应用血管内超声对内源分泌型晚期糖基化终产物受体水平与糖尿病冠状动脉硬化斑块关系的研究
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摘要
目的分析内源分泌型晚期糖基化终产物受体(esRAGE)水平与冠心病(CHD)合并糖尿病患者冠状动脉粥样硬化斑块严重程度的相关性。方法选取2015年4月至2017年7月于福建医科大学附属第二医院心内科住院的经冠状动脉造影(CAG)确诊的CHD患者53例,分为CHD合并T2DM组(CHD+T2DM,n=11)与单纯CHD组(CHD,n=42)。应用血管内超声进行冠状动脉斑块分析,检测冠脉最小血管直径、最小管腔面积和斑块负荷(PB)。ELISA法测定血浆esRAGE水平。结果CHD+T2DM组与CHD组比较,血浆esRAGE[(0.2860±0.1097)vs(0.4738±0.2455)μg/L,P=0.017]、最小血管直径[(1.85±0.16)vs(2.19±0.59)mm,P=0.002)、最小管腔面积[(3.64±1.51)vs(5.32±2.95)mm2,P=0.014]及PB[(73.69±5.91)%vs(67.23±14.57)%,P=0.03]差异均有统计学意义。多元线性回归分析显示,SBP与PB呈正相关,esRAGE与PB呈负相关(P<0.05),提示高SBP和低esRAGE是PB的危险因素。结论糖尿病加剧CHD患者冠状动脉粥样硬化斑块的严重程度;低血浆esRAGE水平可能是冠状动脉粥样硬化斑块病变的危险因素。
Objective To analyze the relationship between plasma endogenous secretion receptor for the advanced glycation end-products(esRAGE)and the severity of coronary atherosclerotic plaques in patients of coronary atherosclerotic heart disease(CHD)with diabetes mellitus(DM). Methods 53 CHD patients diagnosed by coronary angiography were enrolled and divided into two groups according to with or without DM.Intravascular ultrasound(IVUS)was applied to determine the degree of lesion of coronary artery with the minimum lumen diameter(MLD),minimum lumen area(MLA)and plaque burden(PB).The plasma esRAGE level was measured with enzyme-linked immunosorbent assay(ELISA). Results There were significant differences between CHD group and CHD+DM group in the levels of esRAGE [(0.2860±0.1097)vs(0.4738±0.2455)μg/L,P=0.017],MLD [(1.85±0.16)vs(2.19±0.59)mm,P=0.002],MLA [(3.64±1.51)vs(5.32±2.95)mm2,P=0.014]and PB [(73.69±5.91)% vs(67.23±14.57)%,P=0.03].Linear multivariate regression analysis showed that higher systolic blood pressure and lower esRAGE level were risk factors of PB. Conclusion DM exacerbates the progress of arteriosclerosis in CHD. The lower plasma esRAGE level may associate with arteriosclerosis.
Objective To analyze the relationship between plasma endogenous secretion receptor for the advanced glycation end-products(esRAGE)and the severity of coronary atherosclerotic plaques in patients of coronary atherosclerotic heart disease(CHD)with diabetes mellitus(DM). Methods 53 CHD patients diagnosed by coronary angiography were enrolled and divided into two groups according to with or without DM.Intravascular ultrasound(IVUS)was applied to determine the degree of lesion of coronary artery with the minimum lumen diameter(MLD),minimum lumen area(MLA)and plaque burden(PB).The plasma esRAGE level was measured with enzyme-linked immunosorbent assay(ELISA). Results There were significant differences between CHD group and CHD+DM group in the levels of esRAGE [(0.2860±0.1097)vs(0.4738±0.2455)μg/L,P=0.017],MLD [(1.85±0.16)vs(2.19±0.59)mm,P=0.002],MLA [(3.64±1.51)vs(5.32±2.95)mm2,P=0.014]and PB [(73.69±5.91)% vs(67.23±14.57)%,P=0.03].Linear multivariate regression analysis showed that higher systolic blood pressure and lower esRAGE level were risk factors of PB. Conclusion DM exacerbates the progress of arteriosclerosis in CHD. The lower plasma esRAGE level may associate with arteriosclerosis.
引文
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[10]Yang SJ,Kim S,Hwang SY,et al.Association between sRAGE,esRAGE levels and vascular inflammation:analysis with(18)F-fluorodeoxy glucose positron emission tomography.Atherosclerosis,2012,2:402-406.
[11]Heier M,Margeirsdottir HD,Gaarder M,et al.Soluble RAGE and atherosclerosis in youth with type 1diabetes:a 5-year follow-up study.Cardiovasc Diabetol,2015,14:126-133.
[12]Lin XH,Chen XY,Ye JS,et al.Association between endogenous secretory receptor for advanced glycation-end products(esRAGE)and carotid Intima-media thickness in type 2Diabetes.Exp Clin Endocrinol Diabetes,2014,5:277-280.
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[15]World Health Organisation.Guidelines for controlling and monitoring the tobacco epidemi c.Geneva:Tobacco or Heahh Programme,WHO,1997.
