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目的探讨血清糖化白蛋白(GA)、内源性分泌型终末糖化产物受体(esRAGE)、炎症因子C-反应蛋白(CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平与糖尿病冠状动脉弥漫病变的关系。方法根据冠状动脉造影结果及有无糖尿病将374例患者分成五组:冠状动脉局灶病变组(Ⅰ组,n=107)、冠状动脉弥漫病变组(Ⅱ组,n=94)、单纯糖尿病组(Ⅲ组,n=46)、2型糖尿病合并冠状动脉局灶病变组(Ⅳ组,n=46)及2型糖尿病合并冠状动脉弥漫病变组(Ⅴ组,n=81),分别检测各组患者血清GA、esRAGE、高敏CRP(hsCRP)、IL-6和TNF-α的水平。结果Ⅴ组的GA和hsCRP水平最高,而esRAGE水平最低,与其他四组比较差异均有统计学意义(P<0.01)。Ⅳ组的GA和hsCRP高于Ⅰ～Ⅲ组,而esRAGE水平则均低于Ⅰ～Ⅲ组(P<0.05)。糖尿病患者中,GA水平与hsCRP和糖化血红蛋白(HbA1c)值呈正相关(r=0.249、0.695),与esRAGE呈负相关(r=-0.480)(均P<0.001);而esRAGE与HbA1c、hsCRP均呈负相关(r=-0.224、-0.236)(P<0.01)。2型糖尿病合并冠心病患者中,hsCRP与冠状动脉弥漫病变支数呈正相关(r=0.220,P<0.001);hsCRP和IL-6与空腹血糖水平均呈正相关(r=0.259,P<0.001;r=0.124,P<0.05)。结论糖尿病患者血清GA和hsCRP水平升高、esRAGE水平降低不仅是糖尿病并发冠心病的重要危险因子,也是反映糖尿病冠状动脉广泛弥漫和严重病变的重要指标。
Objective To investigate the expression of serum glycosylated albumin (GA), esRAGE, CRP, IL-6 and tumor necrosis factor-α TNF-α) levels and diabetes coronary artery diffuse lesions. Methods 374 patients were divided into five groups according to coronary angiography and diabetes mellitus: group with coronary lesions (group Ⅰ, n = 107), group with diffuse coronary artery (group Ⅱ, n = 94), group with diabetes mellitus (Group Ⅲ, n = 46), type 2 diabetic patients with focal coronary lesions (group Ⅳ, n = 46) and type 2 diabetic patients with diffuse coronary artery disease (groupⅤ, n = 81) Patient serum GA, esRAGE, high-sensitivity CRP (hsCRP), IL-6 and TNF-α levels. Results The highest level of hsCRP and the lowest level of esRAGE were found in group V, which were significantly different from the other four groups (P <0.01). The levels of GA and hsCRP in group Ⅳ were higher than those in group Ⅰ ~ Ⅲ, while the levels of esRAGE in group Ⅳ were lower than those in group Ⅰ ~ Ⅲ (P <0.05). There was a positive correlation between GA level and hsCRP and HbA1c (r = 0.249,0.695), but negatively correlated with esRAGE (r = -0.480) (all P <0.001), while esRAGE, HbA1c and hsCRP (R = -0.224, -0.236) (P <0.01). There was a positive correlation between hsCRP and the number of diffuse coronary artery lesions in patients with type 2 diabetes mellitus (r = 0.220, P <0.001). There was a positive correlation between hsCRP and IL-6 and fasting blood glucose (r = 0.259, r = 0.124, P <0.05). Conclusions Serum GA and hsCRP levels are elevated in patients with diabetes mellitus. The esRAGE level is not only an important risk factor of diabetes mellitus complicated by coronary heart disease, but also an important index reflecting the extensive diffuse and serious diseases of diabetic coronary arteries.