2型糖尿病患者血清可溶性细胞间和血管细胞黏附分子1及CRP与下肢血管病变的关系

目的探讨2型糖尿病患者血清可溶性细胞间黏附分子1（sICAM-1）、血管细胞黏附分子1（sVCAM-1）及高敏CRP（hsCRP）水平与下肢大血管病变程度的关系。方法对130例2型糖尿病患者（糖尿病组）与30例年龄匹配的体检健康者（对照组）血清sICAM-1、sVCAM-1、hsCRP及生化指标水平进行测定，同时行下肢动脉彩色多普勒超声检查。糖尿病组根据病变性质及严重程度评分分为血管无病变组（26例）、血管轻度病变组（45例）和血管中重度病变组（59例）。比较各组问指标水平，对sICAM-1、sVCAM-1分别进行单因素相关分析，下肢血管病变与各项危险因素的Person相关性分析，以下肢血管评分作为应变量行多元逐步回归分析。结果糖尿病血管中重度病变组的sICAM-1（385±88）gg／L]、sVCAM-1（811±293）μg/L]水平，高于血管轻度病变组（292±84）μg/L与（572±189）μg/L]、血管无病变组（282±56）μg/L与（4504-176）μg/L]和对照组（2394-60）μg/L与（358±177）μg/L]（t值为4．15—8．93，均P〈0．05）；hsCRP水平为（1．614-1．01）mg／L，高于血管轻度病变组（1．044-0．79）mg／L、血管无病变组（0．594-0．34）mg／L和对照组（0．924-0．56）mg／L（t值为2．18～4．27，均P〈0．05）。sICAM-1水平与TC、LDL．C、sVCAM．1水平呈正相关r值分别为0．23、0．20和0．49，均P〈0．05，sVCAM-1水平与病程、收缩压、hsCRP呈正相关（r值分别为0．24、0．18和0．21，均P〈0．05）。结论T2DM患者sICAM—1、sVCAM-1及hsCRP水平与下肢大血管病变程度有关，其升高与高血压、脂代谢紊乱及炎症反应相关。

Association of serum soluble intercellular cell adhesion molecule-1, soluble vascular cell adhesion molecule-1 and hypersensitivity-CRP levels with peripheral vascular disease of lower limbs in patients with type 2 diabetes mellitus

Objective To investigate the association of serum levels of soluble intercellular cell adhesion molecule-1 （ sICAM-1 ）, soluble vascular cell adhesion molecule-1 （ sVCAM-1 ） and high sensitivity C-reactive protein （hs-CRP） with peripheral vascular disease of lower limbs in patients with type 2 diabetes mellitus （T2DM）. Methods One hundred and thirty T2DM patients admitted from October 2011 to October 2012, and 30 age/sex-matched healthy subjects were enrolled in the study, The serum levels of sICAM-1, sVCAM-1, hs-CRP and other clinical parameters were measured ; the peripheral blood vessels of lower limbs were examined with color Doppler uhrasonography. Based on the extent of angiopathy of lower limbs T2DM patients were classified as normal vascular group （ n = 26 ） , mild angiopathy group （ n = 45 ） , moderate/ severe angiopathy group （ n = 59）. Results The serum levels of sICAM-1 and sVCAM-1 in moderate/ severe angiopathy group of T2DM patients were higher than those in mild angiopathy group, normal vascular group and healthy controls （t ： 4. 15 - 8.93, all P 〈 0. 05） ; the serum levels of hs-CRP in moderate/severe angiopathy group were higher than those in mild angiopathy group, normal vascular group and healthy controls （t： 2. 18 -4. 27, all P 〈 0.05）. The serum sICAM-1 level was positively correlated with total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C） and sVCAM-1. The serum sVCAM-1 level was positively correlated with course of disease, systolic blood pressure and CRP. Conclusions Serum levels of sICAM-1, sVCAM-1 and hs-CRP are correlated with the extent of angiopathy of lower limbs in T2DM patients, and the elevated sICAM-1 ; sVCAM-1 and hs-CRP levels are also associated with hyper blood pressure, dislipidemia and chronic inflammation.