本文選題：2型糖尿病 + 下肢動(dòng)脈病變��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察2型糖尿病(Type 2 diabetes mellitus,T2DM)下肢動(dòng)脈病變(lower-extremity arterial disease,LEAD)患者血清中血管內(nèi)皮鈣黏蛋白(vascular endothelial cadherin,VE-cadherin)和細(xì)胞間粘附分子-1(intercellular adhesion molecule-1,sICAM-1)的水平及T2DM合并LEAD患者行下肢動(dòng)脈造影、球囊擴(kuò)張及支架植入術(shù)前后VE-cadherin及sICAM-1水平的變化,旨在探討血管內(nèi)皮功能障礙與2型糖尿病合并下肢動(dòng)脈病變之間的關(guān)系,并進(jìn)一步探討介入治療對(duì)血管內(nèi)皮功能的影響及其與介入術(shù)后血管再狹窄之間的關(guān)系。方法:選取2015年12月到2016年12月于我院內(nèi)分泌科住院診斷為T2DM合并LEAD(Fontaine IIb-IV期)行下肢動(dòng)脈造影、球囊擴(kuò)張及支架植入術(shù)并取得成功的患者23例作為觀察對(duì)象(A組)。選擇同期于我科住院治療的單純2型糖尿病患者23例作為糖尿病組(B組),及健康體檢者23例作為對(duì)照組(C組)。三組均禁食10小時(shí)于第二天清晨6:00抽取肘靜脈血4ml,檢測空腹血糖(FBG)、糖化血紅蛋白(Hb A1c)、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C),同時(shí)測定VE-cadherin及sICAM-1水平。A組行介入治療時(shí),分別于動(dòng)脈鞘置入成功后動(dòng)脈鞘內(nèi)(介入術(shù)前動(dòng)脈血)、導(dǎo)絲及導(dǎo)管通過下肢動(dòng)脈狹窄或閉塞處后病變動(dòng)脈遠(yuǎn)端(缺血部位介入前動(dòng)脈血)、球囊擴(kuò)張或支架植入后病變動(dòng)脈的遠(yuǎn)端(缺血部位介入術(shù)后動(dòng)脈血)取血4ml,并于介入術(shù)后24h、14d取肘靜脈血4ml(介入術(shù)后24h、14d靜脈血)。所有血樣均于室溫靜置2h后,以1000r/min離心20分鐘,離心半徑15cm,取上清液置于-20℃冰箱冷凍保存待測,所有標(biāo)本于同一廠家試劑盒中進(jìn)行測定。采用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)數(shù)資料采用χ2檢驗(yàn),計(jì)量資料以(?)±s表示,多組間比較均采用完全隨機(jī)單因素方差分析(One-way ANOVA),兩組間比較采用兩樣本均數(shù)t檢驗(yàn),指標(biāo)間比較采用線性相關(guān)分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1三組一般情況比較:A、B、C三組研究對(duì)象年齡、性別、BMI比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2三組FBG、Hb A1c水平:A組為:(8.30±1.13)mmol/L、(8.40±1.34)%;B組為:(8.10±1.15)mmol/L、(8.18±1.08)%;C組為:(5.06±0.54)mmol/L、(4.92±0.35)%。FBG、Hb A1c水平,A、B組較C組均顯著升高,差別均有統(tǒng)計(jì)學(xué)意義(P0.01),A、B兩組組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3三組血脂水平:TC、TG、LDL、HDL水平:A組分別為(4.68±0.57)mmol/L,(1.81±0.78)mmol/L,(3.08±0.59)mmol/L,(1.19±0.30)mmol/L;B組分別為(4.79±1.00)mmol/L,(1.85±0.90)mmol/L,(2.78±0.38)mmol/L,(1.20±0.20)mmol/L;C組分別為(4.21±1.18)mmol/L,(1.38±0.70)mmol/L,(2.58±0.78)mmol/L,(1.25±0.41)mmol/L。A、B、C三組在TC、TG、LDL、HDL水平上差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。4血清VE-cadherin水平:靜脈血VE-cadherin水平:A、B、C三組分別為(11.06±0.75)ng/ml,(10.23±0.82)ng/ml,(9.53±0.77)ng/ml,A組術(shù)前靜脈血較B、C組均顯著增高(P0.05,P0.01),B組較C組明顯增高(P0.05)。A組術(shù)后24h、14d分別為(17.52±3.19)ng/ml、(12.80±0.84)ng/ml,與術(shù)前靜脈血比較均顯著增高(P0.01;P0.05),術(shù)后14d與術(shù)后24h比較水平顯著降低(P0.01)。A組動(dòng)脈血VE-cadherin水平:介入術(shù)前動(dòng)脈血為(11.08±0.97)ng/ml,與介入術(shù)前靜脈血相比無明顯差異(P0.05),缺血部位介入前動(dòng)脈血為(12.33±1.12)ng/ml,與介入前動(dòng)脈血相比VE-cadherin水平明顯增高(P0.05),缺血部位介入術(shù)后動(dòng)脈血(15.08±1.63)ng/ml,較介入術(shù)前動(dòng)脈血及缺血部位介入術(shù)前動(dòng)脈血均明顯增高(P0.01,P0.05)。5血清sICAM-1水平:靜脈血sICAM-1水平,A、B、C三組分別為(2.92±0.22)ng/ml,(1.93±0.36)ng/ml,(0.61±0.15)ng/ml,A組術(shù)前靜脈血較B、C組均顯著增高(P0.01,P0.01),B組較C組明顯增高(P0.01)。A組術(shù)后24h、14d:(4.98±0.18)ng/ml、(6.06±0.34)ng/ml,與術(shù)前靜脈血比較均顯著增高(P0.01;P0.01),術(shù)后14d與術(shù)后24h比較水平顯著升高(P0.01)。A組動(dòng)脈血ICAM-1水平:介入術(shù)前動(dòng)脈血(2.93±0.22)ng/ml,與介入術(shù)前靜脈血相比無明顯差異(P0.05),缺血部位介入前動(dòng)脈血為(3.55±0.37)ng/ml,與介入前動(dòng)脈血相比sICAM-1水平明顯增高(P0.01),缺血部位介入術(shù)后動(dòng)脈血(4.29±0.26)ng/ml,較介入術(shù)前動(dòng)脈血及缺血部位介入前動(dòng)脈血均明顯增高(P0.01,P0.01)。6 VE-cadherin與sICAM-1之間的關(guān)系:對(duì)A組及B組介入前靜脈血中VE-cadherin與sICAM-1行直線相關(guān)分析,兩者呈正相關(guān)(r=0.629,P0.01)。7 ABI、Tc PO2水平比較:B組為1.00±0.17、(45.58±8.30)mm Hg,A組介入術(shù)前為0.47±0.12、(26.08±4.81)mm Hg,A組明顯低于B組水平(P0.01;P0.01);A組介入術(shù)后1天為0.72±0.07、(43.67±4.96)mm Hg,明顯高于介入前水平(P0.01,P0.01)。結(jié)論:1 T2DM合并LEAD患者血清中VE-cadherin與sICAM-1較單純T2D M水平明顯升高,表明VE-cadherin及sICAM-1在LEAD發(fā)生中有重要作用,其水平升高可能是LEAD發(fā)生的危險(xiǎn)因素之一。2介入術(shù)后VE-cadherin與sICAM-1水平明顯增高,且術(shù)后14天仍未回歸到術(shù)前水平,表明介入治療會(huì)進(jìn)一步加重血管內(nèi)皮功能損傷,促進(jìn)炎癥反應(yīng),為術(shù)后保護(hù)內(nèi)皮完整性及抗炎治療防止動(dòng)脈再狹窄及血栓形成提供依據(jù)。
