2型糖尿病合并急性脑梗死患者糖化血红蛋白与血清相关炎症因子及颈动脉粥样硬化斑块的相关性研究

Research on the association between glycosylated hemoglobin and serum related inflammatory factors and carotid atherosclerotic plaque in patients with type 2 diabetes mellitus complicated with acute cerebral infarction

目的探讨2型糖尿病合并急性脑梗死患者糖化血红蛋白(Glycosylated Hemoglobin,HbA1c)与血清相关炎症因子及颈动脉粥样硬化斑块的关系。方法选择2019年1月—2020年11月在本院住院治疗的85例2型糖尿病合并急性脑梗死患者作为研究对象,根据颈部血管超声检查结果分为无斑块组(13例)、稳定斑块组(26例)和不稳定斑块组(46例)三组。三组患者均进行HbA1c、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)测定。观察比较HbA1c、hs-CRP、TNF-α和IL-6水平及HbA1c与血清相关炎症因子相关分析结果,采用MedCalc软件绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析HbA1c预测发生颈动脉不稳定斑块的价值。结果不稳定斑块组患者的HbA1c、hs-CRP、TNF-α和IL-6水平均显著高于无斑块组和稳定斑块组,差异有统计学意义(P<0.01);稳定斑块组患者的HbA1c、hs-CRP、TNF-α和IL-6水平均显著高于无斑块组,差异有统计学意义(P<0.05)。血清hs-CRP、TNF-α和IL-6水平均与HbA1c呈正相关(P<0.01)。ROC曲线分析显示,HbA1c是发生颈动脉不稳定斑块的显著预测因子[ROC曲线下面积(area under the ROC curve,AUC):0.737,P<0.01]。结论HbA1c可能通过炎症因子促进2型糖尿病合并急性脑梗死患者发生颈动脉不稳定斑块,有望成为评估颈动脉斑块的廉价临床检测指标。

Objective To explore the association between glycosylated hemoglobin(HbA1c)and serum related inflammatory factors and carotid atherosclerotic plaque in patients with type 2 diabetes mellitus complicated with acute cerebral infarction.Methods A total of 85 patients suffered with type 2 diabetes mellitus complicated with acute cerebral infarction those hospitalized in our hospital during January 2019 and November 2020 were included in this study.According to the results of cervical vascular ultrasound examination,the patients were divided into three groups:no plaque group(n=13),stable plaque group(n=26)and unstable plaque group(n=46).The HbA1c,high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels in all cases were detected.The levels of HbA1c,hs-CRP,TNF-αand IL-6,and the results of correlation analysis between HbA1c and serum related inflammatory factors were observed and compared.Receiver operating characteristic(ROC)curve was drawn by MedCalc software,and the value of HbA1c in predicting the occurrence of carotid artery unstable plaque was analyzed.Results The HbA1c,hs-CRP,TNF-αand IL-6 levels in the unstable plaque group were significantly higher than those in the no plaque group and stable plaque group(P<0.01);the HbA1c,hs-CRP,TNF-αand IL-6 levels in the stable plaque group were significantly higher than those in the no plaque group(P<0.05).Serum hs-CRP,TNF-αand IL-6 levels were positively correlated with HbA1c(P<0.01).ROC curve analysis revealed that HbA1c was a significant predictor of carotid artery unstable plaque[area under the ROC curve(AUC):0.737,P<0.01].Conclusions HbA1c may promote the occurrence of carotid unstable plaques in patients with type 2 diabetes mellitus complicated with acute cerebral infarction through inflammatory factors,which is expected to be used as a cheap clinical detection indicator for assessing carotid plaque.