糖尿病和冠心病患者高密度脂蛋白结构与其抗炎作用的相关性研究

Relationship between the HDL composition and its anti-inflammation function in patients with diabetes and coronary heart disease

目的比较2型糖尿病和冠心病患者与健康人高密度脂蛋白(HDL)对内皮细胞表达粘附分子的抑制能力,并研究其与HDL中血清淀粉样蛋白A(SAA)含量改变的相关性。方法通过密度梯度离心法从健康人、单纯糖尿病患者、糖尿病合并冠心病患者以及单纯冠心病患者血浆样本中提取HDL,用酶联免疫吸附法检测HDL中SAA及载脂蛋白AⅠ(apo AⅠ)含量。将健康人及不同患者的HDL与脐静脉内皮细胞(HUVEC)共同孵育,通过肿瘤坏死因子α刺激,分别与抗人CD54-PE、CD106-FITC单克隆抗体及Calcein-AM荧光染色剂标记后的THP-1细胞共同孵育后,流式细胞术检测平均荧光强度获得HUVEC细胞间粘附分子1(ICAM-1)、血管细胞粘附分子1(VCAM-1)表达数量及THP-1细胞粘附数量,从而比较不同组别HDL抑制粘附分子表达及抑制细胞粘附的能力。结果健康人群HDL中SAA含量与单纯糖尿病及单纯冠心病患者HDL中SAA含量相比均明显降低[(4.89±1.46)ng/μg比(22.54±7.40)ng/μg及(13.28±5.05)ng/μg,均为P<0.05]。健康对照组及各疾病组HDL均可使HUVEC表达ICAM-1、VCAM-1水平明显下降,其中健康对照组HDL抑制ICAM-1表达能力均明显强于糖尿病组及糖尿病合并冠心病组(17 318.60±4 364.77比34 171.67±13 918.07及39 633.60±8 728.22,均为P<0.05)。健康对照组HDL抑制VCAM-1表达能力明显强于糖尿病合并冠心病组(244.80±119.55比388.80±75.76,P=0.04)。健康对照组及各疾病组HDL均可抑制THP-1细胞粘附HUVEC的能力,但健康对照组HDL抑制细胞粘附能力明显强于糖尿病组、冠心病组及糖尿病合并冠心病组(503.24±63.50比2 918.00±0.00、1 510.33±1 353.87及4 196.50±412.60,均为P<0.05)。HDL中SAA的含量与其抗ICAM-1表达(回归系数为1.57,t=3.22,P<0.01)及THP-1细胞粘附能力(回归系数为1.16,t=3.05,P=0.01)具有明显相关性。HDL中apo AⅠ的含量与其抗ICAM-1表达能力具有明显相关性(回归系数为-0.35,t=-2.40,P=0.02)。结论糖尿病和冠心病患者HDL抑制血管内皮细胞粘附分子表达及抑制单核细胞粘附能力均显著减弱。SAA含量越多,HDL抑制粘附能力越弱;apo AⅠ含量越高,HDL抑制细胞粘附能力越强。

Objective In this case-control study we enrolled healthy subjects and subjects with type 2 diabetes mellitus （ DM）, coronary heart disease（CHD） only, or both disorders. The objective is to study the inhibition of intracellular adhesion molecule-1 （ ICAM-1 ）, vascular cell adhesion molecule-1 （ VCAM-1 ） expression and the cell adhesion by high density lipoprotein（HDL） in different groups; and to investigate the relationship between the level of HDL-serum amyloid A （SAA） and anti-adhesion function. Methods HDLs were isolated from plasma with ultracentrifugation. The levels of lipoprotein-associated SAA and apolipoprotein A- Ⅰ （apoA Ⅰ ） were detected with Enzyme-Linked Immuno Sorbent Assay（ELISA）. Human umbilical vein endothelial cells （HUVECs） were incubated with HDLs and stimulated with TNF-α, then labeled with antiCD54-PE, or antiCD106-FITC monoclonal antibodies respectively, then incubated with THP-1 cells, which were labeled by calcein-AM antibody. The expression of cell-surface molecules and the number of adhering THP-1 cells were measured as fluorescence intensity by flow cytometer. Results The levels of HDL-SAA in the healthy controls were lower than patients with DM only and CHD only [ （4. 89 ±1.46） ng/μgvs. （22.54±7.40） ng/μg and （13.28 ±5.05） ng/μg, both P〈0.05]. The HDLs of all groups could inhibit the expression of ICAM-1, VCAM-1, while the HDLs obtained from healthy subjects could inhibit the expression of ICAM-1 significantly greater than HDLs obtained from DM and DM ＋ CHD subjects （ 17 318.60 ±4 364. 77 vs. 34 171.67± 13 918. 07 and 39 633.60 ± 8 728.22, both P 〈 0. 05 ）, and the inhibition of VCAM-1 expression by normal HDLs was significantly greater than HDLs obtained from DM ＋ CHD subjects （ 244. 80 ± 119. 55 vs. 388. 80 ± 75.76, P = 0.04 ）. The HDLs of all groups could inhibit the adhesion of THP-1. The HDLs from healthy subjects could inhibit the adhesion of THP-1 significantly greater than those from DM, CHD and DM ＋ CHD subjects （503.24 ±63.50 vs. 2 918. 00 ± 0. 00, 1 510. 33 ± 1 353.87 and 4 196. 50 ± 412. 60, all P 〈 0. 05 ）. The level of HDL-SAA was correlated to the level of ICAM-1 expression （ the regression coefficient was 1.57, t = 3.22, P 〈 0.01 ） and THP-1 adhesion （the regression coefficient was 1.16, t = 3.05, P = 0. 01 ）. In addition, the level of apoA I was reversely correlated with the level of ICAM-1 expression （ the regression coefficient was - 0. 35, t = - 2.40, P = 0. 02 ）. Conclusions The levels of ICAM-1, VCAM-1 expression and THP-1 adhesion induced by HDL are significantly attenuated in DM subjects and CHD subjects, which are positively correlated with the level of HDL-SAA and reversely correlated with the level of apoA Ⅰ .