颈动脉IMT、血清IL-18、MMP-9及血浆Fib与急性冠脉综合征合并2型糖尿病的相关性研究  

The relationship of ACS patients complicated with diabetes with carotid artery IMT,serum IL-18,MMP-9 and plasma Fib

作　　者：许涛[1] 刘和俊[1] 周碧蓉[1] 

机构地区：[1]安徽医科大学第一附属医院心血管内科,合肥230022

出　　处：《安徽医科大学学报》2015年第12期1785-1790,共6页Acta Universitatis Medicinalis Anhui

基　　金：安徽高等学校省级自然科学研究重点项目(编号:KJ2011A158)

摘　　要：目的探讨急性冠脉综合征(ACS)合并2型糖尿病(DM)患者颈动脉内膜-中层厚度(IMT)、血浆纤维蛋白原(Fib)、血清白介素-18(IL-18)、基质金属蛋白酶-9(MMP-9)的变化规律以及与院内主要心脏不良事件(MACE)的相关性,并且评估上述指标在ACS合并DM早期预测及预后判断中的价值。方法选择行冠状动脉造影(CAG)的ACS患者120例,分为ACS合并DM组、非DM的ACS组。选择DM患者为DM组,体检健康人员为健康对照组。采用彩色多普勒超声诊断仪检测患者的颈动脉IMT,采用凝固法检测患者血浆Fib含量,采用ELISA法测定患者血清IL-18、MMP-9浓度,并分析ACS患者CAG特点及住院期间MACE的发生情况。结果两组ACS患者颈动脉IMT、血浆Fib、血清IL-18、MMP-9较健康对照组明显增高(P<0.01),其中ACS合并DM组较非DM的ACS组颈动脉IMT、血浆Fib、血清IL-18、MMP-9明显增高,差异有统计学意义(P<0.01)。两组ACS患者颈动脉IMT、血浆Fib、血清IL-18、MMP-9、Gensini积分五项指标之间呈正相关性。ACS合并DM组冠状动脉以多支病变为主(61.7%),而非DM的ACS组以单支和双支病变为主(61.7%);Gensini积分ACS合并DM组高于非DM的ACS组(P<0.01),其中ACS合并DM组血管病变以重度和极重度为主(73.3%),非DM的ACS组血管病变以轻中度为主(56.7%)。两组院内发生MACE的ACS患者血清IL-18、MMP-9、血浆Fib水平显著高于未发生MACE的ACS患者。ACS合并DM经标准化治疗后,随时间延长,血清IL-18、MMP-9、血浆Fib呈下降趋势,具有时间-效应关系。结论颈动脉IMT、血浆Fib、血清IL-18、MMP-9的检测可作为定量检测冠状动脉粥样硬化进而判断ACS合并2型DM危险程度及近期预后的良好指标。Objective To analyze the characteristic of some important clinical indicators, including carotid artery intima-middle thickness （IMT） , peripheral blood Fib levels, serum IL-18 concentrations and serum MMP-9 con- centrations of acute coronary syndrome （ACS） patients. On the other hand, to investigate the correlation among those indicators and major adverse cardiac events （ MACE）, and further to evaluate the value of those indicators in early prediction and prognosis judgement of ACS patients with diabetes （DM） in clinic. Methods This study en- rolled 120 ACS patients who had received coronary arteriography（CAG） examination. Among them, 60 cases had DM. Meanwhile, 60 cases who had DM were selected as DM group ,60 cases of healthy people who received physi- cal health examination were selected as the control group. Carotid artery IMT was determined by color doppler ultra- sonography. The levels of Fib in peripheral blood were detected by solidification method. Immune turbidimetric method and ELISA were used to measure the concentrations of serum IL-18 and MMP-9 respectively. The CAG re- sults, complications and in-hospital mortality of ACS patients were also collected and analyzed. Results Carotid artery IMT, peripheral blood Fib levels, serum IL-18 concentrations and serum MMP-9 concentrations of ACS pa- tients were significantly increased compared with healthy control（ P 〈 0.01 ）. A comparison of those clinical indica- tors of ACS patients between with DM group and without 2 diabetes group showed a significant increase in ACS pa- tients with DM group. Carotid artery IMT, plasma Fib, serum IL-18, MMP-9 and Gensini score in ACS patients were positively correlated. The incidence of multi-vessel diseases of coronary artery was more frequent in ACS pa- tients with DM versus without DM （ 61.7% ） , while one or two vessel diseases of coronary artery was much more common in ACS patients without DM （61.7%）. The Gensini score of ACS patients with DM group was much high- er than that of ACS

关 键 词：急性冠脉综合征 糖尿病 颈动脉IMT 血浆纤维蛋白原 白细胞介素-18 基质金属蛋白酶-9 

分 类 号：R541.4[医药卫生—心血管疾病]