2型糖尿病下肢血管病变患者介入治疗前后OPN及sVCAM-1水平的变化及意义
发布时间：2019-05-30 01:30
【摘要】：目的:通过测定2型糖尿病(type 2 diabetes mellitus,T2DM)合并外周动脉病变(peripheral arterial disease,PAD)患者、单纯T2DM患者及健康人血浆中骨桥蛋白(osteopontin,OPN)及可溶性血管细胞黏附分子-1(soluble vascular cell adhesion molecule-1,s VCAM-1)的浓度,同时测定T2DM合并PAD患者下肢动脉造影、球囊扩张或支架植入术前后二者的浓度变化,探讨其在T2DM合并PAD及介入术后再狭窄过程中的意义,旨在为临床上防治PAD及术后再狭窄提供理论依据。方法:选择2015年6月至2016年12月于我院内分泌科住院,确诊为T2DM合并PAD并成功行下肢动脉造影、球囊扩张或支架植入术的患者27例作为研究对象(PTA组),选取同期于我院住院的确诊为单纯T2DM患者27例,经相应检查可除外糖尿病并发症及相关疾病,作为单纯糖尿病组(T2DM组),选取同期门诊健康体检者27例为对照组(Control组)。PTA组、T2DM组及Control组患者于晨6:00空腹平卧位取肘静脉血4ml(介入术前静脉血),测定空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及骨桥蛋白(OPN)、可溶性血管细胞黏附分子-1(s VCAM-1)的水平。测量PTA组患者介入前后踝肱压指数(ABI)及经皮氧分压(TcPO_2),并在介入治疗过程中,在动脉鞘顺利放置后,取动脉血4ml(介入术前动脉血),导丝、导管顺利穿过狭窄的或闭塞病变动脉段,于病变动脉远端取血4ml(病变术前动脉血),待球囊扩张后或支架植入后,再次于病变的动脉远端取血4ml(病变术后动脉血),于介入术后1d,14d分别取肘静脉血4ml。统一采用酶联免疫吸附法(ELISA)检测标本血浆OPN及s VCAM-1浓度,严格按照说明书进行操作,用全自动生化仪检测一般指标。采用SPSS13.0软件进行统计学分析,以P0.05为差异有统计学意义。结果:1各组FBG、Hb A1c比较:PTA组FBG:(8.97±1.45)mmol/L,Hb A1c:(8.82±0.87)%;T2DM组FBG:(8.90±1.21)mmol/L,Hb A1c:(8.76±0.89)%;Control组FBG:(5.28±0.30)mmol/L,Hb A1c:(5.21±0.42)%。PTA组及T2DM组的FBG及Hb A1c水平均比Control组高,差异有统计学意义(P0.01);而PTA组与T2DM组比较差异无统计学意义(P0.05);2各组血脂水平比较:PTA组TC,TG,LDL-C,HDL-C分别为:(5.49±0.55)mmol/L,(2.24±0.46)mmol/L,(3.74±0.46)mmol/L,(1.02±0.16)mmol/L;T2DM组分别为:(5.11±0.63)mmol/L,(1.93±0.51)mmol/L,(3.43±0.51)mmol/L,(1.11±0.25)mmol/L;Control组分别为:(4.63±0.86)mmol/L,(1.53±0.45)mmol/L,(3.03±0.45)mmol/L,(1.24±0.16)mmol/L。PTA组与Control组相比较:TC、TG、LDL-C水平均明显增高(P0.01,P0.01,P0.01),HDL-C的水平明显降低(P0.01);T2DM组与Control组相比较:TC、TG、LDL-C水平也呈明显增高(P0.05,P0.01,P0.01),HDL-C的水平降低(P0.05);PTA组与T2DM组相比较:TC、TG、LDL-C水平均显著增高(P0.05,P0.01,P0.05),HDL-C的水平均降低(P0.05),以上差异均有统计学意义;3 ABI,TcPO_2水平比较:PTA组患者介入术前1天ABI、TcPO_2分别为:0.61±0.08,(29.23±3.12)mm Hg;介入术后1天ABI,TcPO_2分别为:0.88±0.10,(55.56±3.23)mm Hg。PTA组介入术后二者均较介入术前有显著升高(t=23.371,P0.01;t=45.731,P0.01),差异有统计学意义;4血浆OPN水平:PTA组介入术前静脉血、T2DM组及Control组OPN水平分别为:(12.15±2.36)ng/ml,(6.79±2.03)ng/ml,(4.34±0.87)ng/ml,其中PTA组介入术前静脉血及T2DM组OPN水平较Control组均有显著升高(P0.01;P0.01),PTA组较T2DM组静脉血中OPN水平升高(P0.01);PTA组内介入治疗前动脉血、病变术前动脉血、病变术后动脉血中OPN水平分别为:(12.73±2.56)ng/ml,(14.11±2.43)ng/ml,(16.15±2.28)ng/ml,病变术前动脉血及术后动脉血和介入治疗前的动脉血相比,OPN水平显著升高(P0.05;P0.05),病变术后动脉血比病变术前动脉血中OPN水平显著升高(P0.05);PTA组内介入治疗前静脉血、术后1d及术后14d静脉血内OPN水平分别为:(12.15±2.36)ng/ml,(18.17±3.05)ng/ml,(22.31±3.42)ng/ml,术后1d及术后14d静脉血中OPN水平较术前均有显著增高(P0.01;P0.01),术后14d与术后1d相比,OPN水平也有明显升高(P0.01),以上差异均有统计学意义;介入前的静脉血及术前动脉血中OPN水平比较无明显差异(P0.05);5血浆s VCAM-1水平:PTA组介入治疗前静脉血、T2DM组及Control组s VCAM-1水平分别为:(56.44±7.42)ng/ml,(45.13±4.87)ng/ml,(27.39±5.94)ng/ml,其中PTA组介入前的静脉血及T2DM组s VCAM-1水平较Control组均有明显升高(P0.01;P0.01),PTA组较T2DM组静脉血中s VCAM-1水平升高(P0.01);PTA组内介入治疗前动脉血、病变术前动脉血、病变术后动脉血中s VCAM-1水平分别为:(60.24±6.35)ng/ml,(72.08±6.49)ng/ml,(85.58±7.63)ng/ml,病变术前动脉血及术后动脉血和介入治疗前的动脉血相比,s VCAM-1水平升高(P0.01;P0.01),病变术后动脉血比病变术前动脉血中s VCAM-1水平升高(P0.01);PTA组内介入操作前静脉血、术后1d及术后14d静脉血内s VCAM-1水平分别为:(56.44±7.42)ng/ml,(123.11±18.21)ng/ml,(292.45±20.05)ng/ml,术后1d及术后14d静脉血中s VCAM-1水平较术前均有显著增高(P0.01;P0.01),术后14d与术后1d相比,s VCAM-1水平也有明显升高(P0.01),以上差异均有统计学意义;介入治疗前静脉血及动脉血中s VCAM-1水平无明显差异(P0.05);6 OPN与s VCAM-1的关系:PTA组内介入前静脉血的OPN与s VCAM-1水平进行线性相关分析,二者水平呈正相关(r=0.940,P0.01),差异有统计学意义。结论:1 T2DM及T2DM合并PAD患者存在严重的血脂代谢异常;2 T2DM合并PAD患者血浆中OPN及s VCAM-1的浓度显著升高,提示OPN及s VCAM-1可能在糖尿病下肢血管病变的发生发展中起一定的作用;3 PTA组介入术后OPN及s VCAM-1的浓度较介入术前明显升高,是导致介入术后再狭窄的危险因素之一,可能为抑制平滑肌细胞增殖、迁移及抗炎治疗提供了新的思路。
