炎症标志物C反应蛋白、超敏C-反应蛋白与糖尿病及其心血管并发症关系研究概述

C-反应蛋白(C-reactive protein,CRP)是体内最常见的急性时相反应蛋白,作为一种炎性标志物已被确认是糖尿痛心血管事件的独立预测因子,其升高与糖尿病心血管事件密切相关.超敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)较标准CRP对糖尿病及其心血管...     

糖尿病患者心血管并发症血清中LDL与CRP浓度检测及意义

目的:探讨改善和控制糖尿病并发心血管并发症的发生,为临床提供更有效的诊断依据.方法:将患者分为单纯糖尿病患者组、大血管并发症糖尿病组、微血管并发症糖尿病组,3组患者血清中低密度脂蛋白(LDL)、C-反应蛋白(CRP)浓度检测.结果:糖尿病患者中单纯糖尿病组的LDL(3.57±0.36)mmol/L、CRP(6.2±2.9)mg/L与对照组LDL(2.85±0.41)mg/L、CRP(3.5±2.6)mg/L比较差异有显著性(P＜0.05);大血管并发症组LDL(4.22±0.53)mmol/L、CRP(13.7±8.1)mg/L,微血管并发症组LDL(3.93±0.38)mg/L、CRP(8.5±3.8)mg/L与对照组相比LDL(2.85±0.41)mg/L、CRP(3.5±2.6)mg/L差异有显著性(P＜0.05).大血管并发症组LDL(4.22±0.53)mg/L、CRP(13.7±8.1)mg/L:微血管并发症组LDL(3.93±0.38)mmol/L、CRP(8.5±3.8)mg/L水平与单纯糖尿病的LDL(3.57±0.36)mmol/L、CRP(6.2±2.9)mg/L相比差异也有显著性(P＜0.05).大血管并发症组与微血管并发症组比较差异也有显著性(P＜0.05).结论:糖尿病患者血清中LDL、CRP水平可作为预防糖尿病患者可能发生心血管并发症以及评价发生心血管事件危险程度的监测指标.     

C-反应蛋白与心血管疾病的相关研究进展

长期以来，C-反应蛋白（C-reactive protein，CRP）被视为炎症、感染和组织损伤急性期反应物。自20世纪90年代末以来．人们发现CRP增高可强烈预测未来冠状动脉事件。越来越多的证据表明，炎症过程在动脉粥样硬化及其并发症的发生发展中起着重要作用，是预测未来心血管危险最有力的炎症标记物。     

糖尿病是一种“伤心病”

糖尿病是一种常见的内分泌代谢疾病,糖尿病心血管并发症又是糖尿病最重要的远期并发症之一。糖尿病患者心血管疾病的发生率明显高于非糖尿病患者,因心脏病而死亡的糖尿病患者人数约占糖尿病患者死亡人数的80％。糖尿病心血管并发症已成为糖尿病患者远期生存的主要威胁和死亡的首位原因。     

氨氯地平和坎地沙坦对2型糖尿病合并高血压患者血清炎症因子和颈动脉内中膜厚度的影响

<正>2型糖尿病(T2DM)和高血压均为动脉粥样硬化、心脑血管疾病和其他血管性疾病发生的危险因素。C反应蛋白(CRP)作为一种炎性标志物,已被确认是T2DM心血管事件的独立预测因子,CRP也参与高血压的发生发展,可视其为糖尿病、高血压及心脑血管疾病之间的"风险桥梁";颈动脉     

2型糖尿病血脂改变与心血管并发症关系的分析

目的探讨2型糖尿病患者血脂变化与心血管并发症的致病原因的关系。方法随机抽取我院2009年1月至2011年10月,内分泌科住院的2型糖尿病患者50例为观察组,同时设血糖正常的健康者50例为对照组。采用酶联免疫法测定2型糖尿病及血糖正常人总胆固醇(CH)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、及空腹血糖水平并进行对比分析。结果 2型糖尿病组CH、TG、LDL,HDL、水平与血糖正常组对比有显著性意义(P<0.01)。结论高脂血症与2型糖尿病患者心血管并发症的发生发展有一定的关系,及早检测血脂变化是预测2型糖尿病患者诱发心血管并发症的重要指标之一,应重视对糖尿病高危人群的早期防治,采取降糖、调脂等多种措施并重的综合治疗。     

