VE-cadherin及sICAM-1水平在2型糖尿病下肢动脉病变患者介入前后的变化及意义

发布时间：2018-05-20 17:53

本文选题：2型糖尿病 + 下肢动脉病变　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:观察2型糖尿病(Type 2 diabetes mellitus,T2DM)下肢动脉病变(lower-extremity arterial disease,LEAD)患者血清中血管内皮钙黏蛋白(vascular endothelial cadherin,VE-cadherin)和细胞间粘附分子-1(intercellular adhesion molecule-1,sICAM-1)的水平及T2DM合并LEAD患者行下肢动脉造影、球囊扩张及支架植入术前后VE-cadherin及sICAM-1水平的变化,旨在探讨血管内皮功能障碍与2型糖尿病合并下肢动脉病变之间的关系,并进一步探讨介入治疗对血管内皮功能的影响及其与介入术后血管再狭窄之间的关系。方法:选取2015年12月到2016年12月于我院内分泌科住院诊断为T2DM合并LEAD(Fontaine IIb-IV期)行下肢动脉造影、球囊扩张及支架植入术并取得成功的患者23例作为观察对象(A组)。选择同期于我科住院治疗的单纯2型糖尿病患者23例作为糖尿病组(B组),及健康体检者23例作为对照组(C组)。三组均禁食10小时于第二天清晨6:00抽取肘静脉血4ml,检测空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C),同时测定VE-cadherin及sICAM-1水平。A组行介入治疗时,分别于动脉鞘置入成功后动脉鞘内(介入术前动脉血)、导丝及导管通过下肢动脉狭窄或闭塞处后病变动脉远端(缺血部位介入前动脉血)、球囊扩张或支架植入后病变动脉的远端(缺血部位介入术后动脉血)取血4ml,并于介入术后24h、14d取肘静脉血4ml(介入术后24h、14d静脉血)。所有血样均于室温静置2h后,以1000r/min离心20分钟,离心半径15cm,取上清液置于-20℃冰箱冷冻保存待测,所有标本于同一厂家试剂盒中进行测定。采用SPSS13.0软件进行统计学分析,计数资料采用χ2检验,计量资料以(?)±s表示,多组间比较均采用完全随机单因素方差分析(One-way ANOVA),两组间比较采用两样本均数t检验,指标间比较采用线性相关分析,以P0.05为差异有统计学意义。结果:1三组一般情况比较:A、B、C三组研究对象年龄、性别、BMI比较,差异无统计学意义(P0.05)。2三组FBG、Hb A1c水平:A组为:(8.30±1.13)mmol/L、(8.40±1.34)%;B组为:(8.10±1.15)mmol/L、(8.18±1.08)%;C组为:(5.06±0.54)mmol/L、(4.92±0.35)%。FBG、Hb A1c水平,A、B组较C组均显著升高,差别均有统计学意义(P0.01),A、B两组组间比较差异无统计学意义(P0.05)。3三组血脂水平:TC、TG、LDL、HDL水平:A组分别为(4.68±0.57)mmol/L,(1.81±0.78)mmol/L,(3.08±0.59)mmol/L,(1.19±0.30)mmol/L;B组分别为(4.79±1.00)mmol/L,(1.85±0.90)mmol/L,(2.78±0.38)mmol/L,(1.20±0.20)mmol/L;C组分别为(4.21±1.18)mmol/L,(1.38±0.70)mmol/L,(2.58±0.78)mmol/L,(1.25±0.41)mmol/L。A、B、C三组在TC、TG、LDL、HDL水平上差异均无统计学意义(P0.05)。4血清VE-cadherin水平:静脉血VE-cadherin水平:A、B、C三组分别为(11.06±0.75)ng/ml,(10.23±0.82)ng/ml,(9.53±0.77)ng/ml,A组术前静脉血较B、C组均显著增高(P0.05,P0.01),B组较C组明显增高(P0.05)。A组术后24h、14d分别为(17.52±3.19)ng/ml、(12.80±0.84)ng/ml,与术前静脉血比较均显著增高(P0.01;P0.05),术后14d与术后24h比较水平显著降低(P0.01)。A组动脉血VE-cadherin水平:介入术前动脉血为(11.08±0.97)ng/ml,与介入术前静脉血相比无明显差异(P0.05),缺血部位介入前动脉血为(12.33±1.12)ng/ml,与介入前动脉血相比VE-cadherin水平明显增高(P0.05),缺血部位介入术后动脉血(15.08±1.63)ng/ml,较介入术前动脉血及缺血部位介入术前动脉血均明显增高(P0.01,P0.05)。5血清sICAM-1水平:静脉血sICAM-1水平,A、B、C三组分别为(2.92±0.22)ng/ml,(1.93±0.36)ng/ml,(0.61±0.15)ng/ml,A组术前静脉血较B、C组均显著增高(P0.01,P0.01),B组较C组明显增高(P0.01)。A组术后24h、14d:(4.98±0.18)ng/ml、(6.06±0.34)ng/ml,与术前静脉血比较均显著增高(P0.01;P0.01),术后14d与术后24h比较水平显著升高(P0.01)。A组动脉血ICAM-1水平:介入术前动脉血(2.93±0.22)ng/ml,与介入术前静脉血相比无明显差异(P0.05),缺血部位介入前动脉血为(3.55±0.37)ng/ml,与介入前动脉血相比sICAM-1水平明显增高(P0.01),缺血部位介入术后动脉血(4.29±0.26)ng/ml,较介入术前动脉血及缺血部位介入前动脉血均明显增高(P0.01,P0.01)。6 VE-cadherin与sICAM-1之间的关系:对A组及B组介入前静脉血中VE-cadherin与sICAM-1行直线相关分析,两者呈正相关(r=0.629,P0.01)。7 ABI、Tc PO2水平比较:B组为1.00±0.17、(45.58±8.30)mm Hg,A组介入术前为0.47±0.12、(26.08±4.81)mm Hg,A组明显低于B组水平(P0.01;P0.01);A组介入术后1天为0.72±0.07、(43.67±4.96)mm Hg,明显高于介入前水平(P0.01,P0.01)。结论:1 T2DM合并LEAD患者血清中VE-cadherin与sICAM-1较单纯T2D M水平明显升高,表明VE-cadherin及sICAM-1在LEAD发生中有重要作用,其水平升高可能是LEAD发生的危险因素之一。2介入术后VE-cadherin与sICAM-1水平明显增高,且术后14天仍未回归到术前水平,表明介入治疗会进一步加重血管内皮功能损伤,促进炎症反应,为术后保护内皮完整性及抗炎治疗防止动脉再狭窄及血栓形成提供依据。
