血清趋化素及hs-CRP水平对2型糖尿病患者无症状亚临床动脉粥样硬化诊断的临床意义

Clinical Significance of Serum Chemerin and hs-CRP in the Diagnosis of Subclinical Atherosclerosis in Patients with Type 2 Diabetes

目的探讨血清趋化素及hs-CRP水平对2型糖尿病患者无症状亚临床动脉粥样硬化诊断的临床意义。方法选择2012年1月~2015年12月住院的2型糖尿病患者55例作为研究对象(试验组州=55),同时期非2型糖尿病正常患者55例作为对照(对照组n=55)。应用全自动生化分析仪测定FPG,HbA1c,HDL-C,血清趋化素,TC,TG,LDL-C,INS等指标,应用彩色多谱勒设备测量颈动脉内膜中层厚度(C-IMT)。相关性采用Pearson相关分析,危险因素分析采用多元线性逐步回归分析。结果试验组与对照组比较,两组在体质指数(BMI),腰臀比值(WHR),收缩压,踝臂指数,FPG,HbA1c,HDL-C,hs-CRP,C-IMT,HOMA2-IR和血清趋化素方面差异有统计学意义(t=-6.31~5.79,P≤0.01~0.03)。试验组和对照组患者,血清趋化素水平与WHR,HOMA2-IR,C-IMT和hs-CRP呈正相关(r=0.24~0.29,P=0.01~0.04)。C-IMT与年龄、WHR、收缩压、舒张压、FPG,HbA1c,糖尿病病程、hs-CRP呈正相关(r=0.15~0.68,P≤0.01~0.04);与踝臂指数(WHR)呈负相关(r=-0.32~0.29,P≤0.01)。hs-CRP与HbA1c,HOMA2-IR,血清趋化素和C-IMT呈正相关(r=0.25~0.32,P≤0.01~0.04);与TC和HDL-C呈负相关(r=-0.27^-0.25,P均为0.02)。Cox比例风险回归模型进行多因素分析结果显示:患者血清趋化素、HbA1c和hs-CRP升高是影响C-IMT的危险性因素(β=0.026~0.658,SE=0.015~0.033,t=2.532~3.421,P≤0.01~0.0.04)。结论血清趋化素水平和hs-CRP水平升高是影响C IMT的危险性因素,对2型糖尿病患者无症状亚临床动脉粥样硬化诊断具有重要的临床意义。

Objective To investigate the clinical significance of serum chemokine and hs-CRP levels in patients with type 2 di abetes mellitus with asymptomatic subclinical atherosclerosis. Methods The clinicpathological and follow-up data of 55 pa- tients with Type 2 diabetic from 2012. 1 to 2015.12 were collected and reviewed. At the same time,55 patients with non type 2 diabetes were taken as control. Determination of FPG, H bAlc, HDL-C, TC,TG, LDL-C, INS and other indicators by auto- matic biochemical analyzer, the application of color Doppler ultrasound equipment measurement C-IMT. Correlation using Pearson correlation analysis,risk factor analysis using multiple linear stepwise regression analysis. Results Compared with the control group, the two groups in BMI, WHR, systolic blood pressure, ankle brachial index, FPG, HbAlc, HDL-C, hs- CRP,C-IMT, HOMA2-1R and serum chemokines were significantly different, with statistical significance （t=- 6.31 5.79, P≤0.01～0.03）. In 110 cases of experimental group and control group, the levels of serum ehemokines were positive- ly correlated with WHR,HOMA2-IR,C-IMT and hs-CRP （r=0.24～0.29,P=0.01～0.04）. C-IMT and age,WHR,sys- tolic blood pressure, diastolic blood pressure, FPG, HbAle, diabetes duration, hs-CRP was positively correlated （ r = 0.15 0. 68,P≤0. 01～0. 0. 04） ,and the ankle brachial index was negatively correlated （r= -0.32～0.29,P≤0.01）. Hs-CRP was positively correlated with HbAle, HOMA2-IR, serum chemokine, C-IMT （ r = 0.25 ～ 0.32, P≤ 0.01 -- 0.04 ）, and was negatively correlated with TC and HDL-C （r=-0.27～-0.25 ,P all 0.02）. Cox proportional hazard regression model for multivariate analysis showed that high serum ehemokines,hs-CRP and HbAle were the risk factors of C-IMT （β=0. 026～ 0. 658,SE=0. 015～0. 033 ,t=2. 532～3. 421 ,P≤0.01～0.04）. Conclusion High serum levels of chemokines and hs-CRP are the risk factors of C-IMT,and it has important clinical significance for the diagnosis of asymptomatic subclinical athero- sclerosis in patients with type 2 diabetes mellitus.