| Objective:Carotid stenosis and occlusion is one of the common senile disease in the aged type2diabetes mellitus (T2DM) patients, atherosclerotic stenosis and plaque of carotid artery off are the main reasons that lead to ischemic cerebrovascular disease. Endothelial progenitor cells (EPCs) reduction and dysfunction is correlated with carotid atherosclerosis and plaque formation in T2DM patients. This subject to investigate the releationship between carotid atherosclerosis and serum level of EPCs in the aged T2DM patients with cerebral infarction. We also analyze its role and clinical significance in the development of cerebral infarction in the aged T2DM.So as to clarify the mechanism of cerebral infarction inT2DM and provide a basis for preventing and curing carotid atherosclerosis and cerebral infarction in the agede T2DM.Methods:We selected106patients in the General Hospital of Tianjin Medical University from October in2010to October in2011and selected case-control study. These elderly patients were divided into three groups depending on the disease T2DM group(n=42),cerebral infarction wth diabetes mellitus group(DMCI group):(n=34) and control group(CN group)(n=30),who were randomly selected from the examination people without DM and cerebrovascular disease in the cadres and health Care during the same period. Each group is divided into plaque group (EP group) and no plaques group (NP group) by the existence of plaque whether or not.According to the nature of the plaque, the EP group was divided into stable plaque group (SP group) and unstable plaque group (USP group).All of the cases were taken medical history, BP, body height, body weight and calculated body mass index (BMI).Collect the venous blood in the morning. Endothelial progenitor cells (EPCs) number was detected by flow cytometry. Vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9(MMP-9) level were measured by enzyme-linked immtmo--sorbent assay.Fasting blood glucose (FBG) was taken by glucose oxidase method and HbAlc level was checked by high performance liquid chromatography (HPL--C).Serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were measured by digital biochemical analyzer. Meanwhile, the carotid atherosclerosis and plaque were measured by color Doppler ultrasound.Results:(1) The differences of SBP、EPCs、MMP-9、VEGF、TC、TG、HDL-C、 LDL-C、FBG、HbAlc in three groups were significant (P<0.05).The serum level of SBP、MMP-9、TC、LDL-C、FBG、HbA1C、duration of DM in DMCI group were significant higher than the other groups (P<0.05). The quantity of EPCs and VEGF in the group of DMCI group were lower than that in DM group and CN group (P <0.01).And that in DM group was lower than that in CN group (P<0.01). Duration of DM in DMCI group was longer than DM group (P<0.05).(2) The difference of the level of IMT among three groups was statistically significant (P<0.01). Meanwhile the difference was significant between the two groups (P<0.01). The rate and nature of plaque detection were difference(P<0.01). The main occurring place of atherosclerotic plaque was carotid bifurcation (61.3%), secondly for onset of internal carotid artery (20.5%), which were especially happened in two sides among three groups.(3) The plaque incidence rate in DMCI group was significantly higher than that in CN group (P<0.05), but no significant difference with the DM group (P>0.05).The detection rate of the unstable plaque was significantly higher than the other groups.The difference was significant (P<0.05).(4) The correlation analysis between the level of EPCs and the other indicators in DMCI group found:there is positively correlation between the quantity of EPCs and VEGF(r=0.66,P<0.01).There is negative correlation between the quantity of EPCs and BMI、SBP、TC、LDL-C、 HbAlc、FPG、MMP-9、IMT、the duration of DM (r=-0.42,-0.50,-0.63,-0.36,-0.57,-0.42,-0.56,-0.42,-0.34;P<0.01,P<0.05).TC、HbA1c、VEGF were independently associated with the number of EPCs by multiple linear regression analysis(P<0.01).(5)In DMCI group:the level of EPCs were significantly lower than the other groups; the level of EPCs in patients with unstable plaque was lower than that in patients with stable plaques (P<0.05). There is not statistically significant between that in patients with stable plaques and that in patients without plaques (P>0.05).The level of MMP-9was significantly higher than the other groups and so was that between patients with stable plaques and patients with unstable plaques (P<0.05).Conclusion:(1) The main occurring place of atherosclerotic plaque was carotid bifurcation, secondly for onset of internal carotid artery, which were especially happened in two sides among three groups. The detection rate of carotid artery atherosclerotic plaque and unstable plaque in the aged type2diabetic patients with cerebral infarction was significantly higher. Carotid atherosclerosis is a risk factor for DM patients who maybe happended CI. As a result, prevention of carotid atherosclerosis may reduce the incidence of DMCI.(2) The level of EPCs in DMCI group patients was correlated with carotid atherosclerosis, which significantly reduced in patients with unstable carotid atherosclerotic plaques. The level of EPCs reflect the nature of the carotid atherosclerotic plaque to some certain extent. The reduction of the number of EPCs is a risk factor for the happening CI in T2DM patients. The reduction of EPCs level and the decreased function of EPCs may contribute to the development of atherosclerosis, affect plaque stability and result in the development of DMCI.(3) With the progression of diabetes, the role of the factor who promote EPCs mobilization decreased. As a result, EPCs function and number both declined,which caused the development of DM complications. So improve number and the function of EPCs will be helpful to prevent and cure carotid atherosclerosis and cerebral infarction in DM patients. |
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