糖尿病合并不同程度冠状动脉粥样硬化患者外周血EMP及EPC水平的研究  

Plasma EMPs and EPCs levels in diabetic patients with coronary atherosclerotic lesions

作　　者：匡雅姝 夏金盈[1] 罗轶玮[1] 梅林[1] 刘学波[1] 李莹[1] 

机构地区：[1]同济大学附属东方医院心内科,上海200120

出　　处：《同济大学学报（医学版）》2015年第4期47-52,共6页Journal of Tongji University(Medical Science)

基　　金：上海市科委攻关项目(10411968000);上海市浦东新区科委课题(PKJd2013-Y19)

摘　　要：目的探讨糖尿病患者EMPs、EPCs与不同程度冠状动脉粥样硬化病变及糖代谢异常的关系。方法117例糖尿病患者,根据临床症状、心肌标记物水平以及冠状动脉造影及冠脉内血管超生(IV U S)结果 ,将患者分为急性冠脉综合症组(A组,n=45)、稳定型心绞痛组(B组,n=27)、冠状动脉病变组(狭窄<50%,C组,n=45)。采用流式细胞术检测3组患者外周血中CD144+/A nnexin V+的内皮微颗粒以及C D34+/C D39+内皮祖细胞的水平,并检测血脂、血糖、糖化血红蛋白、炎性指标、心肌标记物、肝肾功能等各项指标。结果 3组相比,年龄、性别、血压、吸烟、体质量指数、血脂等组间差异均无统计学意义。超敏C反应蛋白、C K-M B、Hs T n T均在A组中较高,与其余两组相比差异有统计学意义(P<0.001)。3组之间空腹血糖、餐后血糖及糖化血红蛋白差异无统计学意义。外周血的CD144+/A nnexin V+EM Ps水平3组间差异有统计学意义,其中A组显著高于B组(P<0.05),且A、B组CD144+/A nnexin V+EM Ps水平显著高于C组(P<0.05),EM Ps水平与糖化血红蛋白不相关。A、B组外周血C D34+/C D39+EPC s水平显著低于C组(P<0.05),而A、B组间无差异,且EPC s水平与糖化血红蛋白呈负相关。结论糖尿病患者冠脉病变加重是导致外周血CD144+/A nnexin V+EM Ps水平升高的主导损伤因素。糖代谢异常对内皮功能的损伤主要是通过损伤内皮修复功能因素实现的。Objective To investigate plasma EMPs and EPCs levels in diabetic patients with different degree of coronary atherosclerotic lesions. Methods One hundred and seventeen diabetic patients with different degree of coronary atherosclerotic lesions were enrolled in the study. Patients were classified into 3 categories based on clinical symptoms, cardiac marker levels, coronary angiography and coronary intravenous ultrasound （IVUS） acute coronary syndrome （ group A, n = 45 ）, stable angina（ group B, n = 27 ） and coronary artery disease （ stenosis 〈 50% ） （ group C, n = 45 ）. CD144 ~ / Annexin V ＋ endothelial microparticles （EMPs） and CD34＋/CD39 ~ endothelial progenitor cells （EPCs） in peripheral blood were detected by flow cytometry; and blood lipid, glucose, glycosylated hemoglobin, inflammatory markers, cardiac markers, liver and renal function, and other indicators were also measured. Results There were no significant differences in age, sex, blood pressure, smoking, body mass index and blood lipid among three groups. High sensitivity C-reactive protein, CK-MB and HsTnT levels were significantly higher in group A than those in other two groups （P 〈 0. 001 ）. There were not significant differences in fasting blood glucose, postprandial blood glucose and glycosylated hemoglobin among 3 groups. The CD144 ~/Annexin V ＋ EMPs levels in peripheral blood of group A was significantly higher than those of group B （ P 〈 0. 05 ）, and EPCs levels in group A and B was significantly higher than those in group C （ P 〈 0. 05 ）. EMPs levels were not correlated with glycosylated hemoglobin levels. The levels of peripheral blood CD34 ~/CD39 ~ EPCs in group A and B were significantly lower than those in group C （P 〈 0.05 ）, but there were no differences between group A and B. The levels of EPCs and the levels of glycosylated hemoglobin were negatively correlated. Conclusion Aggravating coronary lesions is a leading cause of elevated peripheral blood CD144 ＋/ Annexin V ＋ EMP

关 键 词：内皮微颗粒 内皮祖细胞 冠心病 急性冠脉综合征 稳定性心绞痛 内皮功能 

分 类 号：R543[医药卫生—心血管疾病]