2型糖尿病下肢血管病變患者介入治療前后OPN及sVCAM-1水平的變化及意義
發(fā)布時(shí)間：2019-05-30 01:30
【摘要】：目的:通過測定2型糖尿病(type 2 diabetes mellitus,T2DM)合并外周動脈病變(peripheral arterial disease,PAD)患者、單純T2DM患者及健康人血漿中骨橋蛋白(osteopontin,OPN)及可溶性血管細(xì)胞黏附分子-1(soluble vascular cell adhesion molecule-1,s VCAM-1)的濃度,同時(shí)測定T2DM合并PAD患者下肢動脈造影、球囊擴(kuò)張或支架植入術(shù)前后二者的濃度變化,探討其在T2DM合并PAD及介入術(shù)后再狹窄過程中的意義,旨在為臨床上防治PAD及術(shù)后再狹窄提供理論依據(jù)。方法:選擇2015年6月至2016年12月于我院內(nèi)分泌科住院,確診為T2DM合并PAD并成功行下肢動脈造影、球囊擴(kuò)張或支架植入術(shù)的患者27例作為研究對象(PTA組),選取同期于我院住院的確診為單純T2DM患者27例,經(jīng)相應(yīng)檢查可除外糖尿病并發(fā)癥及相關(guān)疾病,作為單純糖尿病組(T2DM組),選取同期門診健康體檢者27例為對照組(Control組)。PTA組、T2DM組及Control組患者于晨6:00空腹平臥位取肘靜脈血4ml(介入術(shù)前靜脈血),測定空腹血糖(FBG)、糖化血紅蛋白(Hb A1c)、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)以及骨橋蛋白(OPN)、可溶性血管細(xì)胞黏附分子-1(s VCAM-1)的水平。測量PTA組患者介入前后踝肱壓指數(shù)(ABI)及經(jīng)皮氧分壓(TcPO_2),并在介入治療過程中,在動脈鞘順利放置后,取動脈血4ml(介入術(shù)前動脈血),導(dǎo)絲、導(dǎo)管順利穿過狹窄的或閉塞病變動脈段,于病變動脈遠(yuǎn)端取血4ml(病變術(shù)前動脈血),待球囊擴(kuò)張后或支架植入后,再次于病變的動脈遠(yuǎn)端取血4ml(病變術(shù)后動脈血),于介入術(shù)后1d,14d分別取肘靜脈血4ml。統(tǒng)一采用酶聯(lián)免疫吸附法(ELISA)檢測標(biāo)本血漿OPN及s VCAM-1濃度,嚴(yán)格按照說明書進(jìn)行操作,用全自動生化儀檢測一般指標(biāo)。采用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1各組FBG、Hb A1c比較:PTA組FBG:(8.97±1.45)mmol/L,Hb A1c:(8.82±0.87)%;T2DM組FBG:(8.90±1.21)mmol/L,Hb A1c:(8.76±0.89)%;Control組FBG:(5.28±0.30)mmol/L,Hb A1c:(5.21±0.42)%。PTA組及T2DM組的FBG及Hb A1c水平均比Control組高,差異有統(tǒng)計(jì)學(xué)意義(P0.01);而PTA組與T2DM組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);2各組血脂水平比較:PTA組TC,TG,LDL-C,HDL-C分別為:(5.49±0.55)mmol/L,(2.24±0.46)mmol/L,(3.74±0.46)mmol/L,(1.02±0.16)mmol/L;T2DM組分別為:(5.11±0.63)mmol/L,(1.93±0.51)mmol/L,(3.43±0.51)mmol/L,(1.11±0.25)mmol/L;Control組分別為:(4.63±0.86)mmol/L,(1.53±0.45)mmol/L,(3.03±0.45)mmol/L,(1.24±0.16)mmol/L。PTA組與Control組相比較:TC、TG、LDL-C水平均明顯增高(P0.01,P0.01,P0.01),HDL-C的水平明顯降低(P0.01);T2DM組與Control組相比較:TC、TG、LDL-C水平也呈明顯增高(P0.05,P0.01,P0.01),HDL-C的水平降低(P0.05);PTA組與T2DM組相比較:TC、TG、LDL-C水平均顯著增高(P0.05,P0.01,P0.05),HDL-C的水平均降低(P0.05),以上差異均有統(tǒng)計(jì)學(xué)意義;3 ABI,TcPO_2水平比較:PTA組患者介入術(shù)前1天ABI、TcPO_2分別為:0.61±0.08,(29.23±3.12)mm Hg;介入術(shù)后1天ABI,TcPO_2分別為:0.88±0.10,(55.56±3.23)mm Hg。PTA組介入術(shù)后二者均較介入術(shù)前有顯著升高(t=23.371,P0.01;t=45.731,P0.01),差異有統(tǒng)計(jì)學(xué)意義;4血漿OPN水平:PTA組介入術(shù)前靜脈血、T2DM組及Control組OPN水平分別為:(12.15±2.36)ng/ml,(6.79±2.03)ng/ml,(4.34±0.87)ng/ml,其中PTA組介入術(shù)前靜脈血及T2DM組OPN水平較Control組均有顯著升高(P0.01;P0.01),PTA組較T2DM組靜脈血中OPN水平升高(P0.01);PTA組內(nèi)介入治療前動脈血、病變術(shù)前動脈血、病變術(shù)后動脈血中OPN水平分別為:(12.73±2.56)ng/ml,(14.11±2.43)ng/ml,(16.15±2.28)ng/ml,病變術(shù)前動脈血及術(shù)后動脈血和介入治療前的動脈血相比,OPN水平顯著升高(P0.05;P0.05),病變術(shù)后動脈血比病變術(shù)前動脈血中OPN水平顯著升高(P0.05);PTA組內(nèi)介入治療前靜脈血、術(shù)后1d及術(shù)后14d靜脈血內(nèi)OPN水平分別為:(12.15±2.36)ng/ml,(18.17±3.05)ng/ml,(22.31±3.42)ng/ml,術(shù)后1d及術(shù)后14d靜脈血中OPN水平較術(shù)前均有顯著增高(P0.01;P0.01),術(shù)后14d與術(shù)后1d相比,OPN水平也有明顯升高(P0.01),以上差異均有統(tǒng)計(jì)學(xué)意義;介入前的靜脈血及術(shù)前動脈血中OPN水平比較無明顯差異(P0.05);5血漿s VCAM-1水平:PTA組介入治療前靜脈血、T2DM組及Control組s VCAM-1水平分別為:(56.44±7.42)ng/ml,(45.13±4.87)ng/ml,(27.39±5.94)ng/ml,其中PTA組介入前的靜脈血及T2DM組s VCAM-1水平較Control組均有明顯升高(P0.01;P0.01),PTA組較T2DM組靜脈血中s VCAM-1水平升高(P0.01);PTA組內(nèi)介入治療前動脈血、病變術(shù)前動脈血、病變術(shù)后動脈血中s VCAM-1水平分別為:(60.24±6.35)ng/ml,(72.08±6.49)ng/ml,(85.58±7.63)ng/ml,病變術(shù)前動脈血及術(shù)后動脈血和介入治療前的動脈血相比,s VCAM-1水平升高(P0.01;P0.01),病變術(shù)后動脈血比病變術(shù)前動脈血中s VCAM-1水平升高(P0.01);PTA組內(nèi)介入操作前靜脈血、術(shù)后1d及術(shù)后14d靜脈血內(nèi)s VCAM-1水平分別為:(56.44±7.42)ng/ml,(123.11±18.21)ng/ml,(292.45±20.05)ng/ml,術(shù)后1d及術(shù)后14d靜脈血中s VCAM-1水平較術(shù)前均有顯著增高(P0.01;P0.01),術(shù)后14d與術(shù)后1d相比,s VCAM-1水平也有明顯升高(P0.01),以上差異均有統(tǒng)計(jì)學(xué)意義;介入治療前靜脈血及動脈血中s VCAM-1水平無明顯差異(P0.05);6 OPN與s VCAM-1的關(guān)系:PTA組內(nèi)介入前靜脈血的OPN與s VCAM-1水平進(jìn)行線性相關(guān)分析,二者水平呈正相關(guān)(r=0.940,P0.01),差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:1 T2DM及T2DM合并PAD患者存在嚴(yán)重的血脂代謝異常;2 T2DM合并PAD患者血漿中OPN及s VCAM-1的濃度顯著升高,提示OPN及s VCAM-1可能在糖尿病下肢血管病變的發(fā)生發(fā)展中起一定的作用;3 PTA組介入術(shù)后OPN及s VCAM-1的濃度較介入術(shù)前明顯升高,是導(dǎo)致介入術(shù)后再狹窄的危險(xiǎn)因素之一,可能為抑制平滑肌細(xì)胞增殖、遷移及抗炎治療提供了新的思路。
