Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
BMC Cardiovasc Disord. 2022 Jun 22;22(1):282. doi: 10.1186/s12872-022-02694-7.
The formation of advanced glycation end-products (AGEs) is a crucial risk factor for the pathogenesis of cardiovascular diseases in diabetes. We investigated whether N-epsilon-carboxymethyllysine (CML), a major form of AGEs in vivo, was associated with poor coronary collateral vessel (CCV) formation in patients with type 2 diabetes mellitus (T2DM) and chronic total occlusion (CTO) of coronary artery.
This study consisted of 242 T2DM patients with coronary angiographically documented CTO. Blood samples were obtained and demographic/clinical characteristics were documented. The coronary collateralization of these patients was defined according to Rentrop or Werner classification. Serum CML levels were evaluated using ELISA assay. Receiver operating characteristic curve and multivariable regression analysis were performed.
242 patients were categorized into poor CCV group or good CCV group (107 vs. 135 by the Rentrop classification or 193 vs. 49 by the Werner classification, respectively). Serum CML levels were significantly higher in poor CCV group than in good CCV group (110.0 ± 83.35 vs. 62.95 ± 58.83 ng/ml by the Rentrop classification and 94.75 ± 78.29 ng/ml vs. 40.37 ± 28.69 ng/ml by Werner classification, both P < 0.001). Moreover, these CML levels were also significantly different across the Rentrop and Werner classification subgroups (P < 0.001). In multivariable logistic regression, CML levels (P < 0.001) remained independent determinants of poor CCV according to the Rentrop or Werner classification after adjustment of traditional risk factors.
This study suggests that higher serum CML level is associated with poor collateralization in T2DM patients with CTO.
晚期糖基化终产物（AGEs）的形成是糖尿病患者心血管疾病发病的一个关键风险因素。我们研究了体内主要的 AGE 形式 N-ε-羧甲基赖氨酸（CML）是否与 2 型糖尿病（T2DM）合并冠状动脉慢性完全闭塞（CTO）患者的侧支血管（CCV）形成不良有关。
本研究纳入了 242 例经冠状动脉造影证实的 CTO 的 T2DM 患者。采集血样并记录人口统计学/临床特征。根据 Rentrop 或 Werner 分级来定义这些患者的冠状动脉侧支循环。使用 ELISA 法评估血清 CML 水平。进行受试者工作特征曲线和多变量回归分析。
242 例患者分为侧支循环不良组或侧支循环良好组（Rentrop 分级为 107 例比 135 例，Werner 分级为 193 例比 49 例）。侧支循环不良组的血清 CML 水平明显高于侧支循环良好组（Rentrop 分级为 110.0±83.35ng/ml 比 62.95±58.83ng/ml，Werner 分级为 94.75±78.29ng/ml 比 40.37±28.69ng/ml，均 P<0.001）。此外，这两种 CML 水平在 Rentrop 和 Werner 分级亚组之间也有显著差异（P<0.001）。在多变量逻辑回归中，在校正传统危险因素后，CML 水平（P<0.001）仍然是根据 Rentrop 或 Werner 分级判断侧支循环不良的独立决定因素。
本研究表明，在 CTO 的 T2DM 患者中，较高的血清 CML 水平与侧支循环不良有关。
