化物，在低密度脂蛋白(LDL-C)氧化修饰和HDL-C抗氧化修饰中起重要作用[2]。不少学者认为PON-1活性下降是糖尿病发生心、脑血管病的重要因素[3]。本研究观察48例2型糖尿病合并脑梗死患者血清PON-1活性变化，探讨PON-1活性与2型糖尿病合并脑梗死的相关性。

1资料与方法

1.1临床资料选择2011年5月—2013年10月在唐山市协和医院、滦南县医院神经内科和内分泌科住院的2型糖尿病患者104例，符合WHO(1999年)糖尿病诊断标准，分组：单纯2型糖尿病患者56例，无糖尿病急慢性并发症，男30例，女26例，年龄43岁～87岁(61.03岁±9.33 岁)；2型糖尿病合并脑梗死患者48例，男24例，女24例，年龄44岁～86岁(62.03岁±8.79 岁)。……