[Abstract]:Objective: To determine the concentration of osteopontin (OPN) and soluble vascular cell adhesion molecule-1 (s VCAM-1) in patients with type 2 diabetes (T2DM) combined with peripheral arterial disease (PAD), patients with simple T2DM and healthy people. In order to provide a theoretical basis for the prevention and treatment of PAD and restenosis after operation, the significance of the changes of the concentration of the lower limb, the balloon dilatation or the stent implantation in the patients with T2DM combined with PAD was also determined. Methods: From June 2015 to December 2016,27 patients with T2DM and 27 cases of simple T2DM were selected as the study object (PTA group). The control group (control group) was selected as the control group (control group) for the patients with diabetes and related diseases, except for diabetic complications and related diseases, as a simple type of diabetes (T2DM). The fasting blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured in the PTA group, the patients with T2DM and the control group at 6:00 morning and 6:00, and the blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured. The level of low-density lipoprotein cholesterol (LDL-C) and osteopontin (OPN), soluble vascular cell adhesion molecule-1 (s VCAM-1). The ankle-brachial pressure index (ABI) and the transcutaneous oxygen partial pressure (TcPO _ 2) were measured before and after the intervention of the PTA group, and after the artery was successfully placed in the interventional treatment, 4ml of the arterial blood (pre-operation arterial blood), the guide wire and the catheter were successfully passed through the narrow or occluded lesion artery. 4 ml (pre-operative arterial blood) was taken at the distal end of the diseased artery, and 4 ml of blood was taken at the distal end of the artery after the balloon was expanded or after the stent was implanted (the arterial blood after the lesion), and 4 ml of the cubital vein blood was taken after the intervention. The plasma OPN and s VCAM-1 concentration of the specimen were measured by enzyme-linked immunosorbent assay (ELISA), and the operation was carried out in strict accordance with the instruction, and the general index was detected by the full-automatic biochemical instrument. The software of SPSS13.0 was used for statistical analysis, and the difference was statistically significant with the difference of P0.05. Results: The FBG and Hb of the group were: (8.97-1.45) mmol/ L, Hb: (8.82-0.87)%, FBG (8.90-1.21) mmol/ L in the T2DM group, (8.76-0.89)% in the control group, (5.28-0.30) mmol/ L in the control group, and (5.21-0.42)% in the control group. The levels of FBG and Hb in the PTA group and the T2DM group were higher than that of the control group (P 