降糖过程中2型糖尿病患者心肌肌钙蛋白Ⅰ及超敏C反应蛋白水平的变化

Changes of high sensitive-C reactive protein and cardiac troponin I levels in patients with type 2 diabetesduring glucose-lowering therapy

目的比较强化降糖前后2型糖尿病患者超敏C反应蛋白（hs-CRP）和心肌肌钙蛋白Ⅰ（cTnⅠ）水平变化，探索2型糖尿病患者合理降糖速率。方法对132例2型糖尿病患者和135例2型糖尿病合并冠心病患者强化降糖治疗，比较不同降糖速率下hs-CRP和cTnⅠ水平变化。结果不同降糖速率下，2型糖尿病合并冠心病组cTnⅠ及hs-CRP水平变化幅度不同（P〈0．05）：降糖速率≤4．0mmol·L^-1·d^-1时，降糖后cTnⅠ及hs-CRP水平下降；降糖速率〉4．0mmol·L^-1·d^-1时，降糖后cTnⅠ及hs—CRP水平升高。3个月后随访时，cTnⅠ及hs—CRP水平较降糖前均下降（P〈0．05）。结论强化降糖后心血管事件增加的原因可能与降糖速率过快有关。2型糖尿病患者合理降糖速率与是否合并冠心病有关。合并冠心病2型糖尿病患者降糖速率超过一定范围会导致cTnⅠ及hs—CRP水平急性升高，提示心肌受损，其机制可能为炎症通路激活。长期良好血糖控制可减轻合并冠心病2型糖尿病患者因降糖速率过快而加重的炎症反应，修复受损心肌。

Objective To compare the changes of high sensitive-C reactive protein （hs-CRP） and cardiac troponin Ⅰ （ cTn Ⅰ ） levels before and after intensive therapy in patients with type 2 diabetes, and to find out the reasonable glucose-lowering rate. Methods One hundred and thirty-two cases of type 2 diabetes（ T2DM group） and 135 cases of type 2 diabetes with coronary heart disease（ T2DM＋CHD group） received intensive therapy. After testing hs-CRP and cTn I levels, the variations were analyzed. Results The ranges of the change in cTn I and hs-CRP levels were different under four glucose-lowering rates in the T2DM＋CHD group（ P〈0. 05 ）. cTn I and hs-CRP levels were higher than those before intensive therapy in the T2DM＋CHD group with glucose-lowering rate greater than 4. 0 mmol · L^-1·d^-1. The other two subgroups with glucose-lowering rate less than 4. 0 mmol · L^-1· d^-1 showed decreased cTn I and hs-CRP levels. While at the end of 3 months follow-up, cTn I and hs-CRP levels were all significantly lower than those before intensive therapy in four subgroups （ P 〈 0. 05 ）. Conclusions The increase of cardiovascular events after intensive therapy may be due to excessively fast glucose-lowering rate. The reasonable glucose-lowering rate for patients with type 2 diabetes should depend on whether there is accompanying coronary heart disease. For type 2 diabetes with coronary heart disease, excessively fast glucose-lowering rate could lead to acute rise of cTn I and hs-CRP levels, which causes myocardial injury. The mechanism of myocardial injury resulted from excessively fast glucose-lowering rate may be due to activation of the inflammatory pathway. In type 2 diabetes with coronary heart disease, long-term good control of blood glucose could alleviate inflammatory response and cardiac damage resulted from excessively fast glucose-lowering rate.