糖尿病心血管自主神经病变（DCAN）

糖尿病心血管自主神经病变（DCAN）是一种严重的、常见的糖尿病慢性并发症，可造成危及生命的严重后果如心肌梗死、心源性猝死等。随着各种心血管自主神经功能检查方法的发展，DCAN已成为糖尿病自主神经病变中倍受关注的焦点。这对早期诊断、早期治疗糖尿病及其并发症和预防糖尿病患者心肌梗死和心源性猝死等心血管事件都有非常重要的意义。     

C反应蛋白、低密度脂蛋白与2型糖尿病患者血管病变关系研究

目的探讨血浆CRP、LDL-C与2型糖尿病患者血管病变关系。方法用自动生化分析仪对182例2型糖尿病患者和50例正常对照组进行血清C反应蛋白和血脂含量的检测。结果 2型糖尿病患者血清CRP、LDL-C明显升高,与健康对照组比较,差异有统计学意义(P<0.05),2型糖尿病患者组CRP及LDL-C明显升高的患者发生大血管及微血管病变并发症率明显高于CRP及LDL-C正常的患者,差别有统计学意义。结论 CRP与LDL-C测定在预测2型糖尿病血管疾病并发症中具有重要的临床应用价值;2型糖尿病患者多合并LDL-C升高,提示患动脉粥样硬化的风险大。     

C反应蛋白与2型糖尿病大血管 微血管并发症关系探讨

近年研究发现C反应蛋白（CRP）与2型糖尿病密切相关，认为2型糖尿病可能是炎症因子介导的炎症反应性疾病，炎症因子导致胰岛B细胞分泌胰岛素功能受损及产生胰鸟紊抵抗（IR）。最近越来越多的研究表明，血清炎症因子与糖尿病及其大血管并发症有关，并在糖尿病微血管病变的发生发展中起重要的作用。本文对90例2型糖尿病患者的血清CRP水平进行检测，旨在探讨其与糖尿病及其大血管、微血管并发症关系。     

C反应蛋白对老年冠心病患者高危事件的预测价值

目前业已证明除了高血脂、高血压、吸烟、肥胖、糖尿病是冠心病的危险因素外,高龄也作为其一项独立危险因素存在.而近年炎症与冠心病的关系日渐受到人们的重视.目前认为,C反应蛋白(CRP)对诊断冠心病、判断其预后、预测急性心肌梗死后心脏破裂及预测冠状动脉支架术后心血管事件的危险等方面均有重要的价值.有研究报道了CRP可预测急性冠状动脉综合征.本研究观察了104例老年冠心病患者,旨在探讨CRP对其近期预后的预测价值.     

超敏C反应蛋白对急性ST段抬高心肌梗死患者心脏终点事件的预测价值

目的：探讨超敏 C 反应蛋白（hs - CRP）对急性 ST 段抬高心肌梗死患者心脏终点事件的预测价值。方法选择我院冠心病监护病房2011—2012年收治的69例胸痛发作24h 内急性 ST 段抬高心肌梗死患者,患者入院后均根据病情给予对症的 PCI、保守或溶栓治疗。PCI 治疗患者术前采血检测hs - CRP。根据心脏终点事件发生情况将所有患者分为非事件组（未发生不良心血管事件）、事件组（发生不良心血管事件）,判断年龄、性别、吸烟、高血压史、糖尿病史、高胆固醇史、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）及hs - CRP与发生不良心血管事件的关系。结果事件组患者中男性、糖尿病史所占比例高于对照组,年龄、hs - CRP均大于非事件组,LVEF低于非事件组,差异有统计学意义（P 〈0.05）。多因素 Logistic 回归分析发现,年龄、糖尿病史、LVEF、hs - CRP进入回归方程〔比值比（ OR）及95％可信区间（ CI）分别为1.08（1.056,1.100）,2.48（2.050,2.930）,1.11（1.070,1.150）,1.01（1.010,1.021）〕。结论 hs - CRP可作为预测急性 ST 段抬高心肌梗死患者心脏终点事件的指标。     

罗格列酮对初诊2型糖尿病患者颈动脉内中膜厚度和血清C反应蛋白的影响

目的观察罗格列酮治疗对于初诊2型糖尿病患者颈动脉内中膜厚度和血清C反应蛋白的影响。方法本试验采用前瞻性开放性病例对照研究,将62例初诊2型糖尿病患者随机分为2组：A组（33例）采用罗格列酮（4mg·d^-1）与二甲双胍联合治疗;B组（29例）单用二甲双胍治疗,在治疗前以及治疗3个月后检测患者胰岛素敏感性、颈动脉内中膜厚度和血清超敏C反应蛋白水平。结果单独应用二甲双胍对颈动脉内中膜厚度和血清C反应蛋白水平无影响,但对胰岛素抵抗有一定改善;罗格列酮与二甲双胍联合应用不但能有效改善患者胰岛素抵抗,还显著降低颈动脉内中膜厚度和血清C反应蛋白水平。结论罗格列酮降低2型糖尿病患者颈动脉内中膜厚度和血清C反应蛋白水平,对于防止2型糖尿病的血管并发症具有良好作用。     

