降糖方案和循环内皮祖细胞数量的关系

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摘要目的：探讨不同降糖方案对初发2型糖尿病患者循环内皮祖细胞（EPCs）数量的影响。方法：通过纳入标准和排除标准，选取初发2型糖尿病住院患者，共45例，记录其年龄、性别、身高、体质量、腹围并计算体质量指数（BMI），同时检测空腹血糖（FPG）、空腹胰岛素（FINS）、餐后2 h血糖（PPG）、糖化血红蛋白（HbA1c）、胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）等主要指标。根据降糖方案不同，将初发2型糖尿病患者随机分为3组。A组（15例）：胰岛素皮下泵（CSII，诺和锐针）治疗2周后改为一日2次预混胰岛素治疗（优泌乐25针，一日2次）；B组（15例）：口服降糖药物治疗组（达美康缓释片30～120 mg/d）；C组（15例）：一日2次预混胰岛素治疗组（优泌乐25针，一日2次）。测定一般临床资料后，用流式细胞仪测定治疗前、治疗4周后的CD34和KDR双标阳性EPCs水平，进行治疗前后的组内比较与治疗后3组之间的组间比较。结果：治疗前，A、B、C 3组各项临床指标及EPCs的数量水平相近（P＞0.05）。组内比较显示各组经治疗后，EPCs数量均明显升高，差异有统计学意义（P＜0.05）。治疗4周后，A、C 2组的EPCs数量水平明显高于口服降糖药B组（P＜0.05），而A组与C组的EPCs数量水平相当（P＞0.05）。同时多元线性回归分析显示：EPCs的数量与HbA1c呈负相关（R2=0.664，P＜0.05）。结论：对于初发2型糖尿病患者，首选胰岛素强化治疗方案，快速缓解“高糖毒性”的同时，能够提高患者EPCs数量，从而可能进一步改善糖尿病引起的内皮功能障碍，对预防及延缓糖尿病慢性血管并发症的发生与发展起着一定的作用。血糖水平直接影响了糖尿病患者的EPCs的数量，即HbA1c越高，其EPCs的数量越少。

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	张爱鸣1
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关键词 ：循环内皮祖细胞, 初发2型糖尿病, 胰岛素强化治疗, 口服降糖药

Abstract：Objective: To investigate the effects of different hypoglycemic programme on the influence of the number of circulating endothelial progenitor cells (EPCs) in patients with primary type 2 diabetes. Methods: Forty-five newly diagnosed type 2 diabetes hospitalized patients were selected through the inclusion and exclusion criteria. The age, gender, height, weight, waist circumference and calculated body mass index (BMI) were recorded for each patient. The level of fasting blood glucose (FPG), fasting insulin (FINS), 2 hour postprandial blood glucose (PPG), glycosylated hemoglobin (HbA1c), triglyceride (TG), cholesterol (TC), high density lipoprotein (HDL) and low density lipoprotein (LDL) were measured. The newly diagnosed type 2 diabetes mellitus patients (mentioned above) were randomly divided into three groups according to the different hypoglycemic treatment. group A (n=15): patients were treated with twice per day of premixed insulin therapy (Humalog 25 pin) after 2 weeks of subcutaneous insulin pump therapy (CSII insulin aspart). group B (n=15): patients were treated with oral hypoglycemic drug (Diamicron MR 30-120 mg/d); group C (n=15): patients were treated with premixed insulin (Humalog 25 pin twice perday). After determination of general clinical data, the level of EPCs labled with CD34 and KDR double positive before and after 4 weeks of treatment were measured with flow cytometry. The number of EPCs before and after treatment and three groups after 4 weeks treatment were compared to investigate the short-term effects of different hypoglycemic therapy effects of intensive treatment in newly diagnosed type 2 diabetic patients on the number of EPCs. Results: The clinical indexes and the number of EPCs in the A, B, C three groups showed no difference before treatment (P>0.05). However, treatment significantly increased the number of EPCs in A.C groups was higher than B group after 4 weeks treatment. However no difference observed between A and C group. Meanwile, the number of EPCs and HbA1c had obvious negative linear correlation through mulitiple linear regression analysis. Conclusion: Altogether, these results suggest that the insulin strengthening treatment is better for newly diagnosed patients with type 2 diabetes mellitus. This treatment can relief of “glucotoxicity” rapidly and increase the number of EPCs, which may alleviate the endothelial dysfunction induced by diabetes and may prevent or delay the diabetes chronic vascular complication incidence. Meanwile, the level of blood glucose has a direct impact on the number of EPCs in patients of diabetes. Our result is consistant with published reported that the higher HbA1c usually accompany with the less the number of EPCs in diabetes.

