糖尿病对急性心肌梗死患者细胞凋亡因子和炎性因子的影响

Effects of diabetes mellitus on apoptotic cytokines and inflammatory cytokines in patients with acute myocardial infarction

目的了解糖尿病(DM)对急性心肌梗死(AMI)患者Fas受体细胞凋亡途径和炎症反应的影响。方法70例急性ST段抬高心肌梗死患者,根据是否合并DM分为非糖尿病(NDM)组(36例)和DM组(34例)。应用ELISA方法测定两组患者血清sFas、sFasL和TNF-α、IL-6的含量。结果AMI合并DM组直接PCI后血清sFas和sFasL浓度明显高于NDM组(4.18±0.86vs3.30±0.82μg/L,6.15±1.56vs4.34±1.37μg/L;P<0.01)。前者血清TNF-α、IL-6的浓度也高于后者(32.78±6.16vs20.54±9.17ng/L,75.28±19.60vs54.35±14.74ng/L;t=2.476,2.598;P<0.05)。心功能killip3、4级患者血清sFas、sFasL、TNF-α和IL-6的浓度均高于killip2、1级患者(F=4.52,P<0.05)。结论糖尿病可能通过促进Fas/FasL系统的激活加速AMI时细胞凋亡的发生,同时加剧机体炎症反应,这可能是合并DM的AMI患者病情较重和预后不良的原因之一。

Objective To study the effects of diabetes mellitus（DM） on fas receptor-induced cardiomyocytes apoptosis and inflammatory response in patients with acute myocardial infarction（AMI）. Methods 70 patients with ST-elevated myocardial infarction were divided into two groups：without（n=36） and with diabetes mellitus （n= 34）. Strepavidin-biotin ELISA was used to examine the serum levels of sFas, sFasL,TNF-α and IL-6. Results As the concentrations of sFas and sFasL immediately after primary PCI were higher in patients of AMI with DM than without DM （4.18±0. 86 vs 3.30±0.82 ng/ml, 6.15 ± 1.56 vs 4. 34 ± 1.37 ng/ml, respectively, P〈0.01）, so did the concentrations of TNF-α and IL-6 （32. 78 ±6.16 vs 20. 54±9.17 pg/ml, 75.28±19.60 vs 54.35±14.74 pg/ml,respectively, P〈0.05）. The concentrations of sFas,sFasL,TNF-α and IL-6 were higher in patients with killip 3,4 than in the patients with killip2,1 （ F= 4.52,P〈0.05）. Conclusions Diabetes mellitus may accelerate cardiomyocytes apoptosis through activation of Fas/FasL system and aggravate inflammatory response in patients with acute myocardial infarction, which may be one of the reasons for severe conditions and ill prognosis in patients with acute myocardial infarction and diabetes mellitus.