二甲双胍对急性冠状动脉综合征患者血清组织因子的影响  

Effects of metformin on tissue factor in patients with acute coronary syndrome

作　　者：顾明霞[1] 王春宁[1] 印小荣[1] 董莉[1] 

机构地区：[1]南京市市级机关医院心内科,南京医学硕士研究生210018

出　　处：《医学研究生学报》2011年第3期302-304,共3页Journal of Medical Postgraduates

基　　金：南京市卫生局医学科技发展项目(YKK07103)

摘　　要：目的血清组织因子(tissue factor,TF)一定程度上反映了动脉硬化稳定性。文中研究二甲双胍对急性冠状动脉综合症(acute coronary syndrome,ACS)患者TF的影响。方法抽取10名ACS患者空腹静脉血进行人单核细胞分离、培养,并分别予以终浓度为0、0.1、1和10μmol/L的二甲双胍进行干预,用酶联免疫吸附法检测培养细胞膜TF浓度。同时选取51名ACS患者根据服用药物分为常规治疗+二甲双胍组(n=29)和常规治疗组(n=22),4周后检测其外周循环血中TF的浓度,同时检测患者空腹血糖、血脂、胰岛素、C肽、C反应蛋白等相关指标。结果二甲双胍组在0.1、1和10μmol/L浓度干预下测定的单核细胞膜TF值分别为(5.12±0.88)、(3.97±0.46)和(3.02±0.88)pg/ml,差异有统计学意义(P<0.05)。在51名ACS患者外周循环血中,常规治疗+二甲双胍组与常规治疗组的TF分别为(57.63±23.75)和(98.25±20.50)pg/ml(P<0.05),同时低密度脂蛋白[(1.99±0.32)vs(2.99±0.56)mmol/L]、血糖[(5.38±1.88)vs(6.47±0.78)mmol/L]、C肽[(6.86±4.24)vs(10.83±3.08)ng/ml]及CRP[(8.32±1.24)vs(16.66±2.34)ng/ml]等相关指标均有统计学意义(P<0.05)。结论二甲双胍可降低ACS患者外周血单核细胞合成TF的表达,并呈现浓度依赖性,在ACS患者中二甲双胍可改善血脂异常,提高胰岛素敏感性,降低ACS患者循环血中TF表达。Objective The serum tissue factor（TF） reflects the stability of atherosclerosis.This study investigates the effects of metformin on TF in patients with acute coronary syndrome（ACS）.MethodsIn the first part of the study,10 patients with ACS were subjected to peripheral blood sampling.The peripheral human monocytes were cultured with metformin（0,0.1,1 or 10μmol/L）,24hours,the expression of TF were investigated.In the second part of the study,51 patients with ACS were enrolled.Patients were randomized to conventional therapy ＋ metformin therapy group（n=29） or conventional therapy group（n=22）.The levels of TF in serum,blood lipids,blood glucose and insulin,as well as C peptide and C-reactive protein expression,were studied after therapy four weeks.ResultsIn vitro,a dose-dependent effect of TF expression on monocytes membrane in cultured peripheral blood monocytes was found,the TF levels in 0.1,1 and 10μmol/L metformin groups were 5.12±0.88,3.97±0.46 and 3.02±0.88 pg/ml,respectively.In vivo,treatment of conventional ＋ metformin reduced the expression of TF,compared with that of conventional only（57.63±23.75pg/ml vs 98.25±20.50pg/ml,P0.05）.There were significant differences in blood lipids,blood glucose,C peptide,and C-reactive protein expression between the metformin group and the placebo group.ConclusionFor patients with ACS,metformin can inhibit TF expression on monocytes in a concentration-dependent pattern,it also improves blood lipid abnormalities and insulin sensitivity.

关 键 词：组织因子 二甲双胍 动脉硬化 氧化应激 炎症反应 

分 类 号：R543.3[医药卫生—心血管疾病]