Department of Internal Medicine, Dokuz Eylul University School of Medicine, 35340 Inciralti, Izmir, Turkiye.
Metabolism. 2010 Mar;59(3):305-13. doi: 10.1016/j.metabol.2009.04.034. Epub 2009 Dec 16.
The metabolic syndrome (MS) is associated with a systemic inflammatory response that plays an important pathogenetic role in atherothrombotic disease. Increasing evidence indicates that CD40-CD40 ligand interactions constitute an important mediator for vascular inflammation. The purpose of this study was to assess whether high-sensitivity C-reactive protein (hs-CRP) and soluble CD40 ligand (sCD40L) levels were increased in patients with MS. During the study period from January 2004 to August 2004, 312 patients with MS and 98 control subjects were included. Anthropometric measurements, blood pressure assessment, electrocardiography, and blood measurements including fasting blood glucose, postprandial blood glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, glycated hemoglobin, white blood cell (WBC), platelets, hs-CRP, and sCD40L were performed. Patients with MS were divided into 3 groups based upon their glucose tolerance (group 1, normal glucose tolerance; group 2, prediabetic group; and group 3, diabetes mellitus). Patients with MS showed a significant increase of WBC, hs-CRP, and sCD40L levels compared with control subjects. The levels of both hs-CRP and sCD40L were positively correlated with body mass index (BMI). High-sensitivity CRP levels were also positively correlated with waist circumferences, fasting blood glucose, postprandial blood glucose, and glycated hemoglobin, and negatively correlated with high-density lipoprotein cholesterol. In patients with MS, both hs-CRP and sCD40L levels were positively correlated with WBC count. We found a positive correlation between sCD40L and platelets. Among the subgroups of patients with MS, the mean levels of WBC, hs-CRP, and sCD40L did not show any significant differences. In conclusion, elevated levels of WBC, hs-CRP, and sCD40L in MS patients provide further insight into the relationship between MS and inflammation. In our study, positive correlations between BMI and both hs-CRP and sCD40L levels suggest that BMI is an important determinant of a chronic inflammatory state in patients with MS. Moreover, this study reports significantly increased levels of WBC, hs-CRP, and sCD40L not only in diabetic subjects with MS but also in prediabetic subjects and nondiabetic subjects with MS compared with control subjects. Our data suggest that MS patients have proinflammatory state independent of their glucose tolerance status. In our study, the positive correlation between the levels of sCD40L and platelets in patients with MS supports previous reports indicating that sCD40L are derived predominantly from platelets.
代谢综合征（MS）与全身炎症反应有关，在动脉血栓形成疾病中发挥重要的发病机制作用。越来越多的证据表明，CD40-CD40 配体相互作用构成血管炎症的重要介质。本研究旨在评估高敏 C 反应蛋白（hs-CRP）和可溶性 CD40 配体（sCD40L）水平是否在 MS 患者中升高。在 2004 年 1 月至 2004 年 8 月期间，纳入 312 例 MS 患者和 98 例对照者。进行人体测量学测量、血压评估、心电图和血液测量，包括空腹血糖、餐后血糖、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、糖化血红蛋白、白细胞（WBC）、血小板、hs-CRP 和 sCD40L。根据葡萄糖耐量将 MS 患者分为 3 组（第 1 组，正常糖耐量；第 2 组，糖尿病前期组；第 3 组，糖尿病组）。与对照组相比，MS 患者的 WBC、hs-CRP 和 sCD40L 水平显著升高。hs-CRP 和 sCD40L 水平与体重指数（BMI）呈正相关。hs-CRP 水平与腰围、空腹血糖、餐后血糖和糖化血红蛋白呈正相关，与高密度脂蛋白胆固醇呈负相关。在 MS 患者中，hs-CRP 和 sCD40L 水平与 WBC 计数呈正相关。我们发现 sCD40L 与血小板之间存在正相关。在 MS 患者的亚组中，WBC、hs-CRP 和 sCD40L 的平均水平没有显著差异。总之，MS 患者白细胞、hs-CRP 和 sCD40L 水平升高进一步阐明了 MS 与炎症之间的关系。在本研究中，BMI 与 hs-CRP 和 sCD40L 水平之间的正相关表明，BMI 是 MS 患者慢性炎症状态的重要决定因素。此外，本研究报告称，不仅在糖尿病合并 MS 的患者中，而且在糖尿病前期和非糖尿病合并 MS 的患者中，与对照组相比，白细胞、hs-CRP 和 sCD40L 水平均显著升高。我们的数据表明，MS 患者存在炎症前状态，而与葡萄糖耐量状态无关。在本研究中，MS 患者 sCD40L 水平与血小板之间的正相关支持先前的报告，表明 sCD40L 主要来自血小板。
