【摘要】 目的 探讨糖尿病心肌病(DCM)与外周血单个核细胞E26转录因子(Ets)1的表达相关性,初步探讨Ets-1在DCM发病机制中可能的作用,为临床诊治DCM提供新的思路。方法 选择2010年1-12月广东医学院附属医院DCM患者28例(DCM组)、单纯2型糖尿病患者30例(2型糖尿病组)和同期体检健康者30例(对照组)。采用SYBR Green I实时荧光定量逆转录聚合酶链反应检测外周血单个核细胞Ets-1 mRNA表达,记录其他临床及实验室生化指标。结果 ①DCM组LDL-C、TG高于对照组,二尖瓣舒张早期血流速度峰值/舒张晚期血流速度峰值(E/A)比值低于对照组,组间差异均有统计学意义[LDL-C:(3.3±1.2)mmol/L比(2.5±0.8)mmol/L,TG:(3.5±1.8)mmol/L比(1.8±0.6)mmol/L,E/A:(0.45±0.14)比(1.24±O.16),均P<0.05];DCM组和2型糖尿病组空腹血糖(FBG)、糖化血红蛋白(HbAle)均高于对照组,组间差异均有统计学意义[DCM组分别为(8.7±3.6)mmol/L和(8.5±2.6)%,2型糖尿病组分别为(9.0±2.5)mmol/L和(9.0±1.6)%,对照组分别为(5.4±1.2)mmol/L和(5.3±1.2)%,均P<0.05]。DCM组E/A低于2型糖尿病组(0.93士0.34),组间差异有统计学意义(P<0.05)。②DCM组单个核细胞Ets-1 mRNA表达明显高于对照组,组间差异有统计学意义(0.58±0.17比0.42±0.15,P<0.05);DCM组和2型糖尿病组基质金属蛋白酶(MMP)9表达[(3.7±0.8)、(2.1±0.6)μg/L]均明显高于对照组[(1.5±0.5)μg/L],差异均有统计学意义(均P<0.05),DCM组与2型糖尿病组间差异无统计学意义(P>0.05)。③DCM患者Ets-1 mRNA表达与MMP-9呈正相关(r=0.81,P=0.03),与E/A比值、FBG、HbAlc、LDL-C、TG无相关性(r值分别为-0.52,0.73,0.26,0.06,0.72,P>0.05)。④DCM危险因素分析结果显示Ets-1 mRNA高表达为危险因素[比值比=3.12,95%置信区间:2.14~4.48,P<0.05]。结论E ts-1可上调MMP-9表达,参与2型糖尿病的发生发展,Ets-1可作为DCM的早期预测因子。更多还原

【Abstract】 Objective To primarily discuss the role of E26 transcription factor(Ets)l in peripheral blood mononuclear cell of the patients with diabetic cardiomyopathy(DCM) and to provide the new measure to cure DCM.Methods DCM group(n = 28) and type 2 diabetic mellitus(T2DM) group(n = 30),control group(n = 30).The expression of Ets-1 mRNA on peripheral-blood mononuclear cells was examined by SYBR Green I real-time quantitative reverse transcription ploymerse chain reaction.Results The levels of low density lipoprotein cholesterol(LDL-C) and triglyceride(TG) in DCM group were significantly higher than those in control group,the E/A in DCM group was significantly lower than that in control group[LDL-C:(3.3 ± 1.2) mmol/L vs(2.5±0.8) mmol/L,TG:(3.5±1.8)mmol/L vs(1.8 ±0.6)mmol/L,E/A:(0.45 ±0.14)vs(1.24 ±0.16),F<0.05].The levels of fasting blood glucose(FBG) and glycosylated hemoglobin(Hb) A1c in DCM and T2DM groups were significantly higher than those in control group[DCM group(8.7 ±3.6) mmol/L and(8.5 ±2.6)%,T2DM(9.0 ±2.5) mmol/L and(9.0 ±1.6)%,control group(5.4 ± 1.2)mmol/L and(5.3 ± 1.2)%,P <0.05].The E/A in DCM group was significantly lower than that in T2DM group(0.93 ±0.34)(P <0.05).The expression of Ets-1 mRNA on peripheral-blood mononuclear cells in DCM group were significantly higher than that in control group(0.58 ±0.17 vs0.42 ±0.15,P <0.05).The expression of matrix metalloproteinase(MMP)9 in DCM group and T2DM group were significantly higher than those in control group[(3.7 ±0.8) μg/L and(2.1 ±0.6) μg/L vs(1.5 ±0.5) μg/L,P < 0.05],there were not statistically significant between DCM group and T2DM group(P < 0.05).The expression of Ets-1 were correlated positively with MMP-9 in DCM(r =0.81,P =0.03),and there were not correlated positively with E/A,FBG,HbA1c,LDL-C and TG(r =-0.52,0.73,0.26,0.06,0.72,all P >0.05).Logistic regression analysis showed that Ets-1 was high risk factors of DCM[odd ratio(OR) =1.31,95%confidonce interval(CI):2.14-4.48,P<0.05].Conclusion Ets-1 can up-regulate the expression of MMP-9 in the progress of DM,but only Ets-1 can be a predictor of DCM.更多还原