血清微小RNA-122及半乳糖凝集素3与2型糖尿病患者合并冠心病的关系

Relationship between serum microRNA-122, galectin-3 and coronary atherosclerotic heart disease in patients with type 2 diabetes mellitus

目的探讨血清微小RNA-122(miR-122)、半乳糖凝集素3(Gal-3)与2型糖尿病患者合并冠心病(冠状动脉粥样硬化性心脏病)的关系。方法选取2018年2月至2020年8月昆明医科大学第一附属医院收治的193例2型糖尿病患者,包括79例合并冠心病(合并冠心病组)、114例未合并冠心病(未合并冠心病组)。另选取同期50例健康志愿者为对照组。收集受试者的临床资料,检测血清miR-122、Gal-3水平,分析miR-122、Gal-3与2型糖尿病合并冠心病的关系,采用受试者工作特征(ROC)曲线分析血清miR-122、Gal-3及二者联合诊断2型糖尿病合并冠心病的价值。结果合并冠心病组、未合并冠心病组体重指数、吸烟史比例、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、空腹胰岛素、稳态模型胰岛素抵抗指数(HOMA-IR)水平均高于对照组,高密度脂蛋白胆固醇水平均低于对照组,差异均有统计学意义(均P <0.05)。合并冠心病组体重指数、2型糖尿病病程、吸烟史比例、高脂血症比例、LDL-C、HOMA-IR水平均高于未合并冠心病组,差异均有统计学意义(均P <0.05)。合并冠心病组、未合并冠心病组血清miR-122、Gal-3水平均高于对照组[(8.1±2.3)、(4.2±1.4)比(1.0±0.6),(56.4±6.4)、(26.4±4.2) ng/L比(8.2±2.0) ng/L],且合并冠心病组均高于未合并冠心病组,差异均有统计学意义(均P <0.05)。多因素Logistic回归分析显示,高LDL-C、miR-122、Gal-3水平均为2型糖尿病合并冠心病的独立危险因素(均P <0.05)。ROC曲线显示联合检测miR-122、Gal-3预测2型糖尿病合并冠心病的曲线下面积高于miR-122、Gal-3单独检测[0.885 (95%置信区间:0.830~0.940)比0.747 (95%置信区间:0.674~0.821)、0.740(95%置信区间:0.665~0.815)](Z=2.423、2.419,均P <0.05)。联合检测miR-122、Gal-3诊断2型糖尿病合并冠心病的敏感度、特异度、约登指数均高于单独检测miR-122、Gal-3。结论血清miR-122、Gal-3水平升高是2型糖尿病合并冠心病的独立危险因素,可为2型糖尿病患者心血管疾病风险评估提供依据。

Objective To investigate the relationship between serum microRNA(miR)-122,galectin(Gal)-3 and coronary atherosclerotic heart disease(CHD)in patients with type 2 diabetes mellitus(T2DM).Methods From February 2018 to August 2020,193 patients with T2DM admitted to First Affiliated Hospital of Kunming Medical University were selected,including 79 patients combined with CHD(combined CHD group),114 patients without CHD(non-CHD group).Fifty healthy volunteers at same period were selected as control group.The clinical data of subjects were collected,and serum levels of miR-122 and Gal-3 were detected.The relationships between miR-122,Gal-3 and T2DM combined with CHD were analyzed.The receiver operating characteristic(ROC)curve was used to analyze the value of miR-122,Gal-3 and the two indexes combination in the diagnosis of T2DM combined with CHD.Results Body mass index,proportion of smoking history,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol(LDL-C),fasting plasma glucose,fasting insulin and homeostatic model assessment insulin resistance index(HOMA-IR)levels in combined CHD group and non-CHD group were higher than those in control group,and high-density lipoprotein cholesterol level in combined CHD group and non-CHD group were lower than that in control group.The differences were statistically significant(all P<0.05).Body mass index,duration of T2DM,proportion of smoking history,proportion of hyperlipidemia,LDL-C and HOMA-IR levels in combined CHD group were higher than those in non-CHD group,and the differences were statistically significant(all P<0.05).The serum levels of miR-122 and Gal-3 in combined CHD group and non-CHD group were higher than those in control group[(8.1±2.3),(4.2±1.4)vs(1.0±0.6);(56.4±6.4),(26.4±4.2)ng/L vs(8.2±2.0)ng/L],and those in combined CHD group were higher than those in non-CHD group(all P<0.05).Multivariate Logistic regression analysis showed that high levels of LDL-C,miR-122 and Gal-3 were independent risk factors of T2DM combined with CHD(all P<0.05).ROC curve showed that the area under the curve of miR-122 and Gal-3 combining detection was larger than that of miR-122 and Gal-3 alone[0.885(95%confidence interval:0.830-0.940)vs 0.747(95%confidence interval:0.674-0.821),0.740(95%confidence interval:0.665-0.815)](Z=2.423,2.419,both P<0.05).The sensitivity,specificity and Youden’s index of miR-122 and Gal-3 combining detection were higher than those of miR-122 and Gal-3 alone.Conclusion Serum miR-122 and Gal-3 levels increases are risk factors for T2DM combined with CHD,which can provide a basis for risk assessment of cardiovascular disease in patients with T2DM.