[Abstract]:Objective: To determine the concentration of osteopontin (OPN) and soluble vascular cell adhesion molecule-1 (s VCAM-1) in patients with type 2 diabetes (T2DM) combined with peripheral arterial disease (PAD), patients with simple T2DM and healthy people. In order to provide a theoretical basis for the prevention and treatment of PAD and restenosis after operation, the significance of the changes of the concentration of the lower limb, the balloon dilatation or the stent implantation in the patients with T2DM combined with PAD was also determined. Methods: From June 2015 to December 2016,27 patients with T2DM and 27 cases of simple T2DM were selected as the study object (PTA group). The control group (control group) was selected as the control group (control group) for the patients with diabetes and related diseases, except for diabetic complications and related diseases, as a simple type of diabetes (T2DM). The fasting blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured in the PTA group, the patients with T2DM and the control group at 6:00 morning and 6:00, and the blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured. The level of low-density lipoprotein cholesterol (LDL-C) and osteopontin (OPN), soluble vascular cell adhesion molecule-1 (s VCAM-1). The ankle-brachial pressure index (ABI) and the transcutaneous oxygen partial pressure (TcPO _ 2) were measured before and after the intervention of the PTA group, and after the artery was successfully placed in the interventional treatment, 4ml of the arterial blood (pre-operation arterial blood), the guide wire and the catheter were successfully passed through the narrow or occluded lesion artery. 4 ml (pre-operative arterial blood) was taken at the distal end of the diseased artery, and 4 ml of blood was taken at the distal end of the artery after the balloon was expanded or after the stent was implanted (the arterial blood after the lesion), and 4 ml of the cubital vein blood was taken after the intervention. The plasma OPN and s VCAM-1 concentration of the specimen were measured by enzyme-linked immunosorbent assay (ELISA), and the operation was carried out in strict accordance with the instruction, and the general index was detected by the full-automatic biochemical instrument. The software of SPSS13.0 was used for statistical analysis, and the difference was statistically significant with the difference of P0.05. Results: The FBG and Hb of the group were: (8.97-1.45) mmol/ L, Hb: (8.82-0.87)%, FBG (8.90-1.21) mmol/ L in the T2DM group, (8.76-0.89)% in the control group, (5.28-0.30) mmol/ L in the control group, and (5.21-0.42)% in the control group. The levels of FBG and Hb in the PTA group and the T2DM group were higher than that of the control group (P 0.01), and the difference between the PTA group and the T2DM group was not statistically significant (P0.05); the levels of the blood lipids in the group were: (5.49-0.55) mmol/ L, (2.24-0.46) mmol/ L, respectively, in the PTA group, the TC, the TG, the LDL-C and the HDL-C. (3.74-0.46) mmol/ L, (1.02-0.16) mmol/ L; the T2DM groups were (5.11-0.63) mmol/ L, (1.93-0.51) mmol/ L, (3.43-0.51) mmol/ L, (1.11-0.25) mmol/ L, and Control groups were: (4.63-0.86) mmol/ L, (1.53-0.45) mmol/ L, (3.03-0.45) mmol/ L, (1.24-0.16) mmol/ L. The