[Abstract]:Objective: To observe the level of serum vascular endothelial calcium mucin (vascular endothelial cadherin, VE-cadherin) and intercellular adhesion molecules in patients with type 2 diabetes mellitus (Type 2 diabetes mellitus, T2DM) and the patients with lower-extremity arterial disease (LEAD). The changes of VE-cadherin and sICAM-1 levels before and after lower extremity arteriography, balloon dilatation and stent implantation were conducted to explore the relationship between vascular endothelial dysfunction and type 2 diabetes mellitus with lower extremity arterial lesions, and to further explore the effect of interventional therapy on vascular endothelial function and the relationship between vascular endothelium function and vascular restenosis after intervention. Methods: 23 patients who were hospitalized in Department of endocrinology of our hospital from December 2015 to December 2016 were diagnosed as T2DM combined with LEAD (Fontaine IIb-IV) for lower extremity arteriography, balloon dilatation and stent implantation and successful patients were observed as subjects (group A). 23 patients with type 2 diabetes who were hospitalized at the same time as diabetes were selected as diabetes. Group (group B) and 23 healthy persons as the control group (group C). The three groups were all fasted for 10 hours at 6:00 on the second day at 6:00 to extract the elbow vein blood, to detect the fasting blood glucose (FBG), glycated hemoglobin (Hb A1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), and simultaneously determine VE-cadherin and sICAM-1 levels. In group A, the arterial sheath (arterial blood) was performed after the arterial sheath was successfully implanted (the arterial blood), and the guide and catheter through the stenosis or occlusion of the lower extremity artery (the ischemic part of the anterior artery blood), the distal end of the lesion artery after the balloon dilation or stent implantation (the arterial blood after the ischemic part of the artery), and 4ml were taken. After the intervention, 24h, 14d took 4ml of the elbow vein blood (24h, 14d venous blood after intervention). All blood samples were centrifuged for 20 minutes at room temperature and 2H, centrifugation for 20 minutes, centrifuge radius 15cm, and the supernatant was frozen in the refrigerators at -20 centigrade. All specimens were measured in the same manufacturer's kit. Statistical analysis was carried out by SPSS13.0 software. The data were measured by the chi 2 test, the measurement data were (?) + s, and the multiple groups were compared with the total random single factor analysis of variance (One-way ANOVA). The two groups were compared with two sample mean number T test. The index was compared with linear correlation analysis. The difference of P0.05 was statistically significant. Results: 1 and three groups were compared: A, B, C three research objects Age, sex, and BMI, the difference was not statistically significant (P0.05).2 three groups FBG, Hb A1c level: (8.30 + 1.13) mmol/L, (8.40 + 1.34)%, B group: (8.10 + 1.15) mmol/L, (8.18 + 1.08)%, C group was (5.06 + 0.54) mmol/L, (4.92 + 0.35) There was no statistically significant difference (P0.05).3 three groups of blood lipid levels: TC, TG, LDL, HDL