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目的:探讨炎症因子环加氧酶-2(COX-2)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)与老年糖尿病患者应用阿司匹林后敏感性差异的关系。方法:选取2012年4月至2013年5月本院老年科门诊就诊的2型糖尿病患者123例,均服用阿司匹林(100 mg/d,服药时间>7 d),另选取同期体检中心39名正常老年体检者为正常对照组,门诊120例老年糖尿病患者(未服用抗血小板药物)作为对照组。采用光学法测定研究对象的血小板聚集率,检测其TNF-α、超敏CRP(hs-CRP)、COX-2水平及血糖、血脂等指标。采用实时定量PCR(real-time PCR)和蛋白质印记(Western blotting)的方法 ,检测患者外周血单核细胞中COX-2 m RNA及蛋白质表达水平;测定TNF-α和(或)hs-CRP刺激后COX-2 m RNA的表达量。结果 :1阿司匹林敏感患者(AS组)80例,阿司匹林不敏感患者(NAS组)43例。2NAS组空腹血糖、餐后2 h血糖及糖化血红蛋白的水平均明显高于AS组(P<0.05),Logistic回归分析显示空腹血糖、糖化血红蛋白、TNF-α是NAS的危险因素(相对危险度分别为2.132、2.571和1.079)。3糖尿病患者外周血TNF-α、hs-CRP水平高于正常对照组(P<0.05)。4NAS组外周血单核细胞COX-2 m RNA表达量明显高于AS组(P<0.05),NAS组蛋白表达率(25.6%)高于AS组(3.8%)(P<0.05)。5高糖、TNF-α、hs-CRP均可使COX-2表达增加,三者共同刺激后COX-2表达量较单因子刺激上升明显,差异有统计学意义(P<0.05)。结论:老年糖尿病患者体内TNF-α、hs-CRP水平升高,刺激COX-2的表达,影响其对阿司匹林的反应。
Objective: To investigate the relationship between inflammatory factors cyclooxygenase-2 (COX-2), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) and the sensitivity of senile diabetic patients after aspirin application. Methods: A total of 123 type 2 diabetic patients treated in our department from April 2012 to May 2013 were selected, taking aspirin (100 mg / d, taking> 7 days) and taking 39 normal check-up centers Elderly physical examination for the control group, outpatient 120 elderly patients with diabetes (not taking antiplatelet drugs) as a control group. The platelet aggregation rate was measured by optical method, and the levels of TNF-α, hs-CRP, COX-2 and blood glucose and blood lipid were measured. The mRNA and protein expression of COX-2 in peripheral blood mononuclear cells of patients were detected by real-time PCR and Western blotting. TNF-α and / or hs-CRP stimulation Post-COX-2 m RNA expression levels. Results: 1 Aspirin-sensitive patients (AS group) 80 cases, aspirin-insensitive patients (NAS group) 43 cases. Fasting blood glucose, postprandial blood glucose and glycosylated hemoglobin levels in 2NAS group were significantly higher than those in AS group (P <0.05). Logistic regression analysis showed fasting blood glucose, glycosylated hemoglobin and TNF-α were risk factors for NAS (relative risk respectively 2.132, 2.571 and 1.079). The levels of TNF-α and hs-CRP in peripheral blood of diabetic patients were higher than those of normal controls (P <0.05). The expression of COX-2 mRNA in peripheral blood mononuclear cells of 4NAS group was significantly higher than that of AS group (P <0.05). The protein expression rate of NAS group was higher than that of AS group (25.6% vs 3.8%, P <0.05). The expression of COX-2 increased with high glucose, TNF-α, hs-CRP and COX-2 compared with the single stimulus. The difference was statistically significant (P <0.05). CONCLUSIONS: The levels of TNF-α and hs-CRP in elderly patients with diabetes mellitus are increased, and the expression of COX-2 is stimulated, which affects the response to aspirin.