[16]An YL,Zhang P,Wang JP,et al.Cardiovascular and all-cause mortality over a 23-year period among Chinese with newly diagnosed diabetes in the Da Qing IGT and diabetes study.Diabetes Care,2015,7:1365-1371.
[17]Faghihi-Kashani S,Bonnet F,Hafezi-Nejad N,et al.Fasting hyperinsulinaemia and 2-h glycaemia predict coronary heart disease in patients with type 2diabetes.Diabetes Metab,2016,1:55-61.
[18]Faria A,Persaud SJ.Cardiac oxidative stress in diabetes:Mechanisms and therapeutic potential.Pharmacol Ther,2017,172:50-62.
[19]Daffu G,Del Pozo CH,O’Shea KM,et al.Radical roles for RAGE in the pathogenesis of oxidative stress in cardiovascular diseases and beyond.Int J Mol Sci,2013,10:19891-19910.
[20]Malmstedt J,Krvestedt L,Swedenborg J,et al.The receptor for advanced glycation end products and risk of peripheral arterial disease,amputation or death in type 2diabetes:apopulation-based cohort study.Cardiovasc Diabetol,2015,14:93-101.
[2]Haffner SM,Miettinen H.Insulin resistance implications for type II diabetes mellitus and coronary heart disease.Am J Med,1997,193:152-162.
[3]Andrus EC,Allen EV,Merritt HH,et al.The pathogenesis of arteriosclerosis.Int J Epidemiol,2015,6:1791-1793.
[4]Schmidt AM,Vianna M,Gerlach M,et al.Isolation and characterization of two binding proteins for advanced glycosylation end products from bovine lung which are present on the endothelial cell surface.J Biol Chem,1992,21:14987-14997.
[5]Prasad K.Low levels of serum soluble receptors for advanced glycation end products,biomarkers for disease state:myth or reality.Int J Angiol,2014,1:11-16.
[6]Piarulli F,Lapolla A,Ragazzi E,et al.Role of endogenous secretory RAGE(esRAGE)in defending against plaque formation induced by oxidative stress in type 2diabetic patients.Atherosclerosis,2013,1:252-257.
[7]Yang ZK,Shen Y,Shen WF,et al.Elevated glycated albumin and reduced endogenous secretory receptor for advanced glycation endproducts levels in serum predict major adverse cardiocerebral events in patients with type 2diabetes and stable coronary artery disease.Int J Cardiol,2015,197:241-247.
[8]Koyama H,Shoji T,Yokoyama H,et al.Plasma level of endogenous secretory RAGE is associated with components of the metabolic syndrome and atherosclerosis.Arterioscler Thromb Vasc Biol,2005,12:2587-2593.
[9]Di Pino A,Urbano F,Zagami RM,et al.Low endogenous secretory receptor for advanced glycation end-products levels are associated with inflammation and carotid atherosclerosis in prediabetes.J Clin Endocrinol Metab,2016,4:1701-1709.
[10]Yang SJ,Kim S,Hwang SY,et al.Association between sRAGE,esRAGE levels and vascular inflammation:analysis with(18)F-fluorodeoxy glucose positron emission tomography.Atherosclerosis,2012,2:402-406.
[11]Heier M,Margeirsdottir HD,Gaarder M,et al.Soluble RAGE and atherosclerosis in youth with type 1diabetes:a 5-year follow-up study.Cardiovasc Diabetol,2015,14:126-133.
[12]Lin XH,Chen XY,Ye JS,et al.Association between endogenous secretory receptor for advanced glycation-end products(esRAGE)and carotid Intima-media thickness in type 2Diabetes.Exp Clin Endocrinol Diabetes,2014,5:277-280.
[13]Bashore TM,Bates ER,Berger PB.American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards.J Am Coll Cardiol,2001,8:2170-2214.
[14]孙勇,蒋峻,朱国忠.血管内超声指导下冠状动脉严重钙化病变旋磨治疗的有效性.中华心血管病杂志,2014.7:545-550.
[15]World Health Organisation.Guidelines for controlling and monitoring the tobacco epidemi c.Geneva:Tobacco or Heahh Programme,WHO,1997.
[16]An YL,Zhang P,Wang JP,et al.Cardiovascular and all-cause mortality over a 23-year period among Chinese with newly diagnosed diabetes in the Da Qing IGT and diabetes study.Diabetes Care,2015,7:1365-1371.
[17]Faghihi-Kashani S,Bonnet F,Hafezi-Nejad N,et al.Fasting hyperinsulinaemia and 2-h glycaemia predict coronary heart disease in patients with type 2diabetes.Diabetes Metab,2016,1:55-61.
[18]Faria A,Persaud SJ.Cardiac oxidative stress in diabetes:Mechanisms and therapeutic potential.Pharmacol Ther,2017,172:50-62.
[19]Daffu G,Del Pozo CH,O’Shea KM,et al.Radical roles for RAGE in the pathogenesis of oxidative stress in cardiovascular diseases and beyond.Int J Mol Sci,2013,10:19891-19910.
[20]Malmstedt J,Krvestedt L,Swedenborg J,et al.The receptor for advanced glycation end products and risk of peripheral arterial disease,amputation or death in type 2diabetes:apopulation-based cohort study.Cardiovasc Diabetol,2015,14:93-101.