2型糖尿病及糖尿病肾病患者C反应蛋白水平观察

目的观察C反应蛋白水平在2型糖尿病及糖尿病肾病患者时的浓度变化。方法将63例2型糖尿病患者分为糖尿病组(32例)和糖尿病合并肾病组(31例),而以正常体检健康人作为对照组(31例),测定各组的空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、血清C反应蛋白(CRP),将组间的C反应蛋白(CRP)进行统计学比较。结果糖尿病组及糖尿病并发肾病组血清C反应蛋白(CRP)均比正常对照组明显升高(P<0.01)。而糖尿病并发肾病组与糖尿病组相比亦明显升高(P<0.01)。结论CRP与糖尿病及其血管慢性并发症有关。     

糖尿病联合检测P-选择素、C-反应蛋白和抗心磷脂抗体的意义

目的对糖尿病(DM)患者体内P-选择素(GD62-P)、C-反应蛋白(CRP)抗心磷脂抗体(ACA)水平进行联合检测,旨在探讨其对DM并发症早期评估和风险预测价值。方法60例DM患者被分成无并发症组(A组)和有并发症组(B组),C组为正常对照组。在未服用抗凝剂前或停服抗凝剂1周后,空腹采集血样立即离心血清-20℃保存待测。CRP采用免疫速率散射浊度法;GD62-P及ACA采用ELISA法。结果DM患者B组CRP高于C组,而A组与C组无显著差异;GD62-P在A、B组均升高,以B组升高显著(P<0.01);ACA在各组检出率表现不一,但仍以B组为高。三种检测指标的升高,大都集中在合并有心脑血管病变的患者中,上述指标的升高与DM血管病变发生率相一致。结论GD62-P、CRP、ACA联合检测对指导临床及早预防治疗糖尿病并发症,和对其并发症的风险评估有重要意义和实用价值。     

Implications of the UK prospective diabetes study: questions answered and issues remaining

The UK Prospective Diabetes Study (UKPDS) provides the first conclusive proof for the importance of intensifying diabetes control in individuals with type 2 diabetes mellitus. However, reduction in cardiovascular disease risk with intensive therapy was modest and did not reach statistical significance. Metformin therapy in obese individuals with type 2 diabetes mellitus was associated with reduced cardiovascular death. These observations should be re-evaluated to determine whether various therapeutic agents available for treatment of type 2 diabetes mellitus have different effects on cardiovascular complications of diabetes. The addition of alpha-glucosidase inhibitor, acarbose, improved glycaemic control irrespective of concomitant therapy for diabetes, although compliance with this agent was poor. The tight blood pressure control study embedded in UKPDS reaffirms the importance of lowering the blood pressure below 150/85 to reduce microvascular and macrovascular complications of diabetes.     

Antidiabetic drugs present and future: will improving insulin resistance benefit cardiovascular risk in type 2 diabetes mellitus?

Results from the United Kingdom Prospective Diabetes Study showed that intensive treatment of type 2 (non-insulin-dependent) diabetes mellitus, with sulphonylureas or insulin, significantly reduced microvascular complications but did not have a significant effect on macrovascular complications after 10 years. Insulin resistance plays a key role in type 2 diabetes mellitus and is linked to a cluster of cardiovascular risk factors. Optimal treatment for type 2 diabetes mellitus should aim to improve insulin resistance and the associated cardiovascular risk factors in addition to achieving glycaemic control. Treatment with sulphonylureas or exogenous insulin improves glycaemic control by increasing insulin supplies rather than reducing insulin resistance. Metformin and the recently introduced thiazolidinediones have beneficial effects on reducing insulin resistance as well as providing glycaemic control. There is evidence that, like metformin, thiazolidinediones also improve cardiovascular risk factors such as dyslipidaemia and fibrinolysis. Whether these differences will translate into clinical benefit remains to be seen. The thiazolidinediones rosiglitazone and pioglitazone have been available in the US since 1999 (with pioglitazone also being available in Japan). Both products are now available to physicians in Europe.     

