同型半胱氨酸联合褪黑素检测对2型糖尿病合并冠心病患者冠脉病变程度及预后的预测价值

Value of combined detection of serum homocysteine and melatonin levels in evaluation for coronary artery lesions and prognosis in patients with type 2 diabetes mellitus and coronary heart disease

目的探讨2型糖尿病(T2DM)合并冠心病(CHD)患者血清同型半胱氨酸(homocysteine,Hcy)、褪黑素(melatonin,MT)水平在冠脉病变程度及预后的预测价值。方法选取2018年7月至2019年12月重庆市公共卫生医疗救治中心/西南大学附属公卫医院收治的2型糖尿病合并冠心病患者(DC组)80例,根据诊断后6个月内是否有急性冠脉综合征等不良心血管事件分为预后良好组(n=58)和预后不良组(n=22),同期的单纯2型糖尿病患者(DM组)及健康体检者(NC组)各40例为对照。冠状动脉造影计算冠脉病变支数、Gensini积分法评估冠脉狭窄程度、ELISA法检测血清Hcy、MT水平,采用Spearman秩相关分析2型糖尿病合并冠心病患者血清Hcy、MT水平与冠脉狭窄程度的相关性,绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC),评估血清Hcy、MT水平对2型糖尿病合并冠心病患者不良预后的预测价值。结果DM组、DC组血清Hcy水平明显高于NC组(P<0.05),MT水平明显低于NC组(P<0.05);DC组血清Hcy水平明显高于DM组(P<0.05),MT水平明显低于DM组(P<0.05)。在DC组中,随着冠脉病变数量以及冠脉狭窄程度Gensini评分的增加,血清Hcy水平明显增加,而MT水平则明显下降,各组间差异均表现出统计学意义(P均<0.05)。Spearman秩相关分析显示,2型糖尿病合并冠心病患者血清Hcy水平与冠脉狭窄程度Gensini评分呈正相关(r=0.627,P<0.05),血清MT水平与冠脉狭窄程度Gensini评分呈负相关(r=-0.765,P<0.05)。预后不良者血清Hcy明显高于预后良好者,而血清MT水平明显低于预后良好者(P均<0.05)。ROC曲线分析结果显示:血清Hcy水平预测不良心血管事件的AUC为0.782,灵敏度、特异度分别为63.64%、70.69%,准确性为68.75%;血清MT水平预测不良心血管事件的AUC为0.817,灵敏度、特异度分别为77.27%、79.31%,准确性为77.50%;血清Hcy联合MT水平预测不良心血管事件的AUC为0.861,灵敏度、特异度分别为86.36%、89.66%,准确性为87.50%。结论2型糖尿病合并冠心病患者血清Hcy水平升高,MT水平下降,两者与冠脉病变严重程度密切相关。早期联合检测血清Hcy、MT水平在临床预测患者预后中有一定价值。

Objective To investigate the value of serum homocysteine(Hcy)and melatonin(MT)levels in evaluation of coronary artery lesions and prognosis in patients with type 2 diabetes mellitus(T2DM)and coronary heart disease(CHD).Methods Totally 80 patients with type 2 diabetes mellitus and coronary heart disease(DC group)were enrolled and divided into good prognosis(n=58)and poor prognosis(n=22)according to whether there were adverse cardiovascular events such as acute coronary syndrome within 6 months after diagnosis.Meanwhile,40 patients with simple type 2 diabetes mellitus(DM group)and 40 healthy volunteers(NC group)were served as controls.Coronary angiography was used to calculate the number of coronary artery lesions,Gensini integral method was used to evaluate the degree of coronary artery stenosis,and enzyme-linked immunosorbent assay(ELISA)was used to measure the serum Hcy and MT levels.Spearman rank correlation was used to analyze the correlation between the serum Hcy and MT levels and the degree of coronary artery stenosis in patients with type 2 diabetes mellitus and coronary heart disease.Receiver operating characteristic(ROC)curve was drawn,and area under the curve(AUC)was calculated to evaluate the predictive value of serum Hcy and MT for poor prognosis in patients with type 2 diabetes mellitus and coronary heart disease.Results The serum Hcy level of DM group and DC group was significantly higher than that of NC group(P<0.05),and the MT level was significantly lower than that of NC group(P<0.05);The serum Hcy level of DC group was significantly higher than that of DM group(P<0.05),and the MT level was significantly lower than that of DM group(P<0.05).In DC group,with the increase of the number of coronary artery lesions and Gensini score of coronary artery stenosis,the serum Hcy level was significantly increased,while the MT level was significantly decreased,showing significant statistical differences among the groups(all P<0.05).Spearman rank correlation analysis showed that there was a positive correlation between serum Hcy level and Gensini score(r=0.627,P<0.05),and a negative correlation between serum MT level and Gensini score(r=-0.765,P<0.05).The level of serum Hcy in patients with poor prognosis was significantly higher than that in patients with good prognosis,while the level of serum MT in patients with poor prognosis was significantly lower than that in patients with good prognosis(all P<0.05).ROC curve analysis showed that:AUC of serum Hcy level in predicting adverse cardiovascular events was 0.782,sensitivity,specificity were 63.64%,70.69%,accuracy was 68.75%;AUC of serum MT level in predicting adverse cardiovascular events was 0.817,sensitivity,specificity were 77.27%,79.31%,accuracy was 77.50%;AUC of serum Hcy combined with MT level in predicting adverse cardiovascular events was 0.861,the sensitivity and specificity were 86.36%and 89.66%,and the accuracy was 87.50%.Conclusion The level of Hcy increased and MT decreased in patients with type 2 diabetes mellitus and coronary heart disease,which were closely related to the severity of coronary artery lesions.Early combined detection of serum Hcy and MT levels has a certain value in predicting the poor prognosis of patients with type 2 diabetes mellitus and coronary heart disease.