| Objective:Glucose variability and endothelial cell injury were compared in acute coronary syndrome(ACS) patients with or without type2diabetes mellitus (T2DM). And explored the relationship between the blood glucose variability and inflammation and the effect of blood glucose variability on endothelial cell injury and the severity of coronary artery stenosis in ACS patients.Methods:A total of32patients with acute coronary syndrome (ACS) were enrolled consecutively from January2011to November2011in the Military General Hospital of Beijing PLA, Department of Cardiology. Twenty cases (12males and8females, age (60.2±10.9) yrs) with type2diabetes mellitus(T2DM) and acute coronary syndrome(A group); and twelve cases(8males and4females, age (57.9±11.2)yrs)without T2DM(B group), Ten (4males and6females, age (56.3±6.1)yrs) healthy volunteers were selected as NC group. To detect clinical and biochemical indicators, the concentration of von Willebrand factor (vWF) of each group were measured by ELISA; All the participants underwent continuous glucose monitoring(CGM) for72hours to evaluate CGMS parameters such as largest amplitude of blood glucose excursion(LAGE), mean amplitude of glycemic excursions(MAGE), standard deviation of blood glucose(SDBG), absolute means of daily differences(MODD), postprandial glucose excursion(MPPGE), the mean postprandial maximum glucose(MPMG); The severity scale of coronary artery stenosis was quantitatively assessed according to coronary angiography by Gensini score. The measurement data of two groups were compared with independent samples Test,The data of multiple groups were compared by single factor analysis of variance, and the comparison between two groups was performed with LSD test, Correlation analysis using Pearson correlation and multiple stepwise regression analysis.(1) the clinical characteristics, blood glucose fluctuation parameters and vWF level were compared among the three groups;(2) The correlation was analyzed between blood glucose fluctuations parameters and other clinical and biochemical indicators;(3)Coronary lesion severity of relevant factors (indicators is Gensini narrow fraction) were analysised by Stepwise multiple regression;(4)Endothelial dysfunction related factors(indicators is vWF) were analysised by Stepwise multiple regression.Results:(1) Compared with control group[(5.1±0.4)mmol/L,(1.0,0.9～1.1)mg/L,(1.6,1.5～1.7),(141.9±46.4)U/L], the level of Fasting plasma glucose(FPG), C reactive protein(CRP), Homeostatic model assessment-insulin resistance index(HOMA-IR), vWF in group A [(10.7±4.5)mmol/L,(7.1,4.14-12.2)mg/L,(7.8,5.6-11.0),(521.7±247.7)], and group B[(9.1±5.3)mmol/L,(7.6,4.4-13.1)mg/L,(3.7,2.6-5.3),(266.6±91.9)U/L] were significantly higher (F=5.742,3.572,24.761,13.459, p<0.01). Compared with group B [(5.3±0.4)%,(10.4,9.7～11.1)ImU/L], the level of Glycosylated hemoglobin(HbAlc)(8.3±1.4)%, Fasting Insulin(Fins)(18.5,13.6～25.1)ImU/L, HOMA-IR, vWF were significantly higher in group A (all P<0.01).(2) Compared with control group [(1.2,2.7～3.8),(0.4,1.2～1.8),(0.3,0.6～1.0)mmol/L], there were significantly higher levels of LAGE, MAGE, SDBG in group A [(2.3,8.7～12.4),(1.8,4.8～8.1),(0.9,2.1～3.2)mmol/L], and in group B[(1.6,4.7～5.7),(0.9,1.8～3.1),(0.1,1.1～1.2)mmol/L],(F=56.060,34.414,42.153, all P<0.01), and MODD, MPPGE, MPMG in group A were significantly higher than group NC[(2.9±1.6)vs(0.7±0.2),(3.6±1.6)vs(2.0±0.2),(14.5±2.8)vs(2.9±0.7)mmol/L],(F=11.955,17.637,50.732, all P<0.01). Compared with group B, there were significantly higher levels of LAGE, MAGE, SDBG, MODD, MPPGE, MPMG in group A(all P<0.01).(3)Compared with control group [(0.7±0.3),(0.3±0.1),(0.4±0.1)mmol/L], there were significantly higher levels of PPGE1, PPGE2, PPGE3in group A [(2.2±1.0),(0.7±0.4),(0.7±0.4)mmol/L] and in group B [(1.1±0.3),(0.5±0.1),(0.3±0.1)mmol/L],(F=21.743,20.261,9.208, all P<0.01). Compared with group B, there were significantly higher levels of PPGE1, PPGE2, PPGE3in group A(all P<0.01).(4)In correlation analysis, MAGE were positively related to age, HbAlc, HOMA-IR, CRP,vWF(r=0.618,0.405,0.365,0.479, all P<0.01), LAGE, MAGE, SDBG and MPPGE were positively related with the level of HOMA insulin resistance index (HOMA-IR)(0.466,0.376,0.300,0.663, all P<0.05).(5) In the ACS group, Gensini score was taken as the dependent variable and the various relative factors as the independent variables, multiple stepwise regression analysis showed that MAGE, MODD, and CRP were Independently associated with Gensini score (Gensini分数=82.386+24.892MAGE+7.244CRP+49.396MODD (F=29.440,20.471,16.757, P<0.001).(6) In the ACS group, vWF was taken as the dependent variable and the various relative factors as the independent variables, multiple stepwise regression analysis showed that MAGE, CRP were the impact factors of Endothelial Dysfunction vWF=204.733+28.314MAGE+7.505CRP (F=14.902,13.656, P<0.001).Conclusion:(1)Compared with group NC, MAGE, the state of inflammation and the degree injury of endothelial cell was significantly worse with ACS patients, especially ACS patients with type2diabetes.(2)The mean amplitude of glycemic excursions might through triggering and heighten oxidative stress and the inflammatory reaction, mediated endothelial cell injury. (3)Compared with persistent hyperglycemia,acute glucose fluctuations might further aggravate the degree of coronary lesions.(4)HbAlc might be relevant to blood sugar fluctuations. |
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