血清补体C1q/肿瘤坏死因子相关蛋白3水平与糖尿病合并脂肪肝患者颈动脉粥样硬化的相关性

Relationship between serum complement C1q/tumor necrosis factor related protein 3 level and carotid atherosclerosis in patients with diabetes mellitus complicated with fatty liver

目的探讨补体C1q/肿瘤坏死因子相关蛋白3(C1q/tumour necrosis factor-related protein-3,CTRP3)与2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)患者颈动脉粥样硬化的相关性。方法采用回顾性分析方法,选取2018年1月至2019年12月在南通大学附属南通第三人民医院内分泌科住院的T2DM患者111例及同期在南通大学附属南通第三人民医院体检中心健康体检者30名。健康体检者30名为对照组,T2DM患者111例根据是否合并NAFLD分为T2DM组52例,T2DM+NAFLD组59例。采用横断面研究方法,收集3组相关临床资料,多组间比较数据符合正态分布且方差齐采用单因素方差分析,两两比较采用SNK-q检验,定性资料比较用χ2检验,颈动脉内中膜厚度(carotid intima-media thickness,IMT)与影响因子的相关性采用偏相关性分析,采用多因素线性回归分析颈动脉IMT的影响因素。结果对照组、T2DM组和T2DM+NAFLD组3组间体质量指数(body mass index,BMI)分别为(23.65±2.81)、(25.52±3.12)、(24.90±2.94)kg/m2,收缩压分别为(119.43±15.81)、(130.63±10.20)、(139.37±14.11)mmHg,舒张压(72.93±9.74)、(73.40±9.44)、(77.97±10.00)mmHg,空腹血糖分别为(5.12±0.77)、(9.78±1.37)、(9.24±1.46)mmol/L,糖化血红蛋白(glycosylated hemoglobin,HbA1c)分别为(4.87±1.43)%、(7.99±1.10)%、(8.56±1.29)%,胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)分别为1.56±0.37、2.80±1.00、3.47±0.94,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)分别为(1.52±0.34)、(1.23±0.31)、(1.22±0.31)mmol/L,低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)(2.41±0.53)、(2.73±0.61)、(2.93±0.59)mmol/L,CTRP3分别为(292.93±68.54)、(241.69±61.01)、(150.80±56.67)μg/L,组间比较差异均有统计学意义(F值分别为3.712、23.023、4.074、134.285、90.818、47.105、10.139、7.941、60.035,P均<0.05)。两两比较T2DM+NAFLD组收缩压、舒张压、HbA1c、HOMA-IR均高于对照组和T2DM组,CTRP3低于对照组和T2DM组,差异均有统计学意义(P均<0.05)。T2DM组BMI、空腹血糖、HbA1c、HOMA-IR、HDL-C、LDL-C均高于对照组,CTRP3低于对照组,差异均有统计学意义(P均<0.05)。对照组、T2DM组和T2DM+NAFLD组3组间IMT分别为(0.75±0.13)、(1.11±0.17)、(1.25±0.15)cm,Crouse积分分别为(1.28±0.97)、(3.22±1.42)、(4.54±1.22),斑块检出率分别为16.7%(5/30)、65.4%(34/52)、78.0%(46/59),组间比较差异均有统计学意义(F分别为105.941、67.063,χ^(2)=32.108,P均<0.001)。两两比较差异均有统计学意义(P均<0.05),T2DM+NAFLD组最高,其次为T2DM组,对照组最低。偏相关分析显示颈动脉IMT与收缩压、空腹血糖、HbA1c、HOMA-IR、甘油三酯、LDL-C均呈正相关(r值分别为0.356、0.572、0.575、0.620、0.172、0.291,P均<0.05),与HDL-C、CTRP3呈负相关(r值分别为-0.335、-0.675,P均<0.001)。多因素线性回归分析显示HbA1c、HDL-C、CTRP3均是颈动脉粥样硬化的影响因素(t值分别为2.621、-3.764、-7.280,P均<0.05)。结论血清CTRP3与T2DM合并NAFLD患者的颈动脉粥样硬化相关,可能对T2DM合并NAFLD患者的血管病变有保护作用。

