【摘要】：目的：探討2型糖尿病患者合并冠狀動脈粥樣硬化性心臟病發(fā)病機制的可能影響因素,尤其是生物活性脂質1-磷酸鞘氨醇(Sphingosine-1-phosphate, SIP)口T淋巴細胞CD69抗原的表達與2型糖尿病患者冠心病合并癥的發(fā)生風險關系。方法：本研究自2013年10月至2014年6月間連續(xù)納入2型糖尿病合并冠心病患者共68例(T2DM-CHD);同期納入與之相匹配的2型糖尿病非冠心病患者共81例(T2DM)。利用酶聯(lián)免疫吸附試驗(ELISA)檢測S1P的表達,流式細胞術,免疫熒光染色法檢測植物血凝素(PHA)刺激20小時后外周血CD3+CD4+T淋巴細胞亞群CD69抗原的表達,同時收集包括高敏C反應蛋白(hsCRP)、各項血糖、血脂指標和體重在內(nèi)的生化檢測及臨床信息。結果：T2DM組外周血S1P的濃度、HDL及ApoA1水平明顯高于T2DM-CHD組(P0.01),而經(jīng)PHA刺激后,CD3+CD4+T淋巴細胞亞群CD69抗原的表達明顯低于T2DM-CHD組(尸0.01)。在單純T2DM組中,包括hsCRP、FPG、2hPG、HbAlc、TC、TG、LDL、 ApoB、LP(a)在內(nèi)的炎性標志物、脂質血糖指標及冠心病相關預防治療用藥史均較T2DM-CHD組明顯降低,差異有統(tǒng)計學意義(P0.05)。同時,邏輯回歸分析顯示S1P是2型糖尿病患者獨立保護因素,而T細胞CD69抗原、hsCP、2hPG、LDL、Lp (a)均為2型糖尿病患者合并冠心病的獨立危險因素。結論：在2型糖尿病患者中,下降的外周血S1P表達水平及上調(diào)的CD3+CD4+CD69+ T細胞抗原、HsCRP等免疫炎性相關指標是2型糖尿病患者高冠心病合并風險的強力推動,與其發(fā)生發(fā)展具有密切相關性,可能參與了其病因途徑。
[Abstract]:Objective: to investigate the possible influencing factors of coronary atherosclerotic heart disease in patients with type 2 diabetes mellitus. In particular, the expression of CD69 antigen in T lymphocytes of the mouth of bioactive lipids 1-phosphate (SIP) was associated with the risk of coronary heart disease in patients with type 2 diabetes. Methods: from October 2013 to June 2014, 68 patients with type 2 diabetes mellitus complicated with coronary heart disease (T2DM-CHD) and 81 matched non-coronary heart disease patients with type 2 diabetes mellitus (T2DM) were enrolled in this study. The expression of S1P was detected by enzyme-linked immunosorbent assay (ELISA), and the expression of CD69 antigen of CD3 CD4 T lymphocyte subsets in peripheral blood was detected by flow cytometry and immunofluorescence staining after 20 hours of stimulation with phytohemagglutinin (PHA). Biochemical and clinical information including blood glucose, blood lipids and body weight of Gao Min C reactive protein (hsCRP),) were also collected. Results the levels of S1P and ApoA1 in the peripheral blood of the group of w T2DM were significantly higher than those in the group of T2DM-CHD (P0.01), but the expression of CD69 antigen in T lymphocyte subsets of CD3 CD4 was significantly lower than that in the group of T2DM-CHD (P0.01). In the simple T2DM group, the inflammatory markers, lipid glucose index and the history of preventive therapy for coronary heart disease were significantly lower than those in the T2DM-CHD group (P0.05). At the same time, logistic regression analysis showed that S1P was an independent protective factor for type 2 diabetes mellitus, and T cell CD69 antigen hsCP2hPGL (a) was an independent risk factor for type 2 diabetic patients with coronary heart disease. Conclusion: in patients with type 2 diabetes, the decreased expression of S1P in peripheral blood and the up-regulation of CD3 CD4 CD69 T cell antigen (CD3 CD4 CD69 T cell antigen) and HsCRP are the strong driving factors of high risk of coronary heart disease in patients with type 2 diabetes. It is closely related to its occurrence and development and may be involved in its etiological pathway.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R587.1;R541.4

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