[Abstract]:Objective: To observe the level of serum vascular endothelial calcium mucin (vascular endothelial cadherin, VE-cadherin) and intercellular adhesion molecules in patients with type 2 diabetes mellitus (Type 2 diabetes mellitus, T2DM) and the patients with lower-extremity arterial disease (LEAD). The changes of VE-cadherin and sICAM-1 levels before and after lower extremity arteriography, balloon dilatation and stent implantation were conducted to explore the relationship between vascular endothelial dysfunction and type 2 diabetes mellitus with lower extremity arterial lesions, and to further explore the effect of interventional therapy on vascular endothelial function and the relationship between vascular endothelium function and vascular restenosis after intervention. Methods: 23 patients who were hospitalized in Department of endocrinology of our hospital from December 2015 to December 2016 were diagnosed as T2DM combined with LEAD (Fontaine IIb-IV) for lower extremity arteriography, balloon dilatation and stent implantation and successful patients were observed as subjects (group A). 23 patients with type 2 diabetes who were hospitalized at the same time as diabetes were selected as diabetes. Group (group B) and 23 healthy persons as the control group (group C). The three groups were all fasted for 10 hours at 6:00 on the second day at 6:00 to extract the elbow vein blood, to detect the fasting blood glucose (FBG), glycated hemoglobin (Hb A1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), and simultaneously determine VE-cadherin and sICAM-1 levels. In group A, the arterial sheath (arterial blood) was performed after the arterial sheath was successfully implanted (the arterial blood), and the guide and catheter through the stenosis or occlusion of the lower extremity artery (the ischemic part of the anterior artery blood), the distal end of the lesion artery after the balloon dilation or stent implantation (the arterial blood after the ischemic part of the artery), and 4ml were taken. After the intervention, 24h, 14d took 4ml of the elbow vein blood (24h, 14d venous blood after intervention). All blood samples were centrifuged for 20 minutes at room temperature and 2H, centrifugation for 20 minutes, centrifuge radius 15cm, and the supernatant was frozen in the refrigerators at -20 centigrade. All specimens were measured in the same manufacturer's kit. Statistical analysis was carried out by SPSS13.0 software. The data were measured by the chi 2 test, the measurement data were (?) + s, and the multiple groups were compared with the total random single factor analysis of variance (One-way ANOVA). The two groups were compared with two sample mean number T test. The index was compared with linear correlation analysis. The difference of P0.05 was statistically significant. Results: 1 and three groups were compared: A, B, C three research objects Age, sex, and BMI, the difference was not statistically significant (P0.05).2 three groups FBG, Hb A1c level: (8.30 + 1.13) mmol/L, (8.40 + 1.34)%, B group: (8.10 + 1.15) mmol/L, (8.18 + 1.08)%, C