levels of TC, TG, LDL-C were significantly higher (P0.01, P0.01, P0.01), and the level of HDL-C was significantly lower (P0.01). The levels of TC, TG and LDL-C in the patients with T2DM were significantly higher (P0.05, P0.01, P0.01), and the level of HDL-C was lower (P0.05). The levels of LDL-C were significantly higher (P0.05, P0.01, P0.05), and the levels of HDL-C decreased (P0.05). TcPO _ 2 was 0.88-0.10, (55.56-3.23) mm Hg, respectively. (6.79-2.03) ng/ ml, (4.34-0.87) ng/ ml, in which the level of OPN in the venous and T2DM groups was significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of OPN in the venous blood of the PTA group was higher than that in the group with the T2DM group (P0.01), and the pre-operative arterial blood, the pre-operative arterial blood, The level of OPN in the arterial blood was: (12.73-2.56) ng/ ml, (14.11-2.43) ng/ ml, (16.15-2.28) ng/ ml, and the level of OPN increased significantly (P0.05; P0.05). The level of OPN in the pre-operative arterial blood was significantly higher than that of the pre-operative arterial blood (P0.05), and the level of OPN in the venous blood before and after the operation was (12.15-2.36) ng/ ml, (18.17-3.05) ng/ ml, (22.31-3.42) ng/ ml, respectively. The level of OPN in the venous blood after 1 d and 14 d after operation was significantly higher than that before operation (P0.01; P0.01), and the level of OPN increased significantly after the operation (P0.01). There was no significant difference in the level of OPN in the venous blood before and after the operation (P0.05); the plasma s VCAM-1 level: the levels of VCAM-1 in the venous blood, the T2DM group and the control group s VCAM-1 were: (56.44-7.42) ng/ ml, (45.13-4.87) ng/ ml, (27.39-5.94) ng/ ml, respectively. The levels of sVCAM-1 in the venous and T2DM groups were significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of sVCAM-1 in the venous blood of the PTA group was higher than that in the group with T2DM (P0.01). (60.24-6.35) ng/ ml, (72.08-6.49) ng/ ml, (85.58-7.63) ng/ ml, the level of sVCAM-1 increased (P0.01) compared with the arterial blood in the pre-operative arterial and post-operative arterial and interventional treatment (P0.01). The levels of sVCAM-1 in the venous blood,1 d after operation and 14 days after operation in the PTA group were: (56.44-7.42) ng/ ml, (123.11-18.21) ng/ ml, (292.45-20.05) ng/ ml, and the level of s-VCAM-1 in the venous blood after 1 d and 14 days after operation was significantly higher than that before operation (P0.01; P0.01). There was no significant difference in the level of sVCAM-1 after operation (P <0.01). There was no significant difference in the level of sVCAM-1 in the venous and arterial blood before and after the intervention (P0.05), and the relationship between 6OPN and s VCAM-1: The linear correlation between the level of OPN and s VCAM-1 in the pre-interventional venous blood in the PTA group was positively correlated (r = 0.940, P0.01), and the difference was of statistical significance. Conclusion: There are severe dyslipidemia in the patients with T2DM and T2DM. The concentration of OPN and s VCAM-1 in the plasma of patients with T2DM is significantly increased, suggesting that OPN and s VCAM-1 may play a role in the development of lower limb vessel disease of diabetes. The concentration of OPN and s VCAM-1 after the intervention of the 3 PTA group was significantly higher than that before the intervention, which is one of the risk factors leading to the restenosis after the intervention, which may provide a new way for inhibiting the proliferation, migration and anti-inflammatory treatment of smooth muscle cells.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2