levels: (4.68 + 0.57) mmol/L, (1.81 + 0.78) mmol/L, (3.08 + 0.59) mmol/L, (1.19 + 0.30) mmol/L, B groups were respectively (1.85 + 0.90), respectively. ) mmol/L, (2.58 + 0.78) mmol/L, (1.25 + 0.41) mmol/L.A, B, C three in TC, TG, LDL, HDL levels were not statistically significant (P0.05).4 serum VE-cadherin level: three groups were (11.06 + 0.75) respectively, (10.23 + 0.82), (9.53 + 0.77) 1), group B was significantly higher than group C (P0.05) in group.A after operation 24h, 14d was (17.52 + 3.19) ng/ml, (12.80 + 0.84) ng/ml, and was significantly higher (P0.01; P0.05) compared with preoperative venous blood (P0.01; P0.05). There was no significant difference in blood (P0.05). The arterial blood was (12.33 + 1.12) ng/ml before the intervention of ischemia, and the level of VE-cadherin was significantly higher than that before the intervention of arterial blood (P0.05). The arterial blood (15.08 + 1.63) ng/ml after the intervention of the ischemic site was significantly higher than that of the arterial blood before the intervention of the arterial blood and the bleeding site (P0.01, P0.05).5 serum sIC AM-1 level: venous blood sICAM-1 level, A, B, C three groups (2.92 + 0.22) ng/ml, (1.93 + 0.36) ng/ml, (0.61 + 0.15) ng/ml, A group preoperative venous blood is significantly higher than B, C group (P0.01, 6.06 + 0.18). 01) the level of postoperative 14d and postoperative 24h increased significantly (P0.01) the ICAM-1 level of arterial blood in group.A: preoperative arterial blood (2.93 + 0.22) ng/ml, compared with preoperative venous blood, there was no significant difference (P0.05), the arterial blood was (3.55 + 0.37) ng/ml before intervention, and the level of sICAM-1 was significantly higher than before the arterial blood (P0.01), and the ischemic site was significantly higher (P0.01). The arterial blood (4.29 + 0.26) ng/ml after intervention was significantly higher than that of the arterial blood before interventional procedure and the ischemic part of the artery (P0.01, P0.01).6 VE-cadherin and sICAM-1: the linear correlation between VE-cadherin and sICAM-1 in the venous blood of group A and B group before intervention was positively correlated (r=0.629, P0.01). Group B was 1 + 0.17, (45.58 + 8.30) mm Hg, group A was 0.47 + 0.12, (26.08 + 4.81) mm Hg, A group was significantly lower than that of group B (P0.01; P0.01), A group was 0.72 + 0.07, (43.67 + 4.96) mm, obviously higher than that before intervention. The level of VE-cadherin and sICAM-1 plays an important role in the occurrence of LEAD. The elevation of the level may be one of the risk factors for the occurrence of LEAD. The level of VE-cadherin and sICAM-1 increases obviously after.2 intervention, and the level is still not returned to the preoperative level on the 14 day after the operation, indicating that interventional therapy will further aggravate vascular endothelial dysfunction and promote inflammation. It provides evidence for protecting endothelial integrity and preventing inflammatory restenosis and thrombosis after operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R543.5

【参考文献】