Značaj određivanja inflamatornih parametara kod bolesnika sa koronarnom bolešću i dijabetesom melitusom tipa 2

Goran Damnjanović; Boris Đinđić

doi:10.5937/medrec2504136D

Goran Damnjanović Vojna bolnica Niš https://orcid.org/0009-0002-4082-9721
Boris Đinđić Klinika za kardiologiju, Univerzitetski klinički centar Niš, Medicinski fakultet, Univerzitet u Nišu https://orcid.org/0000-0002-6772-2986

DOI: https://doi.org/10.5937/medrec2504136D

Ključne reči: inflamatorni parametri, koronarna bolest, dijabetes melitus

Sažetak

Inflamacija je i ključ inicijacije i progresije ateroskleroze. Međutim, malo su poznate osobine inflamatornog procesa u dijabetesu. S obzirom na značaj inflamacije u aterosklerozi, kao glavnom etiopatogenetskom mehanizmu koronarne bolesti, cilj ovog rada bio je odrediti značaj pojedinih inflamatronih parametara kod koronarnih bolesnika sa dijabetesom melitusom tipa 2. Istraživanjem je obuhvaćeno 40 bolesnika sa dokazanom koronarnom bolešću (KB) i dijabetesom melitusom (DM) tipa 2, 30 bolesnika sa KB i 20 ispitanika bez znakova za KB, DM tipa 2 i intoleranciju glikoze. Analizirani su uzorci krvi pre terapije i određivan je: broj leukocita, vrednosti visoko senzitivnog C-reaktivnog proteina (hsCRP), koncentracija albumina i adhezivnih molekula ICAM-1 i VCAM-1. Bolesnici sa DM su imali značajno veći broj leukocita (p < 0,05), veći hsCRP i koncentraciju VCAM-1 i ICAM-1 molekula (p < 0,05), dok su bolesnici bez DM imali nepovoljnije profile fibrinogena (p < 0,05). Bolesnici sa KB imali su značajno veću koncentraciju hsCRP i ICAM-1 (p < 0,01), kao i VCAM-1 molekula (p < 0,05). Regresioni model pokazuje da povišene koncentracije albumina imaju značajnu prognostičku vrednost za pojavu KB. Broj leukocita, koncentracija hsCRP, VCAM-1 i ICAM-1 su značajno veći kod KB sa DM tipa 2 (p < 0,05). Koncentracija fibrinogena je značajno niža kod ovih bolesnika u odnosu na bolesnike bez DM tipa 2 (p < 0,05). Inflamatorni markeri kod bolesnika sa KB i DM tipa 2 mogu imati dijagnostički i prognostički značaj u patogenezi bolesti, a taj uvid može dovesti i do novih pristupa u lečenju koronarnih bolesnika sa dijabetesom melitusom tipa 2.

Reference

Kong P, Cui ZY, Huang XF, Zhang DD, Guo RJ, Han M. Inflammation and atherosclerosis: Signaling pathways and therapeutic intervention. Signal Transduct Target Ther 2022;7(1):131.

Zhao Z, Zhang X, Sun T, Huang X, Ma M, Yang S, et al. Prognostic value of systemic immune-inflammation index in CAD patients: Systematic review and meta-analyses. Eur J Clin Invest. 2024;54(2):e14100.

Singh V, Kaur R, Kumari P, Pasricha C, Singh R. ICAM-1 and VCAM-1: Gatekeepers in various inflammatory and cardiovascular disorders. Clin Chim Acta 2023;548:117487.

Calabriso N, Massaro M, Scoditti E, Carluccio C, Verri T, Carluccio MA. Epigenetic mechanisms in vascular inflammation: Modulation of endothelial adhesion molecules and endothelium-leukocyte adhesion. Front Biosci (Landmark Ed) 2023;28(9):194.

