血清25羟基维生素D在糖尿病并发急性冠脉综合征中的变化及意义

Change in serum 25-hydroxy vitamin D and its significance in diabetic patients with acute coronary syndrome

目的探讨血清25羟基维生素D在糖尿病(DM)并发急性冠状动脉综合征(ACS)中的变化及临床意义。方法纳入2006年7月-2008年10月北京军区总医院的27例DM患者作为DM组,52例ACS患者[其中不稳定型心绞痛(UAP)31例、急性心肌梗死(AMI)21例]作为ACS组,DM并发ACS(DM+ACS)组46例[其中DM合并UAP(DM+UAP)26例、DM合并AMI(DM+AMI)20例]作为DM+ACS组,28例健康志愿者作为对照组。自动生化仪检测血清25羟基维生素D和钙离子水平,酶联免疫吸附法(ELISA)检测各组血清C反应蛋白(CRP)、基质金属蛋白酶9(MMP-9)、乙酰肝素酶(HPA)水平,并分析25羟基维生素D与血清钙离子、CRP、MMP-9和HPA的相关性。结果 DM+ACS组血清25羟基维生素D水平显著低于其他3组(P<0.01);DM+AMI亚组血清25羟基维生素D水平显著低于DM+UAP亚组。血清25羟基维生素D与钙离子呈正相关,与CRP、MMP-9和HPA呈负相关。结论血清25羟基维生素D在DM并发急性冠脉综合征发生发展中呈降低趋势,其变化可能与CRP、MMP-9和HPA等炎性因子的上升有一定关联。

Objective To investigate clinical significance of change in level of serum 25-hydroxy vitamin D in diabetic patients with acute coronary syndrome.Methods From Jul.2006to Oct.2008,27diabetic patients admitted to General Hospital of Beijing Military Command were enrolled as DM group,52patients with acute coronary syndrome（ACS）as ACS group in whom 31were with unstable angina pectoris（UAP）and the other 21were with acute myocardium infarct（AMI）,46diabetic patients complicating ACS as DM＋ACS group in whom 20patients were complicated with AMI（DM＋AMI）and the other 26patients with UAP（DM＋UAP）,and 28health volunteers served as normal control group.Serum 25-hydroxy vitamin D and calcium levels were measured by automatic biochemical analyzer.C-reactive protein（CRP）,matrix metalloproteinase-9（MMP-9）and heparanase（HPA）in serum were measured by ELISA.The correlations between serum 25-hydroxy vitamin D and calcium,CRP,MMP-9,HPA were analyzed.Results The serum level of 25-hydroxy vitamin D was significantly lower in DM＋ACS group than in ACS group,DM group and normal control group,and it was significantly lower in DM＋AMI subgroup than in DM＋UAP subgroup.A positive correlation was found between the levels of 25-hydroxy vitamin D and calcium.No significant relationship was found between the serum levels of 25-hydroxy vitamin D and CRP,MMP-9or HPA.Conclusion Serum 25-hydroxy vitamin D in diabetic patients with ACS shows a decreasing tendency,which may have relationship with the increase in CRP,MMP-9and HPA.