胰岛素依赖对2型糖尿病合并冠状动脉粥样硬化患者炎症过程、血栓形成机制及内皮功能的影响。
Effects of insulin dependence on inflammatory process, thrombotic mechanisms and endothelial function, in patients with type 2 diabetes mellitus and coronary atherosclerosis.
作者信息
Antoniades Charalambos, Tousoulis Dimitris, Marinou Kyriakoula, Papageorgiou Nikos, Bosinakou Erini, Tsioufis Costas, Stefanadi Elli, Latsios George, Tentolouris Costas, Siasos Gerasimos, Stefanadis Christodoulos
机构信息
A' Cardiology Department, Athens University Medical School, Athens, Greece.
出版信息
Clin Cardiol. 2007 Jun;30(6):295-300. doi: 10.1002/clc.20101.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction, increased thrombogenicity and abnormal inflammatory response.
HYPOTHESIS
We hypothesizsed that insulin dependence/exogenous insulin administration may affect thrombotic/inflammatory status and endothelial function in patients with T2DM and coronary artery disease (CAD).
METHODS
Fifty-five patients with T2DM + CAD (26 insulin-treated (INS) and 29 under oral biguanide + sulphonylurea (TABL)) were recruited. Endothelial function was assessed by gauge-strain plethysmography, and serum levels of inflammatory and thrombotic markers were determined by enzyme linked immunosorbent assay.
RESULTS
There was no significant difference in endothelium-dependent dilation (EDD) between the study groups, while EDD was correlated with fasting glucose levels in both INS (r = - 0.776, p = 0.0001) and TABL (r = - 0.702, p = 0.0001). Patients in INS group had higher levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), monocyte chemoattractant protein (MCP-1) and vascular cell adhesion molecule (sVCAM-1), compared to TABL. However, TNF-alpha was negatively correlated with protein C (PrtC) only in INS (r = - 0.726, p = 0.01) but not in TABL group (r = - 0.066, p = 0.738). Similarly, sVCAM-1 was correlated with PrtC only among INS patients (r = - 0.451, p = 0.046) but not in TABL (r = 0.069, p = 0.727). In multivariate analysis, insulin dependence was a predictor of IL-6, TNF-alpha, MCP-1 and sVCAM-1 levels independently from the patients' demographic characteristics, the angiographic extend of CAD or the duration of diabetes.
CONCLUSIONS
Insulin treatment in patients with type 2 diabetes mellitus affects the expression of inflammatory cytokines and subsequently modifies the thrombotic mechanisms in patients with coronary atherosclerosis, independently from the duration of diabetes and the extend of coronary artery disease.
背景
2型糖尿病（T2DM）的特征为内皮功能障碍、血栓形成倾向增加及异常炎症反应。
假设
我们推测胰岛素依赖/外源性胰岛素给药可能会影响T2DM合并冠状动脉疾病（CAD）患者的血栓形成/炎症状态及内皮功能。
方法
招募了55例T2DM + CAD患者（26例接受胰岛素治疗（INS），29例接受口服双胍类 + 磺脲类药物治疗（TABL））。通过应变容积描记法评估内皮功能，采用酶联免疫吸附测定法测定炎症和血栓形成标志物的血清水平。
结果
研究组之间内皮依赖性舒张（EDD）无显著差异，而EDD在INS组（r = - 0.776，p = 0.0001）和TABL组（r = - 0.702，p = 0.0001）中均与空腹血糖水平相关。与TABL组相比，INS组患者的白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）、单核细胞趋化蛋白（MCP-1）和血管细胞黏附分子（sVCAM-1）水平更高。然而，仅在INS组中TNF-α与蛋白C（PrtC）呈负相关（r = - 0.726，p = 0.01），而在TABL组中无相关性（r = - 0.066，p = 0.738）。同样，仅在INS组患者中sVCAM-1与PrtC相关（r = - 0.451，p = 0.046），而在TABL组中无相关性（r = 0.069，p = 0.727）。在多变量分析中，胰岛素依赖是IL-6、TNF-α、MCP-1和sVCAM-1水平的预测因素，独立于患者的人口统计学特征、CAD的血管造影范围或糖尿病病程。
结论
2型糖尿病患者的胰岛素治疗会影响炎症细胞因子的表达，进而改变冠状动脉粥样硬化患者的血栓形成机制，独立于糖尿病病程和冠状动脉疾病范围。
Zotero 插件