冠心病患者糖调节异常与两种趋化因子的相关性

目的研究冠心病患者血糖、单核细胞趋化蛋白-1（MCP-1）、活化T细胞趋化因子（RANTES）的变化，探讨其在冠心病发病中的作用。方法纳入冠心病患者300例，分为急性冠脉综合征（ACS）组（n=180）以及稳定型心绞痛（SAP）组（n=120），另纳入正常受试者60例为对照组。全部行冠状动脉造影（CAG）检查，冠状动脉病变严重程度采用Genisin评分评估，酶联免疫法测定RANTES、MCP-1浓度，冠心病组除确诊糖尿病患者，行简易葡萄糖耐量试验（OGTT），分析血糖与RANTES、MCP-1和冠状动脉病变的相关性。结果（1）冠心病患者中糖代谢异常者70．7％，糖尿病组的RANTES、MCP-1浓度显著高于糖调节受损及正常血糖组（组间比较均为P〈0．05）。（2）RANTES、MCP-1与血糖的相关性分析表明RANTE、MCP-1与血糖呈显著正相关。（3）ACS组的RANTES、MCP-1浓度显著高于SAP组及正常对照组（组间比较均为P〈0．05）。（4）多元逐步回归分析表明冠状动脉狭窄程度与RANTES、MCP-1、血糖、低密度脂蛋白胆固醇呈正相关，与高密度脂蛋白胆固醇呈负相关。结论糖调节异常与RANTES、MCP-1呈正相关，共同参与冠心病的发生发展。

Correlation of impaired glycoregulation and serum level of RANTES and MCP-1 in patients with coronary heart disease

Objective To investigate the changes of blood glucose, regulated upon activation normal T cell expressed and secreted （RANTES）, and monocyte chemoattractant protein-1 （MCP-1） in patients with coronary heart disease, and their roles in the incidence of the diseases. Methods A total of 300 patients with coronary heart disease who underwent coronary angiography （CAG） in our department from January to October 2009 were divided into 2 groups, acute coronary syndrome （ACS） group （n = 180）, and stable angina pectoris （SAP） group （n = 120）. And other 60 healthy individuals who received CAG during the same period served as control. The severity of coronary lesions was analyzed by CAG and evaluated with Gensini coronary score system. Serum levels of RANTES and MCP-1 were detected with enzyme linked immunosorbent assay （ELISA）. Oral glucose tolerance test （OGTT） was used to measure the blood glucose except for those with identified diabetes. The correlation of the 3 indexes with coronary lesions was analyzed. Results There were 70.7% coronary heart disease patients identified with diabetes mellitus or pre-diabetes. Those with identified diabetes had significantly higher levels of RANTES and MCP-1 than those with impaired glycoregulation and normal blood glucose （P 〈 0.05）. The correlation analysis showed that blood glucose was positively correlated with serum levels of RANTES and MCP-I（r = 0.69, P 〈 0.05; r = 0.61, P 〈 0.05）. And also their levels were higher in ACS group than in SAP and control groups （P 〈 0.05）. Multiple stepwise regression analysis indicated that the stenosis of coronary artery had a positive correlation with RANTES, MCP-1, blood glucose, and low-density liprotein cholesterol respectively, and a negative correlation with high-density liprotein cholesterol. Conclusion Impaired glycoregulation is positively correlated with RANTES and MCP-1, and they are involved jointly in the incidence and development of coronary heart disease.