巨细胞病毒感染与2型糖尿病患者动脉粥样硬化性心血管疾病的关系

Relationship between human cytomegalovirus infection and atherosclerotic cardiovascular diseases in patients with type 2 diabetes mellitus

目的探究巨细胞病毒(HCMV)感染对2型糖尿病患者动脉粥样硬化性心血管疾病发生的影响。方法收集2018年2月-2019年12月于海南省干部疗养院就诊的首次确诊2型糖尿病患者132例,根据HCMV-DNA检测结果分为阳性组56例和阴性组76例,比较两组糖代谢指标、血脂、颈动脉超声结果、心血管事件及血清Toll样家族受体4(TLR4)、髓样分化蛋白88(MyD88)、核因子-κB(NF-κB)表达。结果阳性组空腹血糖水平高于阴性组(P<0.05);但两组餐后2 h血糖和HbAlc差异无统计学意义。阳性组总胆固醇(TC)、甘油三酯(TG)及低密度脂蛋白胆固醇(LDL-C)水平均高于阴性组(P<0.05);但两组高密度脂蛋白胆固醇(HDL-C)差异无统计学意义。两组斑块分布差异有统计学意义(P<0.05),其中阳性组软斑比例高于阴性组,硬斑比例低于阴性组(P<0.05);阳性组斑块检出例数、颈动脉内膜中层厚度(IMT)、斑块积分及心血管事件例数均高于阴性组(P<0.05)。TLR4/MyD88/NF-κB信号通路表达:阳性组血清TLR4、MyD88、NF-κB水平均高于阴性组(P<0.001)。结论 HCMV感染与2型糖尿病患者动脉粥样硬化性心血管疾病的发生密切相关,可能与调节空腹血糖、血脂水平及TLR4/MyD88/NF-κB信号通路表达有关。

OBJECTIVE To explore the effects of human cytomegalovirus(HCMV) infection on the occurrence of atherosclerotic cardiovascular diseases in patients with type 2 diabetes mellitus(T2 DM).METHODS A total of 132 patients with type 2 diabetes who were diagnosed for the first time in a Cadre Sanatorium of Hainan from Feb.2018 to Dec.2019 were enrolled,and were divided into 56 cases of positive group and 76 cases of negative group according to test results of HCMV-DNA.The glucose metabolism indexes,blood lipid,results of carotid artery ultrasound,cardiovascular events and the expressions of serum Toll-like receptor 4(TLR4),myeloid differentiation protein 88(MyD88) and nuclear factor κB(NF-κB) were compared between the two groups.RESULTS The level of fasting blood glucose in positive group was signigifcantly higher than that in negative group(P<0.05).However,there was no significant difference in levels of 2 h postprandial blood glucose and HbAlc between the two groups.The levels of total cholesterol(TC),triglyceride(TG) and low-density lipoprotein cholesterol(LDL-C) in positive group were signigifcantly higher than those in negative group(P<0.05).However,there was no significant difference in level of high-density lipoprotein cholesterol(HDL-C) between the two groups.The differences in plaques distribution between the two groups were significant(P<0.05).The proportion of soft plaques in positive group was signigifcantly higher than that in negative group,and proportion of hard plaques was signigifcantly lower than that in negative group(P<0.05).The number of detected plaques,intima-media thickness(IMT),plaque score and number of cases with cardiovascular events in positive group were signigifcantly higher than those in negative group(P<0.05).Regarding the expression of TLR4/MyD88/NF-κB signaling pathway,the levels of serum TLR4,MyD88 and NF-κB in positive group were signigifcantly higher than those in negative group(P<0.05).CONCLUSION HCMV infection was closely related to the occurrence of atherosclerotic cardiovascular diseases in T2 DM patients,which might be related to the regulation of fasting blood glucose,blood lipid and the expression of TLR4/MyD88/NF-κB signaling pathway.