Objective To investigate the correlation between serum complement C1q/tumor necrosis factor associated protein 3(CTRP3)and carotid atherosclerosis in patients with type 2 diabetes mellitus(T2DM)and nonalcoholic fatty liver disease(NAFLD).Methods From January 2018 to December 2019,111 T2DM patients hospitalized in the Endocrinology Department of Nantong Third People′s Hospital Affiliated to Nantong University,and 30 healthy physical examiners in the physical examination center of Nantong Third People's Hospital Affiliated to Nantong University in the same period were selected.Thirty cases of healthy physical examination were the control group,111 cases of T2DM were divided into 52 cases of T2DM group and 59 cases of T2DM+NAFLD group according to whether they were combined with NAFLD.The cross-sectional study method was used to collect the relevant clinical data of three groups.The comparison data between multiple groups conformed to the normal distribution and the variance was uniform.One way ANOVA was used.SNK-q test was used for pairwise comparison,χ2 test for qualitative data comparison.The correlation between carotid intima-media thickness(IMT)and influencing factors was analyzed by partial correlation analysis,and the influencing factors of carotid IMT were analyzed by multi factor linear regression.Results In the control group,T2DM group and T2DM+NAFLD group,body mass index(BMI)(23.65±2.81),(25.52±3.12),(24.90±2.94)kg/m2,systolic blood pressure(119.43±15.81),(130.63±10.20),(139.37±14.11)mmHg,diastolic blood pressure(72.93±9.74),(73.40±9.44),(77.97±10.00)mmHg,and fasting blood glucose(5.12±0.77),(9.78±1.37),(9.24±1.46)mmol/L,glycosylated hemoglobin(HbA1c)(4.87±1.43)%,(7.99±1.10)%,(8.56±1.29)%,homeostasis model assessment of insulin resistance(HOMA-IR)(1.56±0.37),(2.80±1.00),(3.47±0.94),high density lipoprotein cholesterol(HDL-C)(1.52±0.34),(1.23±0.31),(1.22±0.31)mmol/L,low density lipoprotein cholesterol(LDL-C)(2.41±0.53),(2.73±0.61),(2.93±0.59)mmol/L,CTRP3(292.93±68.54),(241.69±61.01),(150.80±56.67)μg/L,the difference between groups were statistically significant(F=3.712,23.023,4.074,134.285,90.818,47.105,10.139,7.941,60.035,all P<0.05).Pairwise comparison shows that the systolic blood pressure,diastolic blood pressure,HbA1c and HOMA-IR in T2DM+NAFLD group were higher than those in control group and T2DM group,and CTRP3 was lower than those in control group and T2DM group,the difference was statistically significant(all P<0.05).BMI,fasting blood glucose,HbA1c,HOMA-IR,HDL-C and LDL-C in T2DM group were higher than those in the control group,CTRP3 was lower than that in the control group(all P<0.05).In the control group,T2DM group and T2DM+NAFLD group,IMT were(0.75±0.13),(1.11±0.17)and(1.25±0.15)cm;Crouse scores were(1.28±0.97),(3.22±1.42)and(4.54±1.22);the plaque detection rates 16.7%(5/30),65.4%(34/52)and 78.0%(46/59),and there were significant differences between the two groups(F=105.941,67.063,χ^(2)=32.108,all P<0.001).There were significant differences between the two groups(all P<0.05).T2DM+NAFLD group was the highest,followed by T2DM group,and the control group was the lowest.Partial correlation analysis showed that carotid IMT was positively correlated with systolic blood pressure,fasting blood glucose,HbA1c,HOMA-IR,triglyceride and LDL-C(r=0.356,0.572,0.575,0.620,0.172,0.291,all P<0.05),and negatively correlated with HDL-C and CTRP3(r=-0.335,-0.675,all P<0.001).Multivariate linear regression analysis showed that HbA1c,HDL-C and ctrp3 were the influencing factors of carotid atherosclerosis(t=2.621,-3.764,-7.280,all P<0.05)Conclusion Serum CTRP3 is associated with carotid atherosclerosis in T2DM patients with NAFLD,and may have a protective effect on vascular lesions in T2DM patients with NAFLD.