糖尿病大血管病变

　　【摘要】 目的 探讨B型脑钠肽(BNP)和可溶性血管细胞黏附分子1(sVCAM-1)水平在T2DM合并冠心病(CHD)危险分层中的临床意义。 方法 选取T2DM合并CHD患者(T2DM+CHD组)64例和T2DM未合并CHD患者(T2DM组)64例，进一步将T2DM+CHD组分为急性心肌梗死(AMI)亚组、不稳定型心绞痛(UAP)亚组和稳定型心绞痛(SAP)亚组，检测各组BNP、sVCAM-1等指标水平。 结果 与T2DM组相比，T2DM+CHD组血清BNP、sVCAM-1水平升高，且各亚组间比较差异有统计学意义(P<0.01)。BNP、sVCAM-1与HbA1c呈正相关，且BNP 与sVCAM-1呈正相关(r=0.376，P<0.05;r=0.652，P<0.05;r=0.309，P<0.05)。Logistic多元回归分析显示，HbA1c、TC、LDL-C、BNP和sVCAM-1是T2DM合并CHD发生的危险因素。 结论 联合检测血清BNP、sVCAM-1水平对T2DM合并CHD危险分层有重要的判断意义，BNP可作为预测T2DM患者心血管病变的标记物。

　　【关键词】 B型脑钠肽;可溶性血管细胞黏附分子1;糖尿病，2型;冠心病;危险分层

　　　【Abstract】 Objective To investigate the clinical significance of brain natriuretic peptide (BNP) and solube vascular cell adhesion molecule-1 (sVCAM-1) levels on risk stratification in T2DM patients with coronary heart disease (CHD). Methods 64 cases of T2DM with CHD patients and 64 cases of T2DM without CHD patients were selected. According to the clinical types, T2DM+CHD patients were divided into acute myocardial infarction, unstable angina and stable angina subgroups. BNP, sVCAM-1 and other standards were detected among groups. Results Compared with T2DM group, serum BNP and sVCAM-1 levels were significantly increased in T2DM+CHD group, and there were differences among acute myocardial infarction, unstable angina and stable angina subgroups (P<0.01). BNP and sVCAM-1 were positively correlated with HbA1c, and BNP was positively correlated with sVCAM-1 (r=0.376，P<0.05;r=0.652，P<0.05;r=0.309，P<0.05). Logistic regression analysis showed that, HbA1c, TC, LDL-C, BNP and sVCAM-1 were risk factors in T2DM with CHD. Conclusion It is important to detect serum BNP and sVCAM-1 simultaneously to judge the risk stratification in T2DM patients with CHD, BNP levels can be as a marker to predict the cardiovascular events in patients with diabetes markers.

　　【Key words】 Brain natriuretic peptide (BNP);Soluble vascular cell adhesion molecule-1 (sVCAM-1);Diabetes mellitus，type 2;Coronary heart disease (CHD);Risk stratification