急性冠脉综合征中糖代谢异常与血浆P选择素、冠脉病变程度的关系

Relationship of glycometabolism disturbance with plasma P-selectin and the severity of coronary artery lesions in acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者血糖异常与血浆P选择素和冠状动脉病变程度的关系。方法ACS患者116例,其中单纯ACS组40例、ACS合并糖调节异常组(糖耐量受损组/空腹血糖受损)34例、ACS合并2型糖尿病组42例,单纯2型糖尿病组26例,正常对照组26例。采用ELISA法测定各组血浆可溶性P选择素水平。结果单纯ACS组、ACS合并糖调节异常组、ACS合并2型糖尿病组、单纯2型糖尿病组P选择素水平均高于正常对照组,其中ACS合并糖调节异常组、ACS合并2型糖尿病组P选择素水平均高于单纯ACS组(P<0.05)。ACS合并糖调节异常组以及ACS合并2型糖尿病组多支冠状动脉病变的发生率以及冠状动脉狭窄的严重程度均明显高于单纯ACS组(P<0.05)。结论糖代谢紊乱的ACS患者较糖耐量正常的ACS患者具有更严重的血小板活化状态。ACS合并糖代谢异常患者冠脉病变程度更严重、范围更广泛,临床预后更差。

Objective To investigate the changes of plasma level of P-selectin in patients with acute coronary syndromes （ACS） with or without glycometabolism disturbance and to determine the relationship of abnormality blood sugar with severity of coronary artery lesions in ACS cases. Methods Plasma P-selectin level was detected by ELISA in 116 cases with ACS （40 with ACS alone, 34 with ACS＋IGT/IFG, and 42 with ACS＋type 2 diabetes）, 26 with diabetes and 26 controls. The extent of coronary artery stenosis in ACS patients was evaluated by the classification standard of American Heart Association. Results Significantly increased plasma P-selectin level was found in patients with ACS as well as diabetes groups compaered with that in the controls. Plasma levels of P-selectin in patients with ACS＋ IGT/IFG and ACS＋type 2 diabetes were higher than those in patients with ACS alone （P〈0.05）. The incidence of multiple coronary artery lesions was higher in patients with ACS ＋IGT/IFG and ACS＋type 2 diabetes and changes of coronary artery stenosis were also more severe than those in ACS group （P〈0.05）. Conclusion The abnormal platelet activation exists in ACS patients with or without glycometabolic disorder. The extent and range of the lesions in coronary arteries in patients with ACS＋IGT/IFG and ACS＋type 2 diabetes are more significant than those in patients with ASD alone. Thus, ACS with glucometabolism disturbance may be predisposed to a poorer prognosis.