CAJ | 학술논문

目的：探讨血管细胞粘附因子-1（VCAM-1）、血清细胞粘附因子-1（ICAM-1）在老年糖尿病性心肌病早期诊断中的价值。方法以老年糖尿病性心肌病（DCM）患者为研究对象，根据有无合并症状性心力衰竭分为有心衰症状组（DCM1组）和无心衰症状组（DCM2组），另外设性别、年龄相匹配的单纯2型糖尿病组（DM 组）。所有受试者均检测血清粘附因子 VCAM-1、ICAM-1和血浆脑利钠肽（BNP），同时进行超声心动图检查。结果①与单纯 DM组比较，DCM1组和 DCM2组 VCAM-1、ICAM-1均明显升高，且 DCM1组较 DCM2组升高有显著性（P <0.05）；②DCM1组左室结构各项指标比 DCM2组和单纯 DM 组有明显升高（P <0.05），DCM1组左室功能各项指标比 DCM2组和单纯 DM 组则有明显下降（P <0.05），而 DCM2组与单纯 DM 组间比较，仅舒张功能有显著性差异；③血清VCAM-1、IVAM-1分别与 BNP、左房内径（LA）、左室内径（LV）呈正相关，与左室后壁厚度（ LVPW）、室间隔厚度（IVS）、射血分数（EF%）、短轴缩短率（FS%）、舒张早晚期充盈峰值流速比值（PVE/ PVA）呈负相关（P <0.05或<0.01）。结论粘附因子 VCAM-1、ICAM-1与老年糖尿病性心肌病的发生、发展密切相关，可作为老年糖尿病性心肌病早期诊断的指标。
목적：탐토혈관세포점부인자-1（VCAM-1）、혈청세포점부인자-1（ICAM-1）재노년당뇨병성심기병조기진단중적개치。방법이노년당뇨병성심기병（DCM）환자위연구대상，근거유무합병증상성심력쇠갈분위유심쇠증상조（DCM1조）화무심쇠증상조（DCM2조），령외설성별、년령상필배적단순2형당뇨병조（DM 조）。소유수시자균검측혈청점부인자 VCAM-1、ICAM-1화혈장뇌리납태（BNP），동시진행초성심동도검사。결과①여단순 DM조비교，DCM1조화 DCM2조 VCAM-1、ICAM-1균명현승고，차 DCM1조교 DCM2조승고유현저성（P <0.05）；②DCM1조좌실결구각항지표비 DCM2조화단순 DM 조유명현승고（P <0.05），DCM1조좌실공능각항지표비 DCM2조화단순 DM 조칙유명현하강（P <0.05），이 DCM2조여단순 DM 조간비교，부서장공능유현저성차이；③혈청VCAM-1、IVAM-1분별여 BNP、좌방내경（LA）、좌실내경（LV）정정상관，여좌실후벽후도（ LVPW）、실간격후도（IVS）、사혈분수（EF%）、단축축단솔（FS%）、서장조만기충영봉치류속비치（PVE/ PVA）정부상관（P <0.05혹<0.01）。결론점부인자 VCAM-1、ICAM-1여노년당뇨병성심기병적발생、발전밀절상관，가작위노년당뇨병성심기병조기진단적지표。
Objective:To explore the value of vascular cell adhesion factor-1(VCAM-1)and cell adhesion factor-1 (ICAM-1)in early diagnosis of elderly patients with diabetic cardiomyopathy. Methods:The old patients with diabetic car-diomyopathy(DCM)were taken as the research subjects,and according to the presence of merger symptomatic heart fail-ure,they were divided into heart failure symptoms(DCM1 group)and heart failure group(DCM2 group)with no symp-toms,and simple type 2 diabetes mellitus group(DM group)were set up with gender and age matched. Serum adhesion factor VCAM-1,ICAM-1 and plasma brain natriuretic peptide(BNP)were detected in all the subjects,at the same time echocardiography was done to measure the filling velocity peak of early and late diastolic(E,A)in order to calculate E/ A ratio,which was used to represent the left ventricular diastolic function;and the ejection fraction(EF)% and short axial shortening rate(FS)% were used to express left ventricular systolic function indexes. Results:①Compared with pure DM group,VCAM-1,ICAM-1 were significantly elevated in DCM1 and DCM2 groups,and compared with DCM1 group,those in DCM2 group increased more obviously(P < 0. 05). ②Each index of left ventricular structure in DCM1 group signifi-cantly increased than that in DCM2 group and pure DM group(P < 0. 05). Meanwhile each index of left ventricular func-tion in DCM1 group was significantly decreased than that of DCM2 group and pure DM group(P < 0. 05). While compared with pure DM group,only diastolic dysfunction had significant difference in DCM2 group. ③IVAM-1,VCAM-1 were re-spectively positively correlated with BNP level,left atrial diameter(LA),left the interior diameter(LV),and were nega-tively correlated with left ventricular posterior wall thickness(LVPW),thickness of interventricular septum(IVS),EF, FS,PVE/ PVA(P < 0. 05 or P < 0. 01). Conclusion:Adhesion factor VCAM-1,ICAM-1 are closely related to the occur-rence and development of diabetic cardiomyopathy,and may be used as indicators in early diagnosis of elderly patients with diabetic cardiomyopathy.