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目的观察单纯2型糖尿病(type 2 diabetes mellitus,T2DM)和T2DM并下肢血管病变患者可溶性P选择素(P-selectin,Ps)及C反应蛋白(C-reaction protein,CRP)的变化,探讨Ps、CRP与踝臂指数(ankle artery-brachial pressureratio,ABI)的相关性及其在T2DM下肢血管病变(peripheral arterial disease,PAD)发生、发展中的作用。方法 167例T2DM患者,按ABI测定结果分为下肢血管正常组(NPAD组)和病变组(PAD组),75例同期健康体检者作为对照组。比较各组一般情况、生化指标,测定Ps、CRP。结果①与NPAD组、对照组相比,PAD组Ps、CRP、HbA1c显著升高(P<0.05)。②PAD组、NPAD组Ps与ABI呈明显负相关(r=-0.554,P<0.01;r=-0.359,P<0.05)。PAD组、NPAD组CRP与ABI呈负相关(r=-0.435,P<0.01;r=-0.342,P<0.05)。PAD组Ps、CRP与病程、餐后2 h血糖、胰岛素抵抗指数呈正相关(P<0.05);血浆CRP、Ps之间呈正相关(r=0.977,P<0.01)。CRP、Ps与血脂、年龄、空腹C肽无显著相关性(P>0.05)。结论血浆高Ps、CRP水平是2型糖尿病PAD的重要危险因素,与PAD严重程度密切相关;测定血浆Ps、CRP将有助于预测T2DM并下肢血管病变的发生及其预后的严重性评价。
Objective To investigate the changes of soluble P-selectin (P-selectin, P-selectin, C-reactive protein and CRP in type 2 diabetes mellitus (T2DM) and T2DM patients with lower extremity vascular disease, Correlation between CRP and ankle artery-brachial pressure (ABI) and its role in the occurrence and development of peripheral arterial disease (PAD) in T2DM. Methods One hundred and sixty-seven patients with T2DM were divided into two groups according to the results of ABI: NPAD group and PAD group, and 75 healthy subjects at the same period as the control group. Compare the general conditions of each group, biochemical indicators, determination of Ps, CRP. Results ① Compared with NPAD group and control group, Ps, CRP and HbA1c in PAD group were significantly increased (P <0.05). There was a significant negative correlation between Ps and ABI in PAD group and NPAD group (r = -0.554, P <0.01; r = -0.359, P <0.05). There was a negative correlation between CRP and ABI in PAD group and NPAD group (r = -0.435, P <0.01; r = -0.342, P <0.05). There was a positive correlation between Ps and CRP in PAD group and duration of disease, blood glucose and insulin resistance index at 2 h after meal (P <0.05). There was a positive correlation between plasma P and CRP levels (r = 0.977, P <0.01). CRP, Ps and serum lipids, age, fasting C-peptide was not significantly correlated (P> 0.05). Conclusion Plasma Ps and CRP levels are important risk factors for type 2 diabetes mellitus (PAD) and are closely related to the severity of PAD. Measurement of plasma Ps and CRP will be helpful in predicting the occurrence of T2DM and the severity of lower extremity vascular lesions.