合并糖尿病的急性冠脉综合征患者共刺激分子与炎症指标的研究

Costimulatory molecules and inflammatory indicator in diabetes and non-diabetes acute coronary syndrome patients

摘要:

目的 探讨CD4+CD28null T淋巴细胞及炎症因子C反应蛋白（CRP）在合并糖尿病的冠心病患者发病机制中的作用。方法 51例经冠状动脉造影确认为急性冠脉综合征（ACS）的患者，根据1999年WHO标准分为2型糖尿病合并ACS组21例，单纯ACS组30例，对所有研究对象均通过流式细胞术测量外周血中CD4+CD28null T淋巴细胞的数量，对比分析两组患者的临床资料和冠状动脉造影结果。结果 与单纯ACS患者相比较，合并糖尿病的ACS患者外周血CD4+CD28null T淋巴细胞的数量显著增多[（4.66±4.24）% vs （8.89±6.45）%，P＜0.05]，CRP浓度无明显统计学差异[（1.97±1.05） vs （2.22±1.14）mg/L，P＞0.05]，冠状动脉造影显示完全闭塞、弥漫病变比例较高（7 vs 11，P＜0.05；6 vs 12，P＜0.01 ）。结论 糖尿病合并ACS患者冠状动脉病变累及范围广且程度重，共刺激分子可能与合并糖尿病的ACS患者的免疫调节异常有关。

Abstract:

Objective To determine the roles of the frequency of CD4+CD28null T lymphocytes and the serum level of C-reactive protein (CRP) in diabetes and non-diabetes coronary patients. Methods A total of 51 patients with acute coronary syndrome (ACS) in the Department of Cardiology from our hospital during March 2010 to June 2011 were enrolled in this study. They were further divided into diabetes (n=21) and non-diabetes (n=30) group, according to the diagnostic standards of type 2 diabetes mellitus. Frequency of CD4+CD28null T lymphocytes was analyzed by multiple-color flow cytometry, and serum level of CRP was measured by ELISA. Their clinical data and results of coronary arteriography were recorded and analyzed. Results Compared to the non-diabetes ACS patients, the frequency of CD4+CD28null T lymphocytes was higher in peripheral blood of diabetes ACS patients [(4.66±4.24)% vs (8.89±6.45)%, P＜0.05]. But there was no significant difference in serum level of CRP between the two groups [(1.97±1.05) vs (2.22±1.14)mg/L, P＞0.05]. Coronary angiography suggested that the rate of complete obstruction and diffuse pathogenic changes were more severe in diabetes ACS patients (7 vs 11, P＜0.05; 6 vs 12, P＜0.01). Conclusion Coronary pathogenic changes are more severe in diabetes ACS patients than those without diabetes. Costimulatory molecule may be involved in the immune-modulation disturbance of patients with diabetes and ACS.