Key words： circulating endothelial progenitor cells newly diagnosed type 2 diabetic early intensive insulin therapy oral hypoglycemic drugs

收稿日期: 2015-01-31

基金资助:温州市科技局科研基金资助项目（Y20140088）。

作者简介: 张爱鸣（1975-），女，浙江乐清人，副主任医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I10 /748

[1] Urbich C, Dimmeler S. Endothelial progenitor cells: characterization and role in vascular biology[J]. Circ Res, 2004,95(4): 343-353.
[2] Hill JM, Zalos G, Halcox JP. et al. Circulating endothelial progenitor cells, vascular function, and cardiovascular risk [J]. N Engl J Med, 2003, 348(7): 593-600.
[3] 袁红, 陈君柱, 王兴祥. 高糖对外周血内皮祖细胞数量和功能的影响[J]. 解放军医学杂志, 2004, 29(9): 803-806.
[4] 赵力, 王海昌, 尹涛, 等. 高糖对内皮祖细胞功能的损害及胰岛素的影响[J]. 中国病理生理杂志, 2008, 24(4): 688-691.
[5] Fadini GP, Sartore S, Albiero M, et al. Number and function of endothelial progenitor cells as a marker of severity for diabetic vasculopathy[J]. Arterioscler Thromb Vasc Biol, 2006, 26(9): 2140-2146.
[6] Wang CH, Ting MK, Verma S, et al. Pioglitazone increases the numbers and improves the functional capacity of endothelial progenitor cells in patients with diabetes mellitus [J]. Am Heart J, 2006, 152(6): 1051.e1-e8.
[7] Kumar AH, Caplice NM. Clinical potential of adult vascular progenitor cells[J].Arterioscler Thromb Vasc Biol, 2010, 30(6): 1080-1087.
[8] Fadini GP, Avogaro A. Potential manipulation of endothelial progenitor cells in diabetes and its complications[J]. Diabetes Obes Metab, 2010, 12(7): 570-583.
[9] Peichev M, Naiyer AJ, Pereira D, et al. Expression of VEG-FR-2 and AC133 by circulating human CD34(+) cells identifies a population of functional endothelial precursors[J]. Blood, 2000, 95(3): 952-958.
[10] Hristov M, Weber C. Endothelial progenitor cells: characterization, pathophysiology, and possible clinical relevance[J]. J Cell Mol Med, 2004, 8(4): 498-508.
[11] Asahara T, Murohara T, Sullivan A, et al. Isolation of putative progenitor endothelial cells for angiogenesis[J]. Science, 1997, 275(5302): 964-967.
[12] Pistrosch F, Herbrig K, Oelschlaegel U, et al. PPARgam-ma-agonist rosiglitazone increases number and migratory activity of cultured endothelial progenitor cells[J]. Athero-sclerosis, 2005, 183(1): 163-167.
[13] Fadini GP, Boscaro E, Albiero M, et al. The oral dipeptidyl peptidase-4 inhibitor sitagliptin increases circulating endothelial progenitor cells in patients with type 2 diabetes:possible role of stromal-derived factor-1 alpha[J]. Diabetes Care, 2010, 33(7): 1607-1609.
[14] Humpert PM, Djuric Z, Zeuge U, et al. Insulin stimulates the clonogenic potential of angiogenic endothelial progenitor cells by IGF-l receptor-dependent signaling[J]. Mol Med, 2008,14 (5-6): 30l-308.
[15] Fadini GP, de Kreutzenberg SV, Mariano V, et al. Optimized glycaemic control achieved with add-on basal insulin therapy improves indexes of endothelial damage and regeneration in type 2 diabetic patients with macroangiopathy: a randomized crossover trial comparing detemir versus glargine [J]. Diabetes Obes Metab, 2011, 13(8): 718-725.
[16] 杨吉锋, 陶松桔, 张亚萍, 等. 短期胰岛素泵强化治疗对初诊T2DM患者循环内皮祖细胞水平的影响及其抗炎机制[J]. 中国临床研究, 2011, 24(8): 666-668.
[17] Reinhard H, Jacobsen PK, Lajer M, et al. Multifactorial treatment increases endothelial progenitor cells in patients with type 2 diabetes[J]. Diabetologia, 2010, 53(10): 2129-
2133.
[18] Churdchomjan W, Kheolamai P, Manochantr S, et al. Com parison of endothelial progenitor cell function in type 2 diabetes with good and poor glycemic control[J]. BMC En-docr Disord, 2010, 10: 5.