Association Of Serum Soluble CD40 Ligand And Carotid Atherosclerosis In Type 2 Diabetics With Acute Cerebral Infarction

Diabetes mellitus is associated with a high incidence of cerebrovascular disease, carotid atherosclerosis is the commen cause of acute cerebral infarctions. Recent studies have demonstrated that soluble CD40 ligand (sCD40L) participates in initiation, evolution, and acute complications after the rupture of atherosclerotic lesions. sCD40L is the research focus in the acute coronary syndrome recently. But there are few studies of sCD40L in the acute cerebral infarction.Objective:To investigate the changes of serum concentrations of sCD40L and the characteristics of carotid atherosclerosis in type 2 diabetics with acute cerebral infarction, then to explore the relationship between serum soluble CD40 ligand and carotid plaque stability, and to study the predicted value of cerebral infarction.Methods:101 type2 diabetic patients admitted to Qilu Hospital of Shandong University from April 2008 to June 2009 were divided into two groups:32 subjects with simple type 2 diabetes mellitus (group DM), averaged at 61.26±9.19 years old.69 patients of type 2 diabetes mellitus with acute cerebral infarction (group DACI), averaged at 65.26±9.14 years old.28 normal controls (group NC) were included, averaged at 61.09±8.78 years old. Height, weigh, BMI, FBG, TC, TG, LDL-C, HDL-C and HbA1c were measured. The serum levels of sCD40L were measured by the enzyme-linked immunosorbent assay(ELISA).Intima-media thickness (IMT), plaque echogenicity and morpholog were detected by duplex color doppler ultrasound and Crouse score was calculated. Group DACI was divided into stable plaque and unstable plaque subgroups according to ultrasound results.Results:1.There was no significant difference in age, TC, BMI and diastolic blood pressure(DBP) in the three groups(P>0.05).TG, LDL-C, the systolic blood pressure(SBP), FBG, HbA1c of diabetic patients and diabetics with acute cerebral infarction were higher than those in healthy controls and HDL-C lower (P＜0.05).2. Compared with group NC, the concentrations of sCD40L were higher in other two groups(P< 0.05). Furthermore, serum sCD40L levels in unstable plaque subgroup showed higher than stable plaque subgroup (P< 0.05).3. There were statistically significant differences of IMT, the prevalence of carotid plaques and Crouse score in the three groups(P< 0.05). Compared with those of healthy controls and simple type 2 diabetics, group DACI mainly exhibited unstable plaques.4.The level of serum sCD40L was positively related with IMT (r=0.733, P< 0.01) Crouse score (r=0.645, P< 0.01), HbA1c (r=0.272,P<0.05), and triglyceride (TG) (r=0.276, P<0.05)Conclusions:1.The serum levels of sCD40L in type 2 diabetics with acute cerebral infarction were significantly increased, indicating it may be important risk factor of acute ischemic cerebrovascular disease.2. High levels of circulating sCD40L may predict an increased rate of atherosclerotic plaque rupture, suggesting that it may participate the attack of acute cerebral infarction by affecting the stability of carotid atherosclerofic plaque.3.The serum level of sCD40L has a positive correlation with TG,HbA1c showing that lipids and glucose may play important roles in the development of inflammation.