0.01), and the difference between the PTA group and the T2DM group was not statistically significant (P0.05); the levels of the blood lipids in the group were: (5.49-0.55) mmol/ L, (2.24-0.46) mmol/ L, respectively, in the PTA group, the TC, the TG, the LDL-C and the HDL-C. (3.74-0.46) mmol/ L, (1.02-0.16) mmol/ L; the T2DM groups were (5.11-0.63) mmol/ L, (1.93-0.51) mmol/ L, (3.43-0.51) mmol/ L, (1.11-0.25) mmol/ L, and Control groups were: (4.63-0.86) mmol/ L, (1.53-0.45) mmol/ L, (3.03-0.45) mmol/ L, (1.24-0.16) mmol/ L. The levels of TC, TG, LDL-C were significantly higher (P0.01, P0.01, P0.01), and the level of HDL-C was significantly lower (P0.01). The levels of TC, TG and LDL-C in the patients with T2DM were significantly higher (P0.05, P0.01, P0.01), and the level of HDL-C was lower (P0.05). The levels of LDL-C were significantly higher (P0.05, P0.01, P0.05), and the levels of HDL-C decreased (P0.05). TcPO _ 2 was 0.88-0.10, (55.56-3.23) mm Hg, respectively. (6.79-2.03) ng/ ml, (4.34-0.87) ng/ ml, in which the level of OPN in the venous and T2DM groups was significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of OPN in the venous blood of the PTA group was higher than that in the group with the T2DM group (P0.01), and the pre-operative arterial blood, the pre-operative arterial blood, The level of OPN in the arterial blood was: (12.73-2.56) ng/ ml, (14.11-2.43) ng/ ml, (16.15-2.28) ng/ ml, and the level of OPN increased significantly (P0.05; P0.05). The level of OPN in the pre-operative arterial blood was significantly higher than that of the pre-operative arterial blood (P0.05), and the level of OPN in the venous blood before and after the operation was (12.15-2.36) ng/ ml, (18.17-3.05) ng/ ml, (22.31-3.42) ng/ ml, respectively. The level of OPN in the venous blood after 1 d and 14 d after operation was significantly higher than that before operation (P0.01; P0.01), and the level of OPN increased significantly after the operation (P0.01). There was no significant difference in the level of OPN in the venous blood before and after the operation (P0.05); the plasma s VCAM-1 level: the levels of VCAM-1 in the venous blood, the T2DM group and the control group s VCAM-1 were: (56.44-7.42) ng/ ml, (45.13-4.87) ng/ ml, (27.39-5.94) ng/ ml, respectively. The levels of sVCAM-1 in the venous and T2DM groups were significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of sVCAM-1 in the venous blood of the PTA group was higher than that in the group with T2DM (P0.01). (60.24-6.35) ng/ ml, (72.08-6.49) ng/ ml, (85.58-7.63) ng/ ml, the level of sVCAM-1 increased (P0.01) compared with the arterial blood in the pre-operative arterial and post-operative arterial and interventional treatment (P0.01). The levels of sVCAM-1 in the venous blood,1 d after operation and 14 days after operation in the PTA group were: (56.44-7.42) ng/ ml, (123.11-18.21) ng/ ml, (292.45-20.05) ng/ ml, and the level of s-VCAM-1 in the venous blood after 1 d and 14 days after operation was significantly higher than that before