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ȣ - 510709 284 |
| Serum Retinol Binding Protein 4 and HbA1C level is associated with Target Lesion Revascularization in Type II Diabetes after Drug Eluting Stent Implantation. |
| 가톨릭 대학교 의과대학 순환기 내과 |
| 최윤석, 정욱성, 박철수, 박정환, 오수성, 이동현, 이종민, 김범준, 임상현, 장기육,김희열, 유기동, 전두수, 오용석, 윤호중, 승기배, 김재형, 최규보, 홍순조 |
Background: Retinol Binding Protein 4 (RBP4), a novel marker of insulin resistance and a key regulatory adipokine of Glucose Transporter 4 (GLUT 4) is predictive of and/or contributory to vascular complication in type 2 diabetes. We examined the association between RBP 4 or glycemic control determined by pre and post procedural hemoglobin A1c (HbA1c) level and target lesion revascularization rate(TLR) in diabetic patients undergoing elective percutaneous coronary intervention (PCI) with drug eluting stents.
Methods: 90 patients(mean age : mean age=64±8 years, M:F=41:39, Cypher: Taxus= 65:25) who underwent PCI and six month angiographic follow up were divided into two groups by the result of target lesion revascularization(TLR and no TLR group). Serum RBP 4 concentrations just before procedure and at the time of follow up coronary angiogram were measured by ELISA method. Optimal glycemic control was defined as HbA1c≤7%, and serum adiponectin and hsCRP levels were also compared between two groups respectively.
Results: 1. Among the 90 patients, TLR at six month angiographic follow up was 12.2%. 2.Serum RBP 4 level just before PCI was significantly higher in TLR group than no TLR group (40.5±5.9ug/ml vs 26.7±1.6ug/ml, p=0.008) 3. Serum RBP 4 at follow up was not different between two groups (36.6±7.7 ug/ml vs 52.7±4.7 ug/ml) 4. Patients with HbA1c>7% showed significantly higher TLR rate than those with HbA1c≤7% (17% vs. 11%, p=0.001) at follow up.4. Serum adiponectin, hsCRP and stent length did not show significant difference between two groups but the stent diameter was significantly smaller in TLR than no TLR group(3.0±0.5mm vs 3.1±0.3mm, p=0.02). 4. In a multiple logistic regression analysis, serum RBP 4 elevation at the index intervention was a significant independent predictor for TLR (odds ratio 1.08, 95% confidence interval 1.02 to 1.14; p=0.006) after adjusting with hsCRP and HbA1C level.
Conclusion: In diabetic patients undergoing elective PCI, improving insulin resistance and obtaining optimal glycemic control might be important to reduce TLR.
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