2型糖尿病合并冠心病患者血清TNF-α、hs-CRP、APN和HMG B1水平的变化及临床意义

Changes and Clinical Significance of Levels of Serum TNF-α,hs-CRP,Adiponectin,HMGB1 in Patients of Type 2 Diabetes Mellitus with Coronary Heart Disease

目的:观察2型糖尿病和并冠心病患者血清肿瘤坏死因子(TNF-α)、超敏C-反应蛋白(hs-CRP)、脂联素(APN)和高迁移率族蛋白B1(HMGB1)水平的变化及各炎性因子间的相关性,对病情监测的指导意义。方法:纳入研究对象共324例,其中A组(单纯2型糖尿病)50例;B组(单纯冠心病)64例;C组(糖尿病合并冠心病)90例;120例健康体检者作为对照组。检测空腹血糖(FPG),糖化血红蛋白(GHbA1c)等生化指标,应用ELISA法和散射速率比浊法对TNF-α、hs-CRP、APN和HMGB1水平进行检测。结果:A组和C组患者FPG、GHbA1c、血清hs-CRP、TNF-α、HMGB1水平高于对照组,APN水平低于对照组(均P<0.01)。C组患者血清hs-CRP、TNF-α、HMGB1水平均高于A组和B组(均P<0.01或P<0.05),而APN水平低于A组和B组(均P<0.01);B组患者血清hs-CRP、TNF-α、HMGB1水平均高于A组,而APN水平低于A组(均P<0.01)。C组患者中,血清FPG、GHbA1c、HMGB1水平分别与TNF-α和hs-CRP水平均呈正相关(均P<0.01)。血清APN水平与TNF-α和hs-CRP呈负相关(均P<0.01);Gensini积分与血清HMGB1水平呈正相关(P<0.01)。结论:TNF-α、hs-CRP、APN和HMGB1均参与了2型糖尿病合并冠心病患者动脉粥样硬化的发生和发展,对病情的监测和治疗具有指导意义。

Objective： To observe the changes of levels of tumor necrosis factor （TNF-a）, high sensitivi- ty C-reactive protein （hs-CRP）, adiponectin（APN）, high mobility group box chromosomal pro- tein I（HMGB1） in patients of type 2 diabetes mellitus with coronary heart disease, and tO explore their clinical significance in monitoring the changes of disease. Methods： A total of 324 cases were enrolled, including patients with diabetes mellitus alone （group A,50 cases）, coronary heart dis- ease alone （group B, 64 cases）, and diabetes mellitus plus coronary heart disease （group C, 90 cases）, Another 120 normal persons were set as control group. Serum fasting plasma glucose （FPG）, and glycation hemoglobin Alc （GHbAlc） were measured. Levels of serum hs-CRP, TNF-α, APN and HMGB1 were detected by enzyme-linked immunosorbent assay （ELISA） and- scatter velocity turbidimetry. Results： Levels of FPG, GHbAlc, hs-CRP, TNF-α, and HMGB1 were significantly higher in groups A and C group than in normal control group （all P〈0.01）, while serum adiponectin level in groups A and C was markedly lower than in control group （all P 〈0.01）. Levels of hs-CRP,TNF-α, and HMGB1 were significantly higher in group C than that respectively in group A and group B （all P〈0.01）, while serum adiponectin level in group C was markedly lower than in group A and group B （all P〈0.01）. Levels of hs-CRP, TNF-α, and HMGB1 were significantly higher in group B than in group A （all P〈0.01）, serum adiponectin levels in group B were markedly lower than in group A （P〈0.01）. In group C, each of FPG, GHbAlc, and HMGB1 was positively correlated to hs-CRP or TNF-α （all P〈0.01）, while a negative correlation was found between APN and TNF-α or hs-CRP （both P〈0.01）. Pearson correlation analysis showed that Gensini score was positively correlated to HMGB1 （P〈0.01）. Conclusion： TNF-α, hs-CRP, adiponectin and HMGB1 participate in the mechanism of athero- sclerotic immune pathology in type 2 diabetes mellitus complicated with coronary heart disease, and their measurement are helpful for monitoring disease and guiding treatment.