operation (P0.01; P0.01). There was no significant difference in the level of sVCAM-1 after operation (P <0.01). There was no significant difference in the level of sVCAM-1 in the venous and arterial blood before and after the intervention (P0.05), and the relationship between 6OPN and s VCAM-1: The linear correlation between the level of OPN and s VCAM-1 in the pre-interventional venous blood in the PTA group was positively correlated (r = 0.940, P0.01), and the difference was of statistical significance. Conclusion: There are severe dyslipidemia in the patients with T2DM and T2DM. The concentration of OPN and s VCAM-1 in the plasma of patients with T2DM is significantly increased, suggesting that OPN and s VCAM-1 may play a role in the development of lower limb vessel disease of diabetes. The concentration of OPN and s VCAM-1 after the intervention of the 3 PTA group was significantly higher than that before the intervention, which is one of the risk factors leading to the restenosis after the intervention, which may provide a new way for inhibiting the proliferation, migration and anti-inflammatory treatment of smooth muscle cells.
【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
本文编号：2488392
[Abstract]:Objective: To determine the concentration of osteopontin (OPN) and soluble vascular cell adhesion molecule-1 (s VCAM-1) in patients with type 2 diabetes (T2DM) combined with peripheral arterial disease (PAD), patients with simple T2DM and healthy people. In order to provide a theoretical basis for the prevention and treatment of PAD and restenosis after operation, the significance of the changes of the concentration of the lower limb, the balloon dilatation or the stent implantation in the patients with T2DM combined with PAD was also determined. Methods: From June 2015 to December 2016,27 patients with T2DM and 27 cases of simple T2DM were selected as the study object (PTA group). The control group (control group) was selected as the control group (control group) for the patients with diabetes and related diseases, except for diabetic complications and related diseases, as a simple type of diabetes (T2DM). The fasting blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured in the PTA group, the patients with T2DM and the control group at 6:00 morning and 6:00, and the blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured. The level of low-density lipoprotein cholesterol (LDL-C) and osteopontin (OPN), soluble vascular cell adhesion molecule-1 (s VCAM-1). The ankle-brachial pressure index (ABI) and the transcutaneous oxygen partial pressure (TcPO _ 2) were measured before and after the intervention of the PTA group, and after the artery was successfully placed in the interventional treatment, 4ml of the arterial blood (pre-operation arterial blood), the guide wire and the catheter were successfully passed through the narrow or occluded lesion artery. 