冠心病合并糖尿病患者冠状动脉支架术后炎症因子的变化及临床意义

Changes of inflammatory factors after coronary stenting in patients of coronary artery disease with diabetes mellitus

目的观察冠心病合并糖尿病患者冠状动脉支架术前、后血清中炎症因子的变化,并探讨其临床意义。方法连续选取因冠心病心绞痛住院并成功接受冠状动脉支架术的患者87例,其中合并糖尿病者(糖尿病组)31例,未合并糖尿病者(非糖尿病组)56例。分别于术前、术后24小时和1个月抽取外周血,采用标准的酶联免疫法测定超敏C-反应蛋白(hsCRP)、可溶性CD40配体(sCD40L)、细胞间黏附因子-1(ICAM-1)和基质金属蛋白酶(MMP-9),分析和比较两组各时间点上述指标的变化。结果糖尿病组hsCRP在术后24小时浓度达到高峰(14.35±6.22μg/L),与术前(9.35±5.23μg/L)、术后1个月(7.19±5.32μg/L)相比,差异具有统计学意义(P<0.05);但与非糖尿病组(12.68±6.07μg/L)相比,差异无统计学意义(P>0.05)。两组sCD40L、ICAM-1在术前和术后均没有明显的变化。糖尿病组MMP-9在术后持续升高,1个月时达到高峰(34.74±10.70μg/L),与术前(19.64±6.03μg/L)和术后24小时(20.00±7.06μg/L)相比,差异具有统计学意义(均为P<0.05),且术后1个月时MMP-9的水平明显高于非糖尿病组(29.83±8.51μg/L,P<0.05)。结论冠状动脉支架术后各种炎症因子的表达存在差异,其中MMP-9在冠心病合并糖尿病患者支架置入术后存在较长时间持续增高的现象,其可能与糖尿病患者支架置入术后不良事件增加有关。

Objective To study the serum levels of inflammatory cytokines in patients of coronary artery disease with diabetes mellitus. Methods Eighty seven patients who were hospitalized for angina pectoris and had received coronary stenting were divided into DM group （n =31 ） and non-DM group （n = 56）. Perpheral blood sample were taken before, 24 hours and 1 month after PCI. The level of high sensitive C-reactive protein （hsCRP） ,soluble fragment of CD40 ligand （sCIMOL） , intercellular adhesion molecule-1 （ICAM-1） and matrix metalloproteinase （MMP-9） were detected by enzyme linked immunosement assay （ELISA）. Results The concentration of hsCRP in DM group reached its peak level at 24 hours after stentt implantation, and had significant difference compared with the levels before or 1 month after stent implantation 14. 35 ±6. 22 μg/L vs 9.35 ±5.23 μg/L, 7. 19 ±5.32 μg/L （P 〈0. 05） ; but there were no differences observed in non-DM group （ P 〉 0.05 ）. sCD40L and ICAM-1 had no significant change along different times in the two groups （P 〉0. 05）. MMP-9 reached the peak at 1 month after PCI in DM group, and had significant difference compared with the concentration before or 24h after PCI in DM group 34. 74 ± 10.70 μg/L vs 19. 64±6. 03 μg/L, 20.00 ±7.06 μg/L （P 〈0.05） , and it also had significant difference in MMP-9 at 1 month after PCI compared with that of non-DM group （34. 74± 10.70 μg/L vs 29. 83 ±8.51 μg/L, P 〈 0. 05 ）. Conclusion The expression of inflammation cytokines increases after coronary stenting. MMP-9 had a long-term high expression and may be relevant with the adverse event in patients of coronary artery disease with diabetes mellitus after stent implantation.