本文編號：2488392
[Abstract]:Objective: To determine the concentration of osteopontin (OPN) and soluble vascular cell adhesion molecule-1 (s VCAM-1) in patients with type 2 diabetes (T2DM) combined with peripheral arterial disease (PAD), patients with simple T2DM and healthy people. In order to provide a theoretical basis for the prevention and treatment of PAD and restenosis after operation, the significance of the changes of the concentration of the lower limb, the balloon dilatation or the stent implantation in the patients with T2DM combined with PAD was also determined. Methods: From June 2015 to December 2016,27 patients with T2DM and 27 cases of simple T2DM were selected as the study object (PTA group). The control group (control group) was selected as the control group (control group) for the patients with diabetes and related diseases, except for diabetic complications and related diseases, as a simple type of diabetes (T2DM). The fasting blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured in the PTA group, the patients with T2DM and the control group at 6:00 morning and 6:00, and the blood glucose (FBG), glycosylated hemoglobin (Hb), total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were measured. The level of low-density lipoprotein cholesterol (LDL-C) and osteopontin (OPN), soluble vascular cell adhesion molecule-1 (s VCAM-1). The ankle-brachial pressure index (ABI) and the transcutaneous oxygen partial pressure (TcPO _ 2) were measured before and after the intervention of the PTA group, and after the artery was successfully placed in the interventional treatment, 4ml of the arterial blood (pre-operation arterial blood), the guide wire and the catheter were successfully passed through the narrow or occluded lesion artery. 4 ml (pre-operative arterial blood) was taken at the distal end of the diseased artery, and 4 ml of blood was taken at the distal end of the artery after the balloon was expanded or after the stent was implanted (the arterial blood after the lesion), and 4 ml of the cubital vein blood was taken after the intervention. The plasma OPN and s VCAM-1 concentration of the specimen were measured by enzyme-linked immunosorbent assay (ELISA), and the operation was carried out in strict accordance with the instruction, and the general index was detected by the full-automatic biochemical instrument. The software of SPSS13.0 was used for statistical analysis, and the difference was statistically significant with the difference of P0.05. Results: The FBG and Hb of the group were: (8.97-1.45) mmol/ L, Hb: (8.82-0.87)%, FBG (8.90-1.21) mmol/ L in the T2DM group, (8.76-0.89)% in the control group, (5.28-0.30) mmol/ L in the control group, and (5.21-0.42)% in the control group. The levels of FBG and Hb in the PTA group and the T2DM group were higher than that of the control group (P 0.01), and the difference between the PTA group and the T2DM group was not statistically significant (P0.05); the levels of the blood lipids in the group were: (5.49-0.55) mmol/ L, (2.24-0.46) mmol/ L, respectively, in the PTA group, the TC, the TG, the LDL-C and the HDL-C. (3.74-0.46) mmol/ L, (1.02-0.16) mmol/ L; the T2DM groups were (5.11-0.63) mmol/ L, (1.93-0.51) mmol/ L, (3.43-0.51) mmol/ L, (1.11-0.25) mmol/ L, and Control groups were: (4.63-0.86) mmol/ L, (1.53-0.45) mmol/ L, (3.03-0.45) mmol/ L, (1.24-0.16) mmol/ L. The levels of TC, TG, LDL-C were significantly higher (P0.01, P0.01, P0.01), and the level of HDL-C was significantly lower (P0.01). The levels of TC, TG and LDL-C in the