血清淀粉样蛋白A对2型糖尿病患者不良心血管事件的影响

Effects of serum amyloid A on adverse cardiovascular events in patients with type 2 diabetes

目的探讨血清淀粉样蛋白A(serum amyloid A,SAA)对2型糖尿病患者不良心血管事件的影响。方法选取武警北京总队医院2016年3-12月确诊为2型糖尿病98例作为研究对象,随访2年,根据其是否发生不良心血管事件分为发生组38例与未发生组60例,比较两组患者临床特征的差异,同时分析SAA与不良心血管事件发生的相关性,并采用ROC曲线分析SAA对不良心血管事件发生的预测价值。结果98例中,38例发生不良心血管事件(发生组),占38.8%,其中急性冠脉综合征18例(47.4%),心力衰竭12例(31.6%),有症状的心律失常6例(15.8%),心脏骤停1例(2.6%),死亡1例(2.6%);60例未发生不良心血管事件(未发生组),占61.2%。发生不良心血管事件的患者年龄≥60岁、合并高血压的比例明显高于未发生组,差异有统计学意义(P<0.05)。发生不良心血管事件的患者LVEF水平明显低于未发生组,差异有统计学意义(P<0.05)。多因素Logistic回归模型分析:年龄≥60岁、低密度脂蛋白水平升高、CRP水平升高、同型半胱氨酸水平升高及SAA水平升高是2型糖尿病患者不良心血管事件发生的独立危险因素(P<0.05)。CRP的AUC面积为0.6186,诊断界值为4.81;SAA的AUC面积为0.7248,诊断界值为10.96。结论2型糖尿病患者2年内发生不良心血管事件的风险较高,年龄≥60岁、高LDL-C水平、高CRP水平、高同型半胱氨酸水平及高SAA水平的2型糖尿病患者更容易发生不良心血管事件,SAA水平升高对2型糖尿病患者发生不良心血管事件的风险有一定预测价值。

Objective To investigate the effects of serum amyloid A(SAA)on adverse cardiovascular events in patients with type 2 diabetes.Methods A total of 98 patients with type 2 diabetes diagnosed in Beijing Armed Police Corps Hospital between March to December of 2016 were selected as the subjects.These patients were followed up for two years and divided into the occurrence group(n=38)and the non-occurrence group(n=60).The clinical characteristics of the two groups were compared.Correlations between SAA and adverse cardiovascular events were analyzed,and the ROC curve was used to analyze the predictive value of SAA for adverse cardiovascular events.Results Of the 98 cases,38 experienced adverse cardiovascular events(occurrence group),accounting for 38.8%and including 18 cases of acute coronary syndrome(47.4%),12 cases of heart failure(31.6%),6 cases of symptomatic arrhythmias(15.8%),1 case of cardiac arrest(2.6%),and 1 case of death(2.6%).By contrast,60 cases reported no adverse cardiovascular events(non-occurrence group),accounting for 61.2%.The proportion of patients with adverse cardiovascular events who were sixty or above and complicated with hypertension was significantly higher in the occurrence group than in the non-occurrence group,and the difference was statistically significant(P<0.05).The level of LVEF in patients with adverse cardiovascular events was significantly lower in the occurrence group than in the non-occurring group,and the difference was also statistically significant(P<0.05).Multivariate Logistic regression model analysis suggested that age≥60 years and elevated levels of low-density lipoprotein,CRP,homocysteine and SAA were independent risk factors for adverse cardiovascular events in patients with type 2 diabetes(P<0.05).The AUC of CRP was 0.6186,and the diagnostic cutoff was 4.81,compared with 0.7248 and 10.96 for SAA.Conclusions Patients with type 2 diabetes are at higher risk of adverse cardiovascular events within 2 years.Patients aged 60 or above,with high LDL-C levels of low-density lipoprotein,CRP,homocysteine and SAA are more susceptible to adverse cardiovascular events.Elevated SAA levels are of predictive value for the risk of adverse cardiovascular events in patients with type 2 diabetes.