2型糖尿病患者颈动脉粥样硬化斑块与血清可溶性共刺激分子CD40L的相关性研究

Correlation between serum soluble costimulatory molecule CD40L and carotid atherosclerotic plaque in type 2 diabetes mellitus

目的探讨血清可溶性共刺激分子CD40L(sCD40L)与T2DM患者合并颈动脉粥样硬化(CAS)斑块的相关性。方法选取2015年12月至2016年6月于我院体检的89例T2DM患者和70例非T2DM患者,行颈动脉彩超检查,根据有无CAS斑块分为T2DM合并CAS组(T2DM⁃CAS,n=49)、T2DM不合并CAS组(T2DM⁃NCAS,n=40)、非T2DM合并CAS组(CAS,n=37)和非T2DM不合并CAS组(NCAS,n=33)。检测各组血清sCD40L浓度。分析sCD40L与各指标的相关性及T2DM合并CAS斑块的影响因素。结果T2DM⁃NCAS组血清sCD40L水平较NCAS组升高(P<0.01);CAS组血清sCD40L水平高于NCAS组(P<0.01);T2DM⁃CAS组血清sCD40L水平高于T2DM⁃NCAS组(P<0.01)。血清sCD40L水平与年龄、WHR、BMI、DBP、饮酒、吸烟、TG、FIns、高敏C反应蛋白呈正相关(P<0.05),与HDL⁃C呈负相关(P<0.05)。年龄、饮酒是T2DM合并CAS斑块的影响因素。结论sCD40L在T2DM及CAS斑块性患者中表达增强,可能是高血糖、促炎症反应、血栓形成状态与CAS形成之间的纽带。

Objective To investigate the relationship between serum soluble costimulatory molecule CD40L(sCD40L)and carotid atherosclerosis(CAS)in type 2 diabetes mellitus(T2DM)patients.Methods 89 T2DM patients and 70 non type 2 diabetic controls were enrolled.Carotid artery color Doppler ultrasound examinations were performed in all subjects.According to the ultrasound results,the subjects were further di⁃vided into four groups:T2DM with or without atherosclerosis(T2DM⁃CAS,T2DM⁃NCAS),non⁃T2DM with or without atherosclerosis(CAS,NCAS).Enzyme⁃linked immunosorbent assay(ELISA)method was used to measure the levels of serum sCD40L.Results The serum sCD40L level in T2DM⁃NCAS group was significantly higher than that in NCAS group or T2DM⁃NCAS group(P<0.01).The serum sCD40L level in CAS group was also significantly higher than that in NCAS group(P<0.01).Serum sCD40L level was positively correlated with age,WHR,BMI,DBP,drinking,smoking,TG,FIns and hsC⁃RP levels(P<0.05),and negatively correlated with HDL⁃C(P<0.05).Age and alcohol consump⁃tion are the influencing factors of T2DM with carotid atherosclerotic plaque.Conclusion The sCD40L ex⁃pression is enhanced in T2DM and CAS,which may be a link between hyperglycemia,pro⁃inflammatory re⁃sponse,thrombosis and atherosclerosis.