From diabetes to metabolic syndrome: a viewpoint on an evolving concept

The current diagnostic threshold for diabetes mellitus is imposed on a continuous distribution of blood glucose measurement. A more clinical approach estimates a threshold above which the rate of diabetes-specific complications rises steeply. However, the diagnostic threshold for diabetes is essentially established on the risk of microvascular and not cardiovascular complications. Indeed, while there appears to be a continuous relationship between blood glucose, cardiovascular risk and overall mortality, this association extends into the sub-diabetic range, with no threshold identified. In this regard, the assumption that the diagnosis of diabetes can effectively identify patients at elevated risk of cardiovascular morbidity and mortality is potentially flawed, and questions the utility of diabetes status (as a dichotomous variable) for the assessment and management of cardiovascular risk. Indeed, the increased risk of cardiovascular complications may not be related to diabetes status per se but the frequent association of diabetes with a high-risk phenotype, now recognised as the so-called 'metabolic syndrome'. By implication, cardiovascular disease prevention should not be dominated by a drive for the prevention of diabetes, but this broader clinical syndrome of increased cardiovascular risk.     

Statin Utilization Patterns for the Primary Prevention of Cardiovascular Events

BACKGROUND AND OBJECTIVE: In Hong Kong, about 10% of adults 25-74 years of age have diabetes mellitus. The management of dyslipidemia with lipid-lowering agents (LLAs), including HMG-CoA reductase inhibitors (statins) for the primary prevention of cardiovascular complications, has been found to be beneficial. This study examined statin utilization patterns for the primary prevention of cardiovascular events in patients with diabetes mellitus in two public hospitals in Kong Kong; clinical outcomes in patients who received statins for primary prevention were compared with those in patients not treated with any LLAs. METHODS: This was a retrospective study in patients who were diagnosed with diabetes mellitus. Only patients with no prior history of coronary artery disease were included in the study. Utilization patterns of LLAs and the incidences of cardiovascular complications were recorded from 1 January 2002 to 31 December 2003. RESULTS: A total of 222 patient records were reviewed. Only 75/222 (33.8%) of patients with diabetes mellitus received one or more LLAs for the primary prevention of cardiovascular events. Among these patients, only 21% of patients attained target lipid goals. Nearly half of the patients who were not treated with LLAs (n=147) had dyslipidemia problems. The overall incidence of cardiovascular complications in patients treated and not treated with LLAs was 12.2%. Absence of routine screening for cardiovascular risk and sub-optimal utilization and inadequate dosage titration of LLAs were identified as contributory factors towards cardiovascular events in this patient group. CONCLUSION: The current study failed to prove the benefits of LLAs in reducing the risk of first cardiovascular events in diabetic patients. This may have been due to the use of low doses of LLAs and a lack of laboratory monitoring of cholesterol levels. Development and implementation of guidelines may help promote the use of LLAs in primary prevention of cardiovascular complications.     

联合检测血清GLU、TC和CRP在糖尿病并发冠心病诊断中的价值

目的探讨血清葡萄糖（GLU）、胆固醇（TC）和C-反应蛋白（CRP）联合检测对糖尿病并发冠心病早期的预示和诊断价值。方法分别收集正常对照组（35例）、糖尿病组（85例）、糖尿病并发冠心病组（58例）患者血清,用美国BECKMAN（贝克曼）CX-7全自动生化分析仪检测GLU和TC,用i-CHROMAReader免疫荧光分析仪测定CRP。结果正常对照组：GLU（5．29±0．15）mmol／L、TC（4．20±1．03）mmol／L、CRP（0．68±0．30）mg／L,糖尿病组：GLU（8．33±0．31）mmol／L、TC（4．98±1．121mmol／L、CRP（2．5l±1．311ingle,糖尿病并发冠心病组：GLU（9．98±1．24）mmol／L、TC（5．02±0．871mmol／L、CRP（5．29±1．26）mg／L。糖尿病组、糖尿病并发冠心病组的GLU、CRP均明显高于正常对照组（P〈0．01）。糖尿病组的Tc与正常对照组比较差异无显著性（P〉0．05）,糖尿病并发冠心病组的GLU、TC、CRP均明显高于糖尿病组（P〈0．01）。结论联合检测GLU、TC和CRP水平,在预测糖尿病并发动脉粥样硬化性心血管疾病患者中具有重要的临床意义,对冠心病发病的早期诊断有一定的预示作用和诊断价值。