冠心病合并糖尿病患者冠状动脉狭窄程度与内皮功能损伤的相关性研究

目的：探讨冠心病（CHD）合并2型糖尿病（DM）患者冠状动脉狭窄与内皮功能损伤的相关性。方法选择行冠状动脉造影确诊的CHD患者86例，其中46例合并2型DM（DM组）、40例为非糖尿病患者（NDM组）。用Gensini积分法评估冠状动脉狭窄程度；硝酸还原酶法比色检测患者血浆一氧化氮（NO）浓度；ELISA法测定血浆内皮素（ET），血管性血友病因子抗原（vWF：Ag）、血小板膜蛋白-140（GMP-140）浓度；发光底物法测定血浆组织型纤溶酶原激活剂（t-PA）与血浆纤溶酶原激活物抑制剂-1（PAI-1）活性以评价内皮功能损伤情况。采用直线相关分析法对DM患者Gensini积分与内皮损伤相关指标进行分析。结果 DM组患者的Gensini积分明显大于NDM组（38.25±12.13vs.28.73±10.74，P＜0.05）；DM组患者的NO、t-PA水平明显低于NDM组NO：（52.35±17.62）μmol/Lvs.（98.37±21.20）μmol/L；t-PA：（0.55±0.21）IU/Lvs.（0.87±0.26 IU/L）；P＜0.01]；而ET、PAI-1、vWF：Ag、GMP-140水平明显高于NDM组。DM组患者血浆NO（r=-0.803）、t-PA水平（r=-0.628）与Gensini积分呈显著负相关（P均＜0.01），而ET（r=0.713）、PAI-1（r=0.526）、vWF：Ag（r=0.705）和GMP-140（r=0.512）与Gensini积分呈显著正相关（P均＜0.01）。结论 CHD合并DM患者的Gensini积分与内皮损伤程度密切相关。严重的内皮功能损伤可能是DM患者冠状动脉狭窄程度较重的原因之一。

Correlation between coronary stenosis degree and endothelial dysfunction in patients with coronary heart disease complicating diabetes mellitus

Objective To discuss the correlation between coronary stenosis degree and endothelial dysfunction in the patients with coronary heart disease （CHD） complicating type 2 diabetes mellitus （DM）.Methods The patients （n=86） diagnosed as CHD by coronary angiography （CAG） were chosen and were divided into DM group （CHD complicating DM,n=46） and NDM group （without DM, n=40）. The degree of coronary stenosis was reviewed by using Gensini integral method. The level of plasma NO was detected by using nitrate reductase method. The levels of vWF：Ag and GMP-140 were detected by using ELISA. The activities of t-PA and PAI-1 and injury of endothelial function were determined by using chromogenic substrate assay. Gensini integrals and indexes related to endothelial dysfunction were analyzed by using linear correlation analysis.Results Gensini integrals were significantly higher in DM group than those in NDM group （38.25±12.13vs. 28.73±10.74,P〈0.05）, and levels of NO and t-PA were significantly lower in DM group than those in NDM group （52.35±17.62 μmol/L, 0.55± 0.21 IU/L; 98.37±21.20 μmol/L, 0.87±0.26 IU/L;P〈0.01）. The levels of ET, PAI-1, vWF：Ag and GMP-140 were significantly higher in DM group than those in NDM group 77.72±19.34 μmol/L, 0.77±0.26 IU/L, （376.56 ±87.67）%, 29.85±9.12 g/L; 57.68±15.58 μmol/L, 0.51±0.18 IU/L, （239.81±65.73）%, 18.96±8.07 g/L;P〈0.01]. The levels of NO and t-PA were negatively correlated to Gensini integrals （r=-0.803,r=-0.628; all P〈0.01）, while levels of ET, PAI-1, vWF：Ag and GMP-140 were positively correlated to Gensini integrals （r=0.713, r=0.526,r=0.705,r=0.512; allP〈0.01）.Conclusion Gensini integrals are closely correlated to the degree of endothelial dysfunction, and severe endothelial dysfunction may be one of causes of exacerbated coronary stenosis in the patients with CHD complicating DM.