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2型糖尿病Toll样受体4与颈动脉内膜中层厚度的相关性研究

?糖尿病相关研究?

DOI:10.3760/cma.j.issn.1000?6699.2015.12.002

基金项目:国家自然科学基金资助项目(81260136,30960147);甘肃省自然科学基金资助项目(1010RJZA178)

作者单位:730000兰州,甘肃中医药大学(吕亚亚);甘肃省人民医院内分泌科,甘肃省内分泌代谢病重点实验室(师维雅二许衍甲二权金星二刘静),体检中心(左玉琼二何启娟),临床检验中心(李永红),超声诊断科(周祖邦)

通信作者:权金星,Email:quanxt@http://www.wendangku.net/doc/019d26bda98271fe900ef968.html

2型糖尿病Toll 样受体4与颈动脉内膜中层厚度的相关性研究

吕亚亚 师维雅 左玉琼 何启娟 李永红 周祖邦 许衍甲 权金星 刘静

【摘要】 目的 探讨2型糖尿病患者外周血单个核细胞Toll 样受体4(TLR4)信号与颈动脉内膜中层厚度(CIMT)的相关性三方法

选取本院2型糖尿病住院患者66例,其中2型糖尿病无大血管病变组

[CIMT<0.9mm]20例,2型糖尿病合并大血管病变组(CIMT≥0.9mm 或有颈动脉斑块)46例三性别二年龄匹配的健康志愿者40名作为对照组三采用流式细胞术检测外周血单个核细胞TLR4表达水平,测定CIMT二超敏C 反应蛋白(hs?CRP)二白细胞介素(IL)?6和单核细胞趋化蛋白1(MCP?1)水平三应用单因素方差分析二Pearson 相关分析二多元线性回归分析及logistic 回归分析等进行数据分析三结果2型糖尿病合并大血管病变组TLR4表达水平显著高于2型糖尿病无大血管病变组和对照组[(18.60±4.64对14.92±3.47,12.80±2.60),P <0.05];2型糖尿病合并大血管病变组IL?6二hs?CRP 及MCP?1水平较对照组显著增高[(6.08±3.16对4.52±2.04)pg /ml,(2.67±2.40对1.53±1.49)mg /dl,(307.99±113.39对242.50±48.04)pg /ml,均P <0.05],但与2型糖尿病无大血管病变组比较无显著性差异(均P >0.05);Pearson 相关分析表明:CIMT 与TLR4二IL?6二hs?CRP二MCP?1二年龄二空腹血糖二HbA 1C 和稳态模型评估的胰岛素抵抗指数(HOMA?IR)呈正相关(r =0.540二0.244二0.271二0.329二0.381二0.490二0.471二0.410,均P <0.05),与高密度脂蛋白胆固醇(HDL?C)呈负相关(r =-0.323,P <0.05)三TLR4与CIMT二HOMA?IR二IL?6二hs?CRP 和MCP?1呈正相关(r =0.540二0.428二0.214二0.242二0.385,均P <0.05),与HDL?C 呈负相关(r =-0.384,P <0.05)三多元线性逐步回归分析显示:TLR4二年龄二空腹血糖是CIMT 的独立影响因素(R 2=0.292二0.423二0.492,均P <0.05)三Logistic 回归分析显示TLR4水平升高是颈动脉斑块形成的危险因素(OR =1.345,95%CI 1.10~1.64,P <0.05)三结论

提示TLR4炎症信号通路参与2型糖尿病大血管并发症的发生,TLR4水平升高可

能是颈动脉斑块形成的一个危险因素三

【关键词】 糖尿病,2型;Toll 样受体4;动脉粥样硬化;颈动脉内膜中层厚度

The correlation between toll like receptor 4and carotid intima?media thickness in patients with type 2diabetes Lyu Yaya *,Shi Weiya ,Zuo Yuqiong ,He Qijuan ,Li Yonghong ,Zhou Zubang ,Xu Yanjia ,Quan Jinxing ,Liu Jing.*Gansu University of Traditional Chinese Medicine ,Lanzhou 730000,China Corresponding author :Quan Jinxing ,Email :quanxt@http://www.wendangku.net/doc/019d26bda98271fe900ef968.html

【Abstract 】 Objective To investigate the correlation between toll like receptor 4(TLR4)pathway and carotid intima?media thickness (CIMT)in patients with type 2diabetes mellitus (T2DM).Methods A total of 66patients with T2DM were classified into two groups based on the value of CIMT,T2DM without macrovascular injury group (CIMT <0.9mm,20subjects)and T2DM with macrovascular injury group (CIMT≥0.9mm,or with plaques,46subjects),40gender and age matched healthy subjects were used as the control group.The CIMT,serum levels of high?sensitivity C?reactive protein (hs?CRP),interleukin?6(IL?6),and monocyte chemotactic protein?1(MCP?1)were tested.The level of TLR4protein expression on peripheral blood monocyte cells was detected using flow cytometry.Single?factor analysis of variance,Pearson linear analysis,multivariate linear stepwise regression model,and Logistic regression model were performed to analyze the data.Results The level of TLR4in T2DM with macrovascular injury group was significantly higher than that in both the T2DM without macrovascular injury group and the control group[(18.60±4.64vs 14.92±3.47,12.80±2.60),all P <0.05].In addition,the levels of IL?6,hs?CRP,and MCP?1in T2DM with macrovascular injury group were significantly increased as compared with those in control group[(6.08±3.16vs 4.52±2.04)pg /ml,(2.67±2.40vs 1.53±1.49)mg /dl,(307.99±113.39vs 242.50±48.04)pg /ml,respectively all P <0.05],but there was no significant difference between T2DM with injury group and T2DM without macrovascular injury group.Pearson linear analysis showed that CIMT

7101四中华内分泌代谢杂志2015年12月第31卷第12期 Chin J Endocrinol Metab,December 2015,Vol.31,No.12