2型糖尿病合并冠心病患者sVCAM-1水平及氟伐他汀干预的临床研究

Clinical research on the level of soluble vascular cell adhesion molecule-1 and the effect of fluvastatin intervention on it in type 2 diabetes mellitus complicated with coronary heart disease

目的探讨可溶性血管细胞黏附分子-1(sVCAM-1)在2型糖尿病合并冠心病中的作用及氟伐他汀干预的影响。方法选取门诊及病房中单纯2型糖尿病患者40名、2型糖尿病合并冠心病患者40名及健康对照者40名,检测体重指数(BMI)、血脂、血糖、胰岛素抵抗指数(HOMA-IR),ELISA法测定sVCAM-1。糖尿病患者均以氟伐他汀(40 mg/d)干预治疗24周,于治疗前后检测上述各指标,进行不同治疗时段对照研究及指标间相关性研究。结果sVCAM-1分别与BMI、空腹血糖(FPG)、餐后2h血糖(2hPG)、HOMA-IR、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)呈正相关,与高密度脂蛋白胆固醇(HDL-C)呈负相关;2型糖尿病患者sVCAM-1水平高于健康对照组,2型糖尿病合并冠心病患者组sVCAM-1明显高于单纯2型糖尿病组;氟伐他汀干预后2型糖尿病患者sVCAM-1均有不同程度下降。结论sVCAM-1作为一种重要的黏附分子,参与了胰岛素抵抗、2型糖尿病及其合并冠心病的发生和发展。氟伐他汀能明显降低2型糖尿病合并冠心病患者sVCAM-1水平。

Objective To investigate the role of soluble vascular cell adhesion molecule-1（sVCAM-1） in type 2 diabetes complicated with coronary heart disease（CHD）,and elucidate the mechanism of the protective effects of fluvastatin intervention on these patients.Methods 40 normal subjects,40 type 2 diabetics without CHD and 40 type 2 diabetics with CHD underwent examinations of body mess index（BMI）,blood lipids,blood sugar and HOMA-IR,and their sVCAM-1 was determined by ELISA before fluvastatin treatment.All diabetics received fluvastatin intervention for 24 weeks prior to a second sVCAM-1 detection by ELISA so as to establish contrast of therapeutic stages and research on the correlations between these indices.Simultaneously,their FPG,2hPG,HOMA-IR,HbA1c,TG,TC,LDL-C,HDL-C,and BMI were measured.The results of determination were analyzed statistically.Results The serum VCAM-1 in type 2 diabetics with CHD was higher than that in type 2 diabetics without CHD and healthy controls.Serum VCAM-1 was correlated positively with FPG,2hPG,HOMA-IR,HbA1c,TG,TC,LDL-C,BMI,and correlated negatively with HDL-C.After fluvastatin treatment,the levels of serum sVCAM-1 of all diabetics were reduced to a certain degree.Conclusion The results indicate that sVCAM-1 plays an important role in insulin resistance and the pathogenesis of type 2 diabetics complicated with CHD.The protective effects of fluvastatin on blood vessel partly attribute to its lowering of serum sVCAM-1.Levels of serum sVCAM-1 can serve as an indication in the evaluation and therapy of type 2 diabetics with CHD.