4 ml (pre-operative arterial blood) was taken at the distal end of the diseased artery, and 4 ml of blood was taken at the distal end of the artery after the balloon was expanded or after the stent was implanted (the arterial blood after the lesion), and 4 ml of the cubital vein blood was taken after the intervention. The plasma OPN and s VCAM-1 concentration of the specimen were measured by enzyme-linked immunosorbent assay (ELISA), and the operation was carried out in strict accordance with the instruction, and the general index was detected by the full-automatic biochemical instrument. The software of SPSS13.0 was used for statistical analysis, and the difference was statistically significant with the difference of P0.05. Results: The FBG and Hb of the group were: (8.97-1.45) mmol/ L, Hb: (8.82-0.87)%, FBG (8.90-1.21) mmol/ L in the T2DM group, (8.76-0.89)% in the control group, (5.28-0.30) mmol/ L in the control group, and (5.21-0.42)% in the control group. The levels of FBG and Hb in the PTA group and the T2DM group were higher than that of the control group (P 0.01), and the difference between the PTA group and the T2DM group was not statistically significant (P0.05); the levels of the blood lipids in the group were: (5.49-0.55) mmol/ L, (2.24-0.46) mmol/ L, respectively, in the PTA group, the TC, the TG, the LDL-C and the HDL-C. (3.74-0.46) mmol/ L, (1.02-0.16) mmol/ L; the T2DM groups were (5.11-0.63) mmol/ L, (1.93-0.51) mmol/ L, (3.43-0.51) mmol/ L, (1.11-0.25) mmol/ L, and Control groups were: (4.63-0.86) mmol/ L, (1.53-0.45) mmol/ L, (3.03-0.45) mmol/ L, (1.24-0.16) mmol/ L. The levels of TC, TG, LDL-C were significantly higher (P0.01, P0.01, P0.01), and the level of HDL-C was significantly lower (P0.01). The levels of TC, TG and LDL-C in the patients with T2DM were significantly higher (P0.05, P0.01, P0.01), and the level of HDL-C was lower (P0.05). The levels of LDL-C were significantly higher (P0.05, P0.01, P0.05), and the levels of HDL-C decreased (P0.05). TcPO _ 2 was 0.88-0.10, (55.56-3.23) mm Hg, respectively. (6.79-2.03) ng/ ml, (4.34-0.87) ng/ ml, in which the level of OPN in the venous and T2DM groups was significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of OPN in the venous blood of the PTA group was higher than that in the group with the T2DM group (P0.01), and the pre-operative arterial blood, the pre-operative arterial blood, The level of OPN in the arterial blood was: (12.73-2.56) ng/ ml, (14.11-2.43) ng/ ml, (16.15-2.28) ng/ ml, and the level of OPN increased significantly (P0.05; P0.05). The level of OPN in the pre-operative arterial blood was significantly higher than that of the pre-operative arterial blood (P0.05), and the level of OPN in the venous blood before and after the operation was (12.15-2.36) ng/ ml, (18.17-3.05) ng/ ml, (22.31-3.42) ng/ ml, respectively. The level of OPN in the venous blood after 1 d and 14 d after operation was significantly higher than that before operation (P0.01; P0.01), and the level of OPN increased significantly after the operation (P0.01). There was no significant difference in the level of OPN in the venous blood before and after the operation (P0.05); the plasma s