2型糖尿病患者糖化血红蛋白与颈动脉内-中膜层厚度的关系:Logistic及单核细胞中介效应检验

目的研究2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)与颈动脉内-中膜层厚度(carotid intima-media thickness,CIMT)的关系及单核细胞在HbA1c与CIMT间的中介作用。方法选择2014年至2019年于华东疗养院体检的T2DM患者1539例,根据CIMT的厚度分为正常组808例(CIMT<1.0 mm)、增厚组731例(CIMT≥1.0 mm);通过多因素回归分析HbA1c能否作为CIMT增厚的危险因素;进而采用Hayes编制的SPSS宏中的简单中介模型分析单核细胞在HbA1c与CIMT关系中的中介效应。结果校正年龄、性别、高血压、吸烟、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等混杂因素后,HbA1c是T2DM患者CIMT增厚的危险因素,差异有统计学意义(P<0.05);HbA1c通过单核细胞对CIMT增厚的中介效应值为0.0174(0.0021,0.0353),中介效应显著;加入中介变量单核细胞后,HbA1c对CIMT增厚的直接效应为0.0888(-0.0044,0.1821),直接效应不显著,单核细胞在HbA1c与CIMT关系中起完全中介作用。结论HbA1c是T2DM患者CIMT增厚危险因素,单核细胞在HbA1c与CIMT增厚的关系中起到主要中介作用。

Objective To study the relationship between glycosylated hemoglobin(HbA1c)and carotid intima-media thickness(CIMT)in type 2 diabetes mellitus(T2DM)and the mediating role of monocytes in HbA1c and CIMT.Methods 1539 patients with T2DM who underwent physical examination in East China sanatorium from 2014 to 2019 were selected.According to the thickness of CIMT,they were divided into 808 cases in the normal group(CIMT<1.0 mm)and 731 cases in the thickening group(CIMT≥1.0 mm);Whether HbA1c could be used as a risk factor for CIMT thickening was analyzed by multivariate regression;Then,the simple mediation model in SPSS macro compiled by Hayes was used to analyze the mediation effect of monocytes in the relationship between HbA1c and CIMT.Results After adjusting for confounding factors such as age,sex,hypertension,smoking,triacylglycerol(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C),HbA1c was a risk factor for CIMT thickening in T2DM patients(P<0.05);The mediating effect of HbA1c on CIMT thickening through monocytes was 0.0174(0.0021,0.0353),with significant mediating effect;The direct effect of HbA1c on CIMT thickening was 0.0888(-0.0044,0.1821),without significant direct effect.Monocytes played a complete intermediary role in the relationship between HbA1c and CIMT.Conclusion HbA1c is a risk factor for CIMT thickening in T2DM patients.Monocytes play a major mediating role in the relationship between HbA1c and CIMT thickening.