Effects of insulin dependence on inflammatory process, thrombotic mechanisms and endothelial function, in patients with type 2 diabetes mellitus and coronary atherosclerosis
Effects of insulin dependence on inflammatory process, thrombotic mechanisms and endothelial function, in patients with type 2 diabetes mellitus and coronary atherosclerosis
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DOI：
10.1002/clc.20101
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发表时间：
2007-06-01
影响因子：
2.7
通讯作者：
Stefanadis, Christodoulos
中科院分区：
文献类型：
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作者：
Antoniades, Charalambos;Tousoulis, Dimitris;Stefanadis, Christodoulos
背景：2型糖尿病（T2DM）的特点是内皮功能障碍、血栓形成增加和炎症反应异常。假设：我们假设胰岛素依赖/外源性胰岛素给药可能影响T2DM合并冠状动脉疾病（CAD）患者的血栓形成/炎症状态和内皮功能。方法： 招募了 55 名 T2DM + CAD 患者（26 名接受胰岛素治疗 (INS)，29 名接受口服双胍 + 磺脲类 (TABL) 治疗）。通过应变体积描记法评估内皮功能，并通过酶联免疫吸附测定法测定血清炎症和血栓标志物水平。结果：研究组之间的内皮依赖性扩张（EDD）没有显着差异，而EDD与INS（r = -0.776，p = 0.0001）和TABL（r = -0.702，p = 0.0001）。与TABL组相比，INS组患者白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、单核细胞趋化蛋白（MCP-1）和血管细胞粘附分子（sVCAM-1）水平较高。然而，TNF-α仅在INS中与蛋白C（PrtC）呈负相关（r = -0.726，p = 0.01），而在TABL组中则不然（r = -0.066，p = 0.738）。同样，sVCAM-1 仅在 INS 患者中与 PrtC 相关（r = -0.45 1，p = 0.046），但在 TABL 中不相关（r = 0.069，p = 0.727）。在多变量分析中，胰岛素依赖是 IL-6、TNF-u、MCP-1 和 sVCAM-1 水平的预测因子，与患者的人口统计特征、CAD 血管造影范围或糖尿病病程无关。结论：2 型糖尿病患者的胰岛素治疗会影响炎症细胞因子的表达，从而改变 2 型糖尿病患者的血栓形成机制。 冠状动脉粥样硬化，与糖尿病病程和冠状动脉疾病的范围无关。
Background: Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction, increased thrombogeneisity and abnormal inflammatory response.Hypothesis: We hypothesizsed that insulin dependence/exogenous insulin administration may affect thrombotic/inflammatory status and endothelial function in patients with T2DM and coronary artery disease (CAD).Methods: Fifty-five patients with T2DM + CAD (26 insulin-treated (INS) and 29 under oral biguanide + sulphonylurea (TABL)) were recruited. Endothelial function was assessed by gauge-strain plethysmography, and serum levels of inflammatory and thrombotic markers were determined by enzyme linked immunosorbent assay.Results: There was no significant difference in endothelium-dependent dilation (EDD) between the study groups, while EDD was correlated with fasting glucose levels in both INS (r = -0.776, p = 0.0001) and TABL (r = -0.702, p = 0.0001). Patients in INS group had higher levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), monocyte chemoattractant protein (MCP-1) and vascular cell adhesion molecule (sVCAM-1), compared to TABL. However, TNF-alpha was negatively correlated with protein C (PrtC) only in INS (r = -0.726, p = 0.01) but not in TABL group (r = -0.066, p = 0.738). Similarly, sVCAM-1 was correlated with PrtC only among INS patients (r = -0.45 1, p = 0.046) but not in TABL (r = 0.069, p = 0.727). In multivariate analysis, insulin dependence was a predictor of IL-6, TNF-u, MCP-1 and sVCAM-1 levels independently from the patients' demographic characteristics, the angiographic extend of CAD or the duration of diabetes.Conclusions: Insulin treatment in patients with type 2 diabetes mellitus affects the expression of inflammatory cytokines and subsequently modifies the thrombotic mechanisms in patients with coronary atherosclerosis, independently from the duration of diabetes and the extend of coronary artery disease.