patients with T2DM were significantly higher (P0.05, P0.01, P0.01), and the level of HDL-C was lower (P0.05). The levels of LDL-C were significantly higher (P0.05, P0.01, P0.05), and the levels of HDL-C decreased (P0.05). TcPO _ 2 was 0.88-0.10, (55.56-3.23) mm Hg, respectively. (6.79-2.03) ng/ ml, (4.34-0.87) ng/ ml, in which the level of OPN in the venous and T2DM groups was significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of OPN in the venous blood of the PTA group was higher than that in the group with the T2DM group (P0.01), and the pre-operative arterial blood, the pre-operative arterial blood, The level of OPN in the arterial blood was: (12.73-2.56) ng/ ml, (14.11-2.43) ng/ ml, (16.15-2.28) ng/ ml, and the level of OPN increased significantly (P0.05; P0.05). The level of OPN in the pre-operative arterial blood was significantly higher than that of the pre-operative arterial blood (P0.05), and the level of OPN in the venous blood before and after the operation was (12.15-2.36) ng/ ml, (18.17-3.05) ng/ ml, (22.31-3.42) ng/ ml, respectively. The level of OPN in the venous blood after 1 d and 14 d after operation was significantly higher than that before operation (P0.01; P0.01), and the level of OPN increased significantly after the operation (P0.01). There was no significant difference in the level of OPN in the venous blood before and after the operation (P0.05); the plasma s VCAM-1 level: the levels of VCAM-1 in the venous blood, the T2DM group and the control group s VCAM-1 were: (56.44-7.42) ng/ ml, (45.13-4.87) ng/ ml, (27.39-5.94) ng/ ml, respectively. The levels of sVCAM-1 in the venous and T2DM groups were significantly higher in the PTA group than in the control group (P0.01; P0.01), and the level of sVCAM-1 in the venous blood of the PTA group was higher than that in the group with T2DM (P0.01). (60.24-6.35) ng/ ml, (72.08-6.49) ng/ ml, (85.58-7.63) ng/ ml, the level of sVCAM-1 increased (P0.01) compared with the arterial blood in the pre-operative arterial and post-operative arterial and interventional treatment (P0.01). The levels of sVCAM-1 in the venous blood,1 d after operation and 14 days after operation in the PTA group were: (56.44-7.42) ng/ ml, (123.11-18.21) ng/ ml, (292.45-20.05) ng/ ml, and the level of s-VCAM-1 in the venous blood after 1 d and 14 days after operation was significantly higher than that before operation (P0.01; P0.01). There was no significant difference in the level of sVCAM-1 after operation (P <0.01). There was no significant difference in the level of sVCAM-1 in the venous and arterial blood before and after the intervention (P0.05), and the relationship between 6OPN and s VCAM-1: The linear correlation between the level of OPN and s VCAM-1 in the pre-interventional venous blood in the PTA group was positively correlated (r = 0.940, P0.01), and the difference was of statistical significance. Conclusion: There are severe dyslipidemia in the patients with T2DM and T2DM. The concentration of OPN and s VCAM-1 in the plasma of patients with T2DM is significantly increased, suggesting that OPN and s VCAM-1 may play a role in the development of lower limb vessel disease of diabetes. The concentration of OPN and s VCAM-1 after the intervention of the 3 PTA group was significantly higher than that before the intervention, which is one of the risk factors leading to the restenosis after the intervention, which may provide a new way for inhibiting the proliferation, migration and anti-inflammatory treatment of smooth muscle cells.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2
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