| Impaired glucose tolerance(IGT)and atherosclerosis(AS)may be two concurrent diseases based on the same pathological basis,and inflammatory response may be a common cause.Tumor necrosis factor-alpha(TNF-alpha)is a heterogeneous inflammatory cytokine that plays an important role in the inflammatory response and may be involved in the development of impaired glucose tolerance and macrovascular complications.Objective1.To observe the changes of serum TNF-a concentration in patients with impaired glucose tolerance and carotid atherosclerosis.2.To investigate the changes of serum TNF-alpha expression in patients with impaired glucose tolerance and carotid atherosclerosis,and to provide theoretical basis for the study of impaired glucose tolerance patients with vascular lesions.MethodFrom October 2014 to October 2015,112 patients diagnosed as IGT in the Department of Neurology and endocrinology of East Hospital District of Tianjin First Central Hospitalwere selected,including 64 males and 48 females,aged(53.5 ± 10.6)years.All cases of IGT were in accordance with who’s diagnostic criteria for impaired glucose tolerance in 1999.Type 1 and type 2 diabetes mellitus,secondary diabetes mellitus,diabetic complications,blood system diseases,rheumatic and immune diseases,history of malignant tumors,recent history of major surgical trauma,severe heart,liver and kidney dysfunction,pregnancy and lactation were excluded.All patients used diet control to reduce blood sugar,and did not receive oral medicine and insulin treatment.According to the criteria of arteriosclerosis,IGT patients were divided into two groups,i.e.IGT with CAAS group(group A)and IGT group(group B).There was no significant difference between the two groups in the course of disease and blood glucose level.According to whether there was plaque,IGT patients were divided into plaque group and plaque group.In addition,56 cases of physical examination in our hospital were selected as the control group(Group C);30 men and28 women,54.4 ± 10.5 years old,all of whom had undergone detailed medical history,physical examination and related laboratory tests,excluding diabetes,hypertension,coronary heart disease,liver dysfunction,cerebrovascular disease and other physical diseases,and had not taken any drugs in the past two months.All patients’ sex,age,smoking,drinking,height,weight,blood pressure(SBP,DBP),BMI,FBG,Hb A1 c,TG,LDL-C,TC,HDL-C,serum TNF-α concentration of all subjects were measured,and carotid arteries were used for imaging diagnosis;According to the standard of atherosclerosis diagnosis-color Doppler ultrasound,carotid intima and plaque formation were measured.IGT patients were divided into two groups: IGT with CAAS(group A)and IGT alone(group B).There was no significant difference in course of disease and blood glucose level between the two groups.Take another physical examination in our hospital.Fifty eight patients(30 males and 28 females),aged 54.4 ± 10.5 years,served as the normal control group(Group C).All patients were asked about their medical history,physical examination and related laboratory tests in detail to exclude diabetes,impaired glucose tolerance,hypertension,coronary heart disease,liver dysfunction,cerebrovascular disease and other diseases.They also did not take any drugs in the past two months.In the morning,blood was drawn from elbow vein in fasting and lying position.Take 4ml each time,divide it into two test tubes,and send them to the laboratory of our hospital for blood lipid,blood glucose,glycosylated hemoglobin,insulin and other tests.Hb A1 c was detected by high pressure liquid phase method.TC,TG,LDL-C and HDL-C were detected by automatic biochemical analyzer of Beijing Pulang company.The other tube was kept for 30 minutes,then 3000 rpm / heart separation for 10 minutes.After separation,the serum was taken from the upper layer,sub packed in EP tube,stored in low temperature refrigerator at-80 ℃ for standby.This operation was completed within 15 minutes to avoid repeated freezing and thawing.After the blood sample was collected,the serum TNF-α level was determined by enzyme-linked immunosorbent assay.Analysis of variance of TNF-α between Ig group and control group.Analysis of variance of TNF-α in the group of IGT combined with CAAS.Logistic regression analysis of risk factors of carotid atherosclerosis in IGT.Spss21.0 statistical software was used to process the data,and variance analysis was used to compare the measurement data of multiple groups.Chi square test was used to count the data between the two groups,and logistic regression analysis coefficient was calculated.P ≤ 0.05 was considered statistically significant,P ≤ 0.01 was statistically significant.The inspection level adopts a equal to 0.05.Result1.The level of serum TNF-a in the impaired glucose tolerance group with or without carotid atherosclerosis was higher than that in the control group,and the difference was statistically significant.(P<0.01)2.The level of serum TNF-a in patients with impaired glucose tolerance with atherosclerosis was higher than that in patients with impaired glucose tolerance alone,and the difference was statistically significant.(P<0.01)3.Comparison of serum TNF-alpha level between the atherosclerotic plaque group and the non-atherosclerotic plaque group: the serum TNF-alpha level of the former was significantly higher than that of the latter,and the difference was statistically significant(P<0.05).Conclusion1.Impaired glucose tolerance is involved in the formation of carotid atherosclerosis as pre-diabetes,and its mechanism may be related to inflammation.As an inflammatory factor,TNF-a may be involved in the formation of atherosclerosis and the occurrence and development of plaques.2.The severity of carotid atherosclerosis in patients with impaired glucose tolerance is significantly correlated with the level of serum TNF-alpha expression.Serum TNF-alpha expression level can be used as a laboratory reference index for early diagnosis of macrovascular lesions and judgment of severity in patients with impaired glucose tolerance. |
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