CAJ | 학술논문

目的探讨急性冠脉综合征患者在不同糖耐量状态下,血清可溶性CD40配体(sCD40L)水平与冠脉狭窄程度的相关性.方法入选急性冠脉综合征患者154例,根据OGTT试验结果分三组:糖耐量正常组( NGT)61例、糖耐量减低组(IGT) 48例、2型糖尿病组(T2 )M)45例,三组均于入院时即行酶联免疫吸附法( ELISA)检测血清sCD40L水平,并对其行冠脉造影,采用Gensini 积分系统进行评分,比较各组患者sCD40L水平与冠脉狭窄程度的关系.结果三组患者中,糖耐量减低组[(41.8±19.8)分]和糖尿病组[(40.1±18.7)分]冠脉狭窄程度积分明显高于糖耐量正常组[(21.9±15.3)分](P＜0.01)；糖尿病组与糖耐量减低组间冠脉狭窄程度积分比较差异无统计学意义(P＞0.05)；糖耐量减低组血清sCD40L水平[(2.46±0.79) ng/ml]高于糖耐量正常组[(2.12±0.81)ng/ml](P＜0.05),糖尿病组[(2.57±0.68) ng/ml]明显高于糖耐量正常组(＜0.01)；糖尿病组高于糖耐量减低组,但差异无统计学意义(P＞0.05).三组患者血清可溶性sCD40L水平变化与冠状动脉狭窄程度无相关(r=-0.147,P＞0.05).结论 ACS患者在血糖轻度异常时CD40/CD40L即可过度激活,不一定血糖过高,即达到糖尿病状态时才有CD40/CD40L的激活；糖耐量异常的ACS患者中血清sCD40L水平与冠状动脉病变程度可能无相关.
목적 탐토급성관맥종합정환자재불동당내량상태하,혈청가용성CD40배체(sCD40L)수평여관맥협착정도적상관성.방법 입선급성관맥종합정환자154례,근거OGTT시험결과분삼조:당내량정상조( NGT)61례、당내량감저조(IGT) 48례、2형당뇨병조(T2 )M)45례,삼조균우입원시즉행매련면역흡부법( ELISA)검측혈청sCD40L수평,병대기행관맥조영,채용Gensini 적분계통진행평분,비교각조환자sCD40L수평여관맥협착정도적관계.결과 삼조환자중,당내량감저조[(41.8±19.8)분]화당뇨병조[(40.1±18.7)분]관맥협착정도적분명현고우당내량정상조[(21.9±15.3)분](P＜0.01)；당뇨병조여당내량감저조간관맥협착정도적분비교차이무통계학의의(P＞0.05)；당내량감저조혈청sCD40L수평[(2.46±0.79) ng/ml]고우당내량정상조[(2.12±0.81)ng/ml](P＜0.05),당뇨병조[(2.57±0.68) ng/ml]명현고우당내량정상조(＜0.01)；당뇨병조고우당내량감저조,단차이무통계학의의(P＞0.05).삼조환자혈청가용성sCD40L수평변화여관상동맥협착정도무상관(r=-0.147,P＞0.05).결론 ACS환자재혈당경도이상시CD40/CD40L즉가과도격활,불일정혈당과고,즉체도당뇨병상태시재유CD40/CD40L적격활；당내량이상적ACS환자중혈청sCD40L수평여관상동맥병변정도가능무상관.
Objective To explore the relationship between serum sCD40L level and coronary stenosis degree in acute coronary syndromes(ACS) patients with different glucose tolerance conditions.Methods 154 patients with ACS were divided into normal glucose tolerance group ( NGT),impaired glucose tolerance group (IGT) and type 2 diabetes group (T2DM) according to the OGTT.The levels of serum sCD40L were detected by ELISA,and all patients underwent coronary angiography in order to calculate their Gensini score.Then the relationship between serum sCD40L level and coronary stenosis was analyzed by statistics.Results The Gensini scores of IGT[(41.8 ± 19.8)score] and T2DM groups [(40.1 ± 18.7)score] were higher than NGT group [(21.9 ± 15.3)score] ( P ＜0.01 ),but there was no statistical difference between IGT and T2DM ( P ＞ 0.05 ) group.The serum sCD40L levels of IGT[(2.46 ± 0.79 )ng/ml]were higher than NGT group [(2.12 ± 0.81 )ng/ml] ( P ＜ 0.05 ),and the serum sCD40L levels in T2DM group [( 2.57 ± 0.68) ng/ml] were obviously higher than NGT group [( 2.12 ± 0.81 ) ng/ml] ( P ＜ 0.01 ).The serum sCD40L levels in T2DM group were higher IGT group,but there was no statistical difference between T2DM and IGT groups( P ＞0.05).Statistical analysis revealed that serum sCD40L levels had no statistical difference among the three groups and it had no relationship with coronary stenosis ( r =-0.147,P ＞0.05).Conclusions CD40/CD40L activation would occur in the patients of ACS with wildly abnormal blood sugar,not only in those who had diabetes with much higher blood sugar.The serum sCD40L level in the ACS patients with abnormal glucose tolerance had no relationship with the severity of coronary stenosis.