CAJ | 학술논문

目的：探讨冠心病（CHD）合并2型糖尿病（DM）患者冠状动脉狭窄与内皮功能损伤的相关性。方法选择行冠状动脉造影确诊的CHD患者86例，其中46例合并2型DM（DM组）、40例为非糖尿病患者（NDM组）。用Gensini积分法评估冠状动脉狭窄程度；硝酸还原酶法比色检测患者血浆一氧化氮（NO）浓度；ELISA法测定血浆内皮素（ET），血管性血友病因子抗原（vWF：Ag）、血小板膜蛋白-140（GMP-140）浓度；发光底物法测定血浆组织型纤溶酶原激活剂（t-PA）与血浆纤溶酶原激活物抑制剂-1（PAI-1）活性以评价内皮功能损伤情况。采用直线相关分析法对DM患者Gensini积分与内皮损伤相关指标进行分析。结果 DM组患者的Gensini积分明显大于NDM组（38.25±12.13vs.28.73±10.74，P＜0.05）；DM组患者的NO、t-PA水平明显低于NDM组[NO：（52.35±17.62）μmol/Lvs.（98.37±21.20）μmol/L；t-PA：（0.55±0.21）IU/Lvs.（0.87±0.26 IU/L）；P＜0.01]；而ET、PAI-1、vWF：Ag、GMP-140水平明显高于NDM组。DM组患者血浆NO（r=-0.803）、t-PA水平（r=-0.628）与Gensini积分呈显著负相关（P均＜0.01），而ET（r=0.713）、PAI-1（r=0.526）、vWF：Ag（r=0.705）和GMP-140（r=0.512）与Gensini积分呈显著正相关（P均＜0.01）。结论 CHD合并DM患者的Gensini积分与内皮损伤程度密切相关。严重的内皮功能损伤可能是DM患者冠状动脉狭窄程度较重的原因之一。
목적：탐토관심병（CHD）합병2형당뇨병（DM）환자관상동맥협착여내피공능손상적상관성。방법선택행관상동맥조영학진적CHD환자86례，기중46례합병2형DM（DM조）、40례위비당뇨병환자（NDM조）。용Gensini적분법평고관상동맥협착정도；초산환원매법비색검측환자혈장일양화담（NO）농도；ELISA법측정혈장내피소（ET），혈관성혈우병인자항원（vWF：Ag）、혈소판막단백-140（GMP-140）농도；발광저물법측정혈장조직형섬용매원격활제（t-PA）여혈장섬용매원격활물억제제-1（PAI-1）활성이평개내피공능손상정황。채용직선상관분석법대DM환자Gensini적분여내피손상상관지표진행분석。결과 DM조환자적Gensini적분명현대우NDM조（38.25±12.13vs.28.73±10.74，P＜0.05）；DM조환자적NO、t-PA수평명현저우NDM조[NO：（52.35±17.62）μmol/Lvs.（98.37±21.20）μmol/L；t-PA：（0.55±0.21）IU/Lvs.（0.87±0.26 IU/L）；P＜0.01]；이ET、PAI-1、vWF：Ag、GMP-140수평명현고우NDM조。DM조환자혈장NO（r=-0.803）、t-PA수평（r=-0.628）여Gensini적분정현저부상관（P균＜0.01），이ET（r=0.713）、PAI-1（r=0.526）、vWF：Ag（r=0.705）화GMP-140（r=0.512）여Gensini적분정현저정상관（P균＜0.01）。결론 CHD합병DM환자적Gensini적분여내피손상정도밀절상관。엄중적내피공능손상가능시DM환자관상동맥협착정도교중적원인지일。
Objective To discuss the correlation between coronary stenosis degree and endothelial dysfunction in the patients with coronary heart disease (CHD) complicating type 2 diabetes mellitus (DM).Methods The patients (n=86) diagnosed as CHD by coronary angiography (CAG) were chosen and were divided into DM group (CHD complicating DM,n=46) and NDM group (without DM, n=40). The degree of coronary stenosis was reviewed by using Gensini integral method. The level of plasma NO was detected by using nitrate reductase method. The levels of vWF:Ag and GMP-140 were detected by using ELISA. The activities of t-PA and PAI-1 and injury of endothelial function were determined by using chromogenic substrate assay. Gensini integrals and indexes related to endothelial dysfunction were analyzed by using linear correlation analysis.Results Gensini integrals were significantly higher in DM group than those in NDM group (38.25±12.13vs. 28.73±10.74,P<0.05), and levels of NO and t-PA were significantly lower in DM group than those in NDM group (52.35±17.62 μmol/L, 0.55± 0.21 IU/L; 98.37±21.20 μmol/L, 0.87±0.26 IU/L;P<0.01). The levels of ET, PAI-1, vWF:Ag and GMP-140 were significantly higher in DM group than those in NDM group [77.72±19.34 μmol/L, 0.77±0.26 IU/L, (376.56 ±87.67)%, 29.85±9.12 g/L; 57.68±15.58 μmol/L, 0.51±0.18 IU/L, (239.81±65.73)%, 18.96±8.07 g/L;P<0.01]. The levels of NO and t-PA were negatively correlated to Gensini integrals (r=-0.803,r=-0.628; all P<0.01), while levels of ET, PAI-1, vWF:Ag and GMP-140 were positively correlated to Gensini integrals (r=0.713, r=0.526,r=0.705,r=0.512; allP<0.01).Conclusion Gensini integrals are closely correlated to the degree of endothelial dysfunction, and severe endothelial dysfunction may be one of causes of exacerbated coronary stenosis in the patients with CHD complicating DM.