Pluta W, Lubkowska A, Dudzińska W. Vascular endothelium in health and disease: Structure, function, assessment and role in metabolic disorders. Vasc Health Risk Manag 2025;21:729–47.

Laird CT, Hassanein W, O’Neill NA, French BM, Cheng X, Fogler WE, et al. P- and E-selectin receptor antagonism prevents human leukocyte adhesion to activated porcine endothelial monolayers and attenuates porcine endothelial damage. Xenotransplantation 2018;25(2):e12381.

Hlubocká Z, Umnerová V, Heller S, et al. Circulating intercellular cell adhesion molecule-1, endothelin-1 and von Willebrand factor-markers of endothelial dysfunction in uncomplicated essential hypertension: The effect of treatment with ACE inhibitors. J Hum Hypertens 2002;16(8):557–62.

Pejkov H, Kedev S, Panov S, Srbinovska-Kostovska E, Lang I. Atherosclerosis of coronary blood vessels – local or systemic inflamation? Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2013;34(3):5–11.

Edlinger M, Wanitschek M, Dörler J, Ulmer H, Alber HF, Steyerberg EW. External validation and extension of a diagnostic model for obstructive coronary artery disease: A cross-sectional predictive evaluation in 4888 patients of the Austrian Coronary Artery disease Risk Determination In Innsbruck by diaGnostic ANgiography (CARDIIGAN) cohort. BMJ Open 2017;7(4): e014467.

O’Malley T, Ludlam CA, Riemermsa RA, Fox KA. Early increase in levels of soluble inter-cellular adhesion molecule-1 (sICAM-1); potential risk factor for the acute coronary syndromes. Eur Heart J 2001;22(14):1226-34.

Lu HH, Sheng ZQ, Wang Y, Zhang L. Levels of soluble adhesion molecules in patients with various clinical presentations of coronary atherosclerosis. Chin Med J 2010;123(21):3123–6.

Wannamethee SG, Lowe GDO, Shaper AG, Rumley A, Lennon L, Whincup PH. The metabolic syndrome and insulin resistance: Relationship to haemostatic and inflammatory markers in older non-diabetic men. Atherosclerosis 2005;181(1):101–8.

Koenig W, Sund M, Fröhlich M, et al. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: Results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg cohort study, 1984 to 1992. Circulation 1999;99:237–42.

Saklayen MG. The Global Epidemic of the Metabolic Syndrome. Curr Hypertens Rep 2018;20(2):12.

Zhang Y, Shi R, Jiang YN, el al. Effect of metabolic syndrome on coronary artery atherosclerotic plaque in type 2 diabetes mellitus patients. Front Endocrinol 2025;16:1595475.

Yazdani AN, Pletsch M, Chorbajian A, et al. Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease. Expert Rev Cardiovasc Ther 2023;21(10):675–92.

Gillum RF, Ingram DD, Makuc DM. White blood cell count, coronary artery disease and death: The NHANES I epidemiological follow-up study. Am Heart J 1993;125:855–63.

Kuller LH, Eichner JE, Orchard TJ, Grandits GA, McCallum L, Tracy RP. The relation between serum albumin levels and risk of coronary heart disease in the Multiple Risk Factor Intervention Trial. Am J Epidemiol 1991;134:1266–77.

Güray U, Erbay AR, Güray Y, el al. Levels of soluble adhesion molecules in various clinical presentations of coronary atherosclerosis. Int J Cardiol 2004;96(2):235–40.

Ridker PM, Hennekens CH, Roitman-Johnson B, Stampfer MJ, Allen J. Plasma concentration of soluble intercellular adhesion molecule 1 and risks of future myocardial infarction in apparently healthy men. Lancet 1998;351:88–92.

Stenvinkel P, Lindholm B, Heimbürger M, Heimbürger O. Elevated serum levels of soluble adhesion molecules predict death in pre-dialysis patients: association with malnutrition, inflammation, and cardiovascular disease. Nephrol Dial Transplant 2000;15(10):1624–30.