group was (5.06 + 0.54) mmol/L, (4.92 + 0.35) There was no statistically significant difference (P0.05).3 three groups of blood lipid levels: TC, TG, LDL, HDL levels: (4.68 + 0.57) mmol/L, (1.81 + 0.78) mmol/L, (3.08 + 0.59) mmol/L, (1.19 + 0.30) mmol/L, B groups were respectively (1.85 + 0.90), respectively. ) mmol/L, (2.58 + 0.78) mmol/L, (1.25 + 0.41) mmol/L.A, B, C three in TC, TG, LDL, HDL levels were not statistically significant (P0.05).4 serum VE-cadherin level: three groups were (11.06 + 0.75) respectively, (10.23 + 0.82), (9.53 + 0.77) 1), group B was significantly higher than group C (P0.05) in group.A after operation 24h, 14d was (17.52 + 3.19) ng/ml, (12.80 + 0.84) ng/ml, and was significantly higher (P0.01; P0.05) compared with preoperative venous blood (P0.01; P0.05). There was no significant difference in blood (P0.05). The arterial blood was (12.33 + 1.12) ng/ml before the intervention of ischemia, and the level of VE-cadherin was significantly higher than that before the intervention of arterial blood (P0.05). The arterial blood (15.08 + 1.63) ng/ml after the intervention of the ischemic site was significantly higher than that of the arterial blood before the intervention of the arterial blood and the bleeding site (P0.01, P0.05).5 serum sIC AM-1 level: venous blood sICAM-1 level, A, B, C three groups (2.92 + 0.22) ng/ml, (1.93 + 0.36) ng/ml, (0.61 + 0.15) ng/ml, A group preoperative venous blood is significantly higher than B, C group (P0.01, 6.06 + 0.18). 01) the level of postoperative 14d and postoperative 24h increased significantly (P0.01) the ICAM-1 level of arterial blood in group.A: preoperative arterial blood (2.93 + 0.22) ng/ml, compared with preoperative venous blood, there was no significant difference (P0.05), the arterial blood was (3.55 + 0.37) ng/ml before intervention, and the level of sICAM-1 was significantly higher than before the arterial blood (P0.01), and the ischemic site was significantly higher (P0.01). The arterial blood (4.29 + 0.26) ng/ml after intervention was significantly higher than that of the arterial blood before interventional procedure and the ischemic part of the artery (P0.01, P0.01).6 VE-cadherin and sICAM-1: the linear correlation between VE-cadherin and sICAM-1 in the venous blood of group A and B group before intervention was positively correlated (r=0.629, P0.01). Group B was 1 + 0.17, (45.58 + 8.30) mm Hg, group A was 0.47 + 0.12, (26.08 + 4.81) mm Hg, A group was significantly lower than that of group B (P0.01; P0.01), A group was 0.72 + 0.07, (43.67 + 4.96) mm, obviously higher than that before intervention. The level of VE-cadherin and sICAM-1 plays an important role in the occurrence of LEAD. The elevation of the level may be one of the risk factors for the occurrence of LEAD. The level of VE-cadherin and sICAM-1 increases obviously after.2 intervention, and the level is still not returned to the preoperative level on the 14 day after the operation, indicating that interventional therapy will further aggravate vascular endothelial dysfunction and promote inflammation. It provides evidence for protecting endothelial integrity and preventing inflammatory restenosis and thrombosis after operation.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R543.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 黃達(dá)陽;趙鵑;;血管內(nèi)皮鈣粘蛋白與血管性疾病的研究進(jìn)展[J];中國循環(huán)雜志;2014年02期

