内皮素、降钙素基因相关肽参与糖尿病合并脑梗死发病过程中的作用

Study of endothelin and calcitonin-gene related peptide in relation with diabetes mellitus complicated with cerebral infarction

目的观察糖尿病(DM)合并脑梗死(CI)患者血浆内皮素(ET)和降钙素基因相关肽(CGRP)水平变化,探讨内皮素及降钙素基因相关肽与糖尿病合并脑梗死之间的相互关系。方法2000-03/2001-12在广东医学院附属医院内分泌科住院的DM患者86例,根据有无脑梗死及脑动脉硬化将患者分为DM合并脑梗死(DM+CI)组36例、无脑梗死的DM合并脑动脉硬化(DM+CA)组22例、DM无并发症(SDM)组28例,DM+CI组根据病情程度有分为轻型组、中型组和重型组,选择18例正常人作为正常对照组。采用放射免疫法检测各组患者及对照组血浆ET和CGRP水平并进行比较。结果DM+CI组病程3d内血浆ET犤(99±26)ng/L犦高于病程15～20d者犤(64±19)ng/L犦、DM+CA组犤(64±15)ng/L犦及SDM组犤(56±14)ng/L犦和正常对照组犤(46±13)ng/L犦(t=3.77～10.08,P均<0.01);DM+CI组病程15～20d者与DM+CA组血浆ET比较无显著性差异,但均高于SDM组及正常对照组(t=2.07～4.58,P<0.05或P<0.01);SDM组血浆ET亦较正常对照组升高(t=2.72,P<0.01)。DM+CI组病程3d内、DM+CI组病程15～20d、DM+CA组和SDM组血浆CGRP(ng/L)分别为(99±34),(71±20),(69±22),(76±18),均低于正常对照组(123±26)(t=2.69～8.35,P均<0.01);DM+CI组病程3d内血浆CGRP高于病程15～20d者及DM+CA组和SDM组(t=3.32?

Aim To observe the changes of plasma endothelin(ET) and calcitonin-ge ne related peptide (CGRP) levels in patients with type 2 diabetes mellitus(DM) c omplicated with cerebral infarction (CI), and study the association of ET and CG RP with cerebral infarction in type 2 diabetic patients. Methods The concentrati ons of plasma ET and CGTP were measured by means of radioimmunoassay in 86 inpat ients with type 2 DM,including 36 cases with CI (DM+CI group), 22 with cerebral arteriosclerosis (DM+CA group) and 28 non-complicated cases. Eighteen healthy subjects were recruited as the gender,age and occupation-matched control group . Results The plasma ET concentration of DM+CI group measured within 3 d after CI onset [(99±26)ng/L] were significantly higher than those measured 15 to 20 d after CI [(64±19)ng/L], also higher than those of DM+CA group [(64±15)ng/L], non-complicated DM group[(56±14)ng/L] and the normal control group [(46±13)n g/L],(t=3.77-10.08, P< 0.01 for all indicated comparisons). Similar to the meas urement in DM+CA group, the ET concentration of DM+CI group 15 to 20 d after C I were significantly higher than those of non-complicated DM group and the norm al control group (t=2.07-4.58, P< 0.05 or 0.01), with the control group having lower ET concentration than any other group (t=2.72, P< 0.01 vs non-complicated group).The plasma CGRP concentration of DM+CI group measured 3 d and 15 to 20 d after CI were (99±34) ng/L and (71±20)ng/L respectively, and were (69±22)ng /L and (76±18)ng/L respectively in DM+CA and non-complicated DM groups, all s ignificantly lower than those of the control group [(123±26)ng/L, t=2.69-8.35, P< 0.01 respectively]. In the DM cases, the highest CGRP concentrations occurre d in DM+CI group 3 d after CI, and no significant difference were noted between the measurements in DM +CI group at 15 to 20 d, DM+CA group and SDM group (t= 3.32-4.10, P< 0.01). In patients with DM complicated with CI, the concentratio ns of ET and CGRP in severe cases [(116±23)ng/L and (128±33)ng/L] were signifi cantly higher than those in mild cases [(73±21)ng/L and (79±22)ng/L] and moder ate cases [(88±19)ng/L and (99±33)ng/L] respectively (q=3.21-8.92, P< 0.05 an d P< 0.01 respectively), and moderate cases had higher ET and CGRP concentration s than the mild cases(q=3.06-3.75, P< 0.05 respectively).Conclusion ET and CGRP are involved in the pathophysiological process of CI in type 2 DM patients. The disequilibrium of ET and CGRP has been present in patients with type 2 DM well before the onset of CI, in early stage of which their levels may be elevated in close relation with the severity of the patients' condition. ET might be one of the crucial factors responsible for the brain injury while CGRP possibly plays a role for its prevention.