内源性分泌型糖基化终末产物受体及糖基化白蛋白与2型糖尿病合并冠心病的关系

目的:探讨血清内源性分泌型糖基化终末产物受体(esRAGE)、糖基化白蛋白(GA)水平与糖尿病合并冠心病及冠脉病变严重程度的关系。方法:入选2型糖尿病患者(冠状动脉正常)302例(2型糖尿病组)及2型糖尿病合并冠心病(CAD)患者357例(2型糖尿病并CAD组)。测定并比较二组血清esRAGE、GA水平并分析其与CAD及冠脉病变严重程度的关系。结果:2型糖尿病并CAD组血清GA水平(21.28±4.31%)及GA/esRAGE比值(1.21±0.68)明显高于2型糖尿病组(19.41±3.62%及0.78±0.46,均P<0.01),esRAGE水平(0.22±0.10ng/ml)明显低于2型糖尿病组(0.31±0.14ng/ml,P<0.01);冠脉3支病变组血清esRAGE水平低于1及2支病变组(均P<0.01);冠脉3支病变组血清GA水平、GA/esRAGE比值高于1及2支病变组(均P<0.01)。血清GA水平及GA/esRAGE比值与冠脉病变严重程度呈正相关,esRAGE水平与冠脉病变严重程度呈负相关。结论:血清高GA水平及低esRAGE水平与2型糖尿病并CAD及冠脉病变严重程度相关。糖基化负荷增加伴保护因素削弱,是2型糖尿病患者合并CAD的易感因素,GA/esRAGE比值是反映糖基化负荷与保护因素之间不平衡的简易而有效的指标。

Relation of Serum Levels of Endogenous Secretory Receptor for Advanced Glycation End-products and Glycated Albumin to Coronary Artery Disease in Type 2 Diabetes Mellitus

Objective:To investigate the relation of serum levels of glycated albumin(GA) and endogenous secretory receptor for advanced glycation end-products(esRAGE) to coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM). Method: Serum levels of GA,esRAGE concentration were measured in 302 patients with T2DM and 357 patients with T2DM and significant CAD (T2DM and CAD group) . The relation between biochemical measurements and CAD,number of diseased coronary arteries were analyzed. Results: Serum levels of GA(21.28±4.31%),GA/esRAGE ratio (1.21±0.68) were significantly higher in T2DM and CAD group than T2DM group (19.41±3.62% and 0.78±0.46,all P<0.01). Serum esRAGE level was significantly lower in T2DM and CAD group(0.22±0.10ng/ml ) than T2DM group(0.31±0.14ng/ml,P<0.01). Serum esRAGE level was significantly lower in 3-vessel disease than those of 1,2-vessel disease,Serum GA level and GA/esRAGE ratio were significantly higher in 3-vessel disease than those of 1,2-vessel disease (all P<0.01).Serum GA level and GA/esRAGE ratio correlated positively with severity of CAD,and esRAGE values correlated inversely with severity of CAD (all P<0.01).Conclusion: Serum GA and esRAGE levels are associated with presence and severity of CAD in patients with type 2 diabetes. Increased glycation load and impaired protective effect contribute to CAD in patients with type 2 diabetes. GA / esRAGE ratio is a feasible and effective variable for reflecting imbalance of glycation load and protective effect.