2 臧運(yùn)華;唐明;郭瑞友;葉俊麗;王燕鳴;鄭燕;;含溶栓顆粒血清對(duì)TNF-α損傷人臍靜脈內(nèi)皮細(xì)胞ICAM-1的影響研究[J];中華中醫(yī)藥學(xué)刊;2010年04期

3 林慶賓;張俐;;CAM-1在脊髓缺血再灌注損傷中的作用進(jìn)展[J];中國中醫(yī)骨傷科雜志;2009年12期

4 丁勝;趙n\;王紅祥;王中京;毛紅;周玲;;經(jīng)皮氧分壓檢測診斷2型糖尿病患者周圍血管病變的臨床價(jià)值[J];山東醫(yī)藥;2009年37期

5 朱乃訓(xùn);馮毅;張立;;大鼠血管內(nèi)皮功能障礙及胰島素抵抗與高脂飲食的關(guān)系[J];中國組織工程研究與臨床康復(fù);2007年25期

6 劉彬;程偉;;大鼠新型頸總動(dòng)脈球囊損傷后狹窄模型的建立及其動(dòng)態(tài)病理學(xué)觀察[J];中國比較醫(yī)學(xué)雜志;2007年05期

7 肖宇宏;白云;宋敏;張利永;黃鋼;;內(nèi)毒素刺激人臍靜脈內(nèi)皮細(xì)胞免疫相關(guān)分子的表達(dá)[J];免疫學(xué)雜志;2006年02期

，

本文編號(hào)：1915645