糖尿病性心肌病患者血清PDK4,DECR1和MMP1表达水平及临床价值研究

Diagnostic Value of Combined Detection of Serum PDK4,DECR1 and MMP1 in Diabetes Cardiomyopathy

目的探讨血清丙酮酸脱氢酶激酶同工酶4(pyruvate dehydrogenase kinase isoenzyme 4,PDK4),2,4-二烯酰辅酶A还原酶1(2,4-dienoyl coenzyme A reductase 1,DECR1)及基质金属蛋白酶1(matrix metalloproteinase 1,MMP1)的联合检测在糖尿病性心肌病(diabetic cardiomyopathy,DCM)诊断、临床分级和病情预后中的应用价值。方法选取2021年10月~2023年10月陕西省人民医院收治的126例糖尿病性心肌病(DCM组)患者及120例单纯糖尿病非心肌病患者(对照组),采用酶联免疫吸附法(ELISA)测定血清中PDK4,DECR1及MMP1蛋白表达水平,评估这三个检测指标在DCM中的诊断、临床分级和病情预后中的应用价值。结果DCM组患者血清PDK4(131.38±10.20 pg/ml),DECR1(152.06±12.57 pg/ml)及MMP1(40.27±4.02μg/ml)蛋白表达水平与对照组(82.69±8.17 pg/ml,86.14±9.55 pg/ml,17.77±0.98μg/ml)相比均明显升高,差异具有统计学意义(t=36.24,47.63,12.29,均P<0.001)。DCM组患者血清PDK4,DECR1及MMP1蛋白表达水平与NYHA心功能分级相关,随等级升高其蛋白表达水平均明显升高,差异具有统计学意义(F=24.12,30.04,12.66,均P<0.001);DCM组中重度组患者与轻度组患者比较,血清PDK4(164.92±1.35pg/ml vs 122.48±8.78pg/ml),DECR1(192.17±9.11pg/ml vs124.36±10.83pg/ml)及MMP1(84.44±7.38μg/ml vs 39.41±3.05μg/ml)蛋白表达水平均显著增高,差异具有统计学意义(t=26.33,47.12,15.41,均P<0.001)。血清PDK4,DECR1及MMP1三项联合检测DCM准确度(χ^(2)=18.23,21.37,22.07)、特异度(χ^(2)=9.72,13.43,15.12)、灵敏度(χ^(2)=12.07,16.07,17.55)与单项检测对比均明显升高,差异具有统计学意义(均P<0.05),且ROC曲线分析结果显示联合检测的AUC高达0.955,明显高于单项检测(Z=16.67,17.09,20.44,均P<0.05)。结论血清PDK4,DECR1及MMP1与DCM诊断、临床分级及病情预后有一定关联,三者联合检测有助于DCM的鉴别诊断。

Objective To explore the value of combined detection of serum pyruvate dehydrogenase kinase isoenzyme 4(PDK4),2,4-dienoyl coenzyme A reductase 1(DECR1)and matrix metalloproteinase 1(MMP1)in the diagnosis,clinical grading and prognosis of diabetes cardiomyopathy(DCM).Methods A sum of 26 patients with diabetes cardiomyopathy(DCM group)and 120 patients with diabetes non cardiomyopathy(control group)who were admitted to Shaanxi Provincial People’s Hospital from October 2021 to October 2023 were selected.The expression levels of PDK4,DECR1 and MMP1 proteins in serum were measured by enzyme-linked immunosorbent assay(ELISA)to evaluate the diagnostic value of these three detection indicators in DCM.Results Compared with the Control group,the levels of serum PDK4(131.38±10.20 pg/ml vs 82.69±8.17 pg/ml),DECR1(152.06±12.57 pg/ml vs 86.14±9.55 pg/ml)and MMP1(40.27±4.02μg/ml vs 17.77±0.98μg/ml)protein in the diabetes cardiomyopathy(DCM)group were significantly higher,and the differences were statistically significant(t=36.24,47.63,12.29,all P<0.001).In the DCM group,the protein expression levels of serum PDK4,DECR1 and MMP1 were correlated with NYHA cardiac function grading,while the protein expression levels were significantly increased with the grade increasing,and the differences between the groups were statistically significant(F=24.12,30.04,12.66,all P<0.001).In the DCM group,compared with the mild group,the expression levels of serum PDK4(164.92±1.35pg/ml vs 122.48±8.78pg/ml),DECR1(192.17±9.11pg/ml vs 124.36±10.83pg/ml)and MMP1(84.44±7.38μg/ml vs 39.41±3.05μg/ml)proteins were significantly increased in patients with moderate to severe illness,and the differences were statistically significant(t=26.33,47.12,15.41,all P<0.001).The accuracy(χ^(2)=18.23,21.37,22.07),specificity(χ^(2)=9.72,13.43,15.12)and sensitivity(χ^(2)=12.07,16.07,17.55)of serum PDK4,DECR1 and MMP1 were significantly higher than those of single Test(all P<0.05),the results of ROC curve analysis showed that the AUC of combined detection was 0.955,which was significantly higher than that of single detection(Z=16.67,17.09,20.44,all P<0.05).Conclusion Serum PDK4,DECR1 and MMP1 are related to the diagnosis,clinical grading and prognosis of diabetes cardiomyopathy.The combined detection of the three is helpful to the differential diagnosis of diabetes cardiomyopathy.