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目的观测2型糖尿病合并急性脑梗死(DACI)患者血清可溶性CD40配体(sCD40L)水平变化及颈动脉粥样硬化特点,探讨血清sCD40L水平与颈动脉易损斑块的相关性。方法本实验分为糖尿病合并急性脑梗死组(DACI组,n=69)、单纯糖尿病组(DM组,n=32)和健康对照组(NC组,n=28)。3组研究对象均应用酶联免疫法测量血清sCD40L的水平,常规生化检测空腹血糖(FBG)、血脂、糖化血红蛋白(HbA1c)。并行彩色多普勒检查,测定颈动脉内-中膜厚度(IMT)、有无斑块及计算Crouse积分。根据超声结果将DACI组分为稳定斑块组、不稳定斑块组。结果3组之间血清sCD40L水平、IMT、斑块检出率、Crouse积分差别有统计学意义(P<0.05)。DACI组以不稳定斑块为主,且不稳定斑块组血清sCD40L水平高于稳定斑块组(P<0.05)。相关分析显示,血清sCD40L水平与IMT(r=0.733,P<0.01)、Crouse积分(r=0.645,P<0.01)、HbA1c(r=0.272,P<0.05)、甘油三酯(r=0.276,P<0.05)均呈显著正相关。结论血清sCD40L促进2型糖尿病患者颈动脉粥样硬化,其水平升高可能反应颈动脉粥样斑块的不稳定性。
Objective To observe the changes of serum soluble CD40 ligand (sCD40L) and carotid atherosclerosis in type 2 diabetes mellitus patients with acute cerebral infarction (DACI) and explore the correlation between serum sCD40L level and carotid vulnerable plaque. Methods The experiment was divided into diabetic group with acute cerebral infarction (DACI group, n = 69), simple diabetic group (DM group, n = 32) and healthy control group (NC group, n = 28). Serum levels of sCD40L were measured by ELISA and fasting blood glucose (FBG), lipids and HbA1c were detected by biochemical methods in all three groups. Parallel color Doppler examinations were performed to determine carotid intima-media thickness (IMT), presence of plaque, and Crouse score. According to the ultrasound results, the DACI group was divided into stable plaque group and unstable plaque group. Results The serum sCD40L level, IMT, plaque detection rate and Crouse score in the three groups were significantly different (P <0.05). In the DACI group, the unstable plaque was predominant, and the sCD40L level in the unstable plaque group was higher than that in the stable plaque group (P <0.05). Correlation analysis showed that serum sCD40L level was positively correlated with IMT (r = 0.733, P <0.01), Crouse score (r = 0.645, P <0.01), HbA1c (r = P <0.05) showed a significant positive correlation. Conclusion Serum sCD40L promotes carotid atherosclerosis in patients with type 2 diabetes mellitus, and its elevation may reflect the instability of carotid atherosclerotic plaques.