可溶性黏附分子对2型糖尿病下肢血管病变的影响

目的探讨2型糖尿病并发下肢血管斑块形成时黏附分子可溶性E-选择素（sE-selectin）和可溶性细胞间黏附分子-1（sICAM-1）的水平及2型糖尿病并发下肢血管斑块形成的影响因素。方法采用酶联免疫吸附法检测51例2型糖尿病患者及20例年龄和性别比例相匹配的非糖尿病对照组血浆sE-selectin和sICAM-1的水平。再从病例组选择性别比例、病程和年龄相匹配的无下肢血管斑块形成者16例（组1）、有下肢血管斑块形成者17例（组2）及对照组中选择性别比例和年龄相匹配者17例（组3）,比较三组之间血sE-selectin和sICAM-1的水平。采用Logistic多因素回归分析2型糖尿病并发下肢血管斑块形成的影响因素。结果病例组空腹血糖（FPG）和餐后2小时血糖（2 h PG）、胰岛素抵抗指数（HOMA-IR）、血sE-selectin和sICAM-1均高于对照组,差别有统计学意义（均P〈0.01）。组1 sE-selectin和sICAM-1与组2比较,差别无统计学意义（P〉0.05）。组1和组2血糖高于组3（P〈0.01）;组3空腹胰岛素（FINS）水平依次高于组2和组1,但与组1比较,差别有统计学意义（P〈0.05）;组1sE-selectin高于组3（P〈0.01）;组1和组2 sICAM-1高于组3（均P〈0.05）。Logistic多因素回归分析结果显示,年龄（OR=1.214,95%CI：1.087～1.366）、收缩压（OR=1.492,95%CI：1.291～1.725）、低密度脂蛋白胆固醇（LDL-C,OR=1.045,95%CI：1.214～1.993）为糖尿病下肢血管病变危险因素。结论2型糖尿病患者血sE-selectin与sICAM-1水平高于非糖尿病者,说明糖尿病患者存在内皮细胞的活化;2型糖尿病患者无论有无下肢血管斑块形成,均有内皮细胞功能紊乱,黏附分子的作用在下肢血管斑块形成前可能更为活跃;年龄、收缩压和LDL-C为糖尿病下肢血管病变危险因素。

The Effect of Soluble Adhesion Molecules on Lower Limb Vascular Disease in Type 2 Diabetic

Objective To study variations of plasma sE-selectin and sICAM-1 level of type 2 diabetes（T2DM） patients complicated with lower limb vascular disease,and contribution of these molecules to the formation of the lower limb vascular disease. Methods Plasma sE-selectin and sICAM-1 of 51 type 2 diabetic patients and 20 age ＆ sex matched non-diabetes people（control group） were determined with ELISA.16 T2DM patients without lower limb vascular disease and 17 age ＆ sex matched T2DM complicated with lower limb vascular disease were selected from the patients group,as group 1 and group 2 respectively,and 17 age and sex matched non-diabetic individuals were selected from control group as group 3.sE-selectin and sICAM-1 level were contrasted among the three groups. Results Levels of FPG,2 h PG,HOMA-IR,sE-selectin and sICAM-1 of diabetic group were significantly elevated than those of the control group（P〈0.01）.sE-selectin and sICAM-1 levels were no significance between group 1 and group 2（P〉0.05）.FPG and 2 h PG in group 1 and group 2 were markedly higher than that in group 3（P〈0.01）.Level of FINS of group 3 was higher than that of group 2 and group 1,but only had significance with group 1（P〈0.05）.sE-selectin of group 1 was markedly higher than that of group 3（P〈0.01）,and sICAM-1 of group 1 and group 2 were markedly higher than that of group 3（P〈0.05）.Logistic multiple regression analysis showed that age,systolic pressure and LDL-C were risk factors for the lower limb vascular disease in T2DM. Conclusion Plasma sE-selectin and sICAM-1 of T2DM are higher than that of non-diabetic individuals,which implies that endothelial dysfunction happens in T2DM.Both T2DM patients with and without lower limb vascular disease have endothelial dysfunction.The roles of adhesion molecules may be more active before the occurrence of lower limb vascular disease in T2DM,and age,systolic pressure and LDL-C are risk factors for the lower limb vascular disease in T2DM.