VCAM-1 level: the levels of VCAM-1 in the venous blood, the T2DM group and the control group s VCAM-1 were: (56.44-7.42) ng/ ml, (45.13-4.87) ng/ ml, (27.39-5.94) ng/ ml, respectively. The levels of sVCAM-1 in the venous and T2DM groups were significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of sVCAM-1 in the venous blood of the PTA group was higher than that in the group with T2DM (P0.01). (60.24-6.35) ng/ ml, (72.08-6.49) ng/ ml, (85.58-7.63) ng/ ml, the level of sVCAM-1 increased (P0.01) compared with the arterial blood in the pre-operative arterial and post-operative arterial and interventional treatment (P0.01). The levels of sVCAM-1 in the venous blood,1 d after operation and 14 days after operation in the PTA group were: (56.44-7.42) ng/ ml, (123.11-18.21) ng/ ml, (292.45-20.05) ng/ ml, and the level of s-VCAM-1 in the venous blood after 1 d and 14 days after operation was significantly higher than that before operation (P0.01; P0.01). There was no significant difference in the level of sVCAM-1 after operation (P <0.01). There was no significant difference in the level of sVCAM-1 in the venous and arterial blood before and after the intervention (P0.05), and the relationship between 6OPN and s VCAM-1: The linear correlation between the level of OPN and s VCAM-1 in the pre-interventional venous blood in the PTA group was positively correlated (r = 0.940, P0.01), and the difference was of statistical significance. Conclusion: There are severe dyslipidemia in the patients with T2DM and T2DM. The concentration of OPN and s VCAM-1 in the plasma of patients with T2DM is significantly increased, suggesting that OPN and s VCAM-1 may play a role in the development of lower limb vessel disease of diabetes. The concentration of OPN and s VCAM-1 after the intervention of the 3 PTA group was significantly higher than that before the intervention, which is one of the risk factors leading to the restenosis after the intervention, which may provide a new way for inhibiting the proliferation, migration and anti-inflammatory treatment of smooth muscle cells.
【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
【参考文献】
相关期刊论文 前10条
1 谭元生;田梦影;;血管平滑肌增殖在血管重塑过程中的作用[J];中西医结合心脑血管病杂志;2016年11期
2 徐健;冯丰;刘闺男;王泰然;张希;都晓沫;;转染OPN-002-siRNA对大鼠颈动脉球囊损伤后内膜增生和OPN、TGF-β1、PCNA表达的影响[J];中国动脉硬化杂志;2015年11期
3 李琼;黄鹤;;血管支架在组织血管病变中对血管内皮细胞活化及纤维蛋白原变化的影响[J];安徽医药;2015年09期
4 单鸿;王皓帆;;糖尿病足与膝下血管病变介入治疗的新时代[J];中华放射学杂志;2015年01期
5 崔斌;丁小涵;赵刚;宋明宝;于世勇;陈剑飞;黄岚;;内皮型一氧化氮合酶基因转染促进内皮祖细胞移植对大鼠颈动脉新生内膜增生的抑制作用[J];中国介入心脏病学杂志;2014年10期
6 王富军;高倩;檀淼;刘月芹;邢娜;孙金;;介入治疗糖尿病下肢动脉病变对血管内皮功能和炎症反应的影响[J];中国介入影像与治疗学;2014年04期
7 于云鹏;孙锟;;基质金属蛋白酶与损伤后血管再狭窄[J];中华临床医师杂志(电子版);2013年12期
8 张娜;刘蕴玲;;骨桥蛋白与动脉粥样硬化和骨质疏松的关系[J];中国骨质疏松杂志;2012年10期
9 赵永才;李新胜;张金成;钱红霞;;糖尿病患者血清炎性因子与颈动脉粥样硬化关系的研究[J];中国慢性病预防与控制;2011年01期
10 狄柯坪;齐蕊;蒋凤平;;骨桥蛋白与血管重塑[J];中国组织工程研究与临床康复;2010年50期
相关会议论文 前1条
1 王李华;程国兵;吕杨波;陆炜;廖圣;朱慧芬;;糖尿病性下肢动脉硬化闭塞症患者支架植入术后抗凝治疗的临床研究[A];中华预防医学与临床医学论文汇编（2015年11月）[C];2015年
相关博士学位论文 前1条
1 穆伟;动脉粥样硬化中血管细胞粘附分子-1的表达与基因干预研究[D];山东大学;2015年
，本文编号：2488392
本文链接：https://www.wllwen.com/yixuelunwen/nfm/2488392.html
最近更新
教材专著
