Impact Of Glucose Excursion,vWF And HMGB1 On Coronary Artery Stenosis In Type2 Diabetic Patients With Coronary Heart Disease

ObjectIn this study,select patients with type 2 diabetes mellitus and coronary artery disease as the main research object, through the comparison of coronary heart disease group(CHD&DM) and coronary heart disease group(DM),analyze the correlations among blood glucose fluctuation parameters、clinical biochemical and Gensini score.To provide new evidence on the blood glucose fluctuation and the role of large vascular lesion and its mechanism,provide theoretical basis for the treatment of diabetic patients and the protection of large vascular patients.MethodsSelect eighty diagnosed of type2 diabetic patients as the research object,50 cases were merged with coronary heart disease(group CHD&DM), and 50 cases were not merged with coronary heart disease(group DM).Record all the research object of general clinical data for 72 hours through the continuous glucose monitoring system (CGMS, MiniMed) and analysis the CGMS parameters,for example mean amplitude of glycemic excursions (MAGE), mean postprandial glucose excursion(MPPGE), the largest amplitude of glycemic excursions(LAGE),absolute means of daily differences(MODD),meanwhile measure the levels’of high mobility group proteins(HMGB1) and von willebrand factor(vWF).Doctors can score coronary angiography using Gensini scoring criteria,according to Gensini score we divided the patients into three groups:GroupA(18):1≤Gensini score<20;groupB(15):20<Gensini score<40;group C(17):Gensini score≥40.Compare the levels of HMGB1,vWF and blood sugar fluctuation parameters between the two groups,then analyze the correlations among blood glucose fluctuation parameters、clinical biochemical and Gensini score.All analyses were performed using the SPSS version 17.0 software package.All continuous variables were tested for normal distribution and homogeneity for variance.Measurement date was expressed as mean±standard deviation (x±s),median with interquartile range,qualitative variables were expressed as numbers and percentages.Quantitative variables were analyzed by Student’s t tests (for normally distributed quantitative items) and one way ANOVA and Mann-Whiteney U tests or Kruskal-Wallis tests as appropriate.Choosing the right time to check the variables by pearson correlation analysis and multivariate regression analysis.Result1. The differences in both group CHD&DM in generally clinical and biochemical data There are two groups of BMI,age, gender, systolic blood pressure, diastolic blood pressure, the application of hypoglycemic drugs, use of lipid-lowering drugs, cholesterol, FPG, HOMA-IR, HbAlc and the difference have no statistically significant (P> 0.05), but there was statistical significance in the course of disease.2. The comparison between glucose fluctuation, vWF, HMGB1 in CHD&DM each groupThere were significantly higher levels of disease course,glucose fluctuation index,high mobility group proteins(HMGB1),von willebrand factor(vWF) in group CHD&DM compared to group DM(P<0.05).According to the Gensini scores we divided the CHD&DM group into A,B,C groups and among the three groups the difference was statistically significant(P<0.05). The levels of MAGE, LAGE, MPPGE, MODD,HMGB1, vWF in group B&C was higher than group B(P<0.05), meanwhile,the difference between group C and B group is also significance(P<0.05).3. Correlation analysis of CHD&DM groupCorrelation analysis showed that the levels of MAGE, LAGE, MODD, MPPGE, vWF, HMGB1, age, TC in CHD&DM group were significantly related to the Gensini score(r=0.267,0.341,0.533,0.341,0.635,0.691,0.226,0.106, P< 0.05).The regression analysis suggests that vWF, HMGB1 and MAGE were dependent risk to Gensini score(Gensini= 342.865+35.117MAGE+14.821HMGB1+7.927vWF).4. Correlation between the group of CHD&DM and DM Correlation analysis showed that the levels of vWF, HMGB1,HOMA-IR were significantly related to the MAGE(r=0.51、0.50、03, P<0.05).The regression analysis suggests that HMGB1 and MAGE were dependent risk to vWF (vWF= 65.89+23.18MAGE+19.13HMGB1)Conclusions1.The level of blood glucose fluctuation was increased in type 2 diabetic patients with coronary heart disease.2.The greater of blood glucose fluctuation the serious of the coronary atherosclerosis.3.Blood glucose fluctuation is the main factors of type 2 diabetes mellitus with coronary heart disease in atherosclerosis.