血清Metrnl、RANTES水平与2型糖尿病患者并发冠心病的关系

Associations of serum Metrnl and RANTES levels with type 2 diabetes mellitus complicated with coronary artery disease

目的 探讨血清流星蛋白样胶质细胞分化调节剂(Metrnl)、受激活调节正常T细胞表达和分泌因子(RANTES)水平与2型糖尿病(T2DM)患者并发冠心病(CHD)的关系。方法 选取240例行冠状动脉造影检查的T2DM患者(T2DM组),根据冠状动脉造影检查结果分为CHD组129例和无CHD组111例,另选取同期64例体检健康志愿者(对照组)。收集临床资料,采用酶联免疫吸附法检测血清Metrnl、RANTES。Spearman相关法分析T2DM患者血清Metrnl、RANTES水平与Gensini评分的相关性,多因素Logistic回归分析T2DM患者并发CHD的影响因素,受试者工作特征曲线(ROC)分析血清Metrnl、RANTES水平对T2DM患者并发CHD的预测价值。结果 与对照组比较,T2DM组血清Metrnl水平低,血清RANTES水平高(P<0.05)。与无CHD组比较,CHD组血清Metrnl水平低,血清RANTES水平高(P<0.05)。Spearman相关分析显示,T2DM患者Gensini评分与血清Metrnl水平呈负相关,与RANTES水平呈正相关(rs分别为-0.657、0.683,P均<0.05)。多因素Logistic回归分析显示,体质量指数增加(OR=1.145,95%CI:1.008~1.300)、T2DM病程长(OR=1.120,95%CI:1.038~1.208)、低密度脂蛋白胆固醇升高(OR=1.959,95%CI:1.009~3.805)、糖化血红蛋白升高(OR=1.361,95%CI:1.079~1.718)、RANTES水平升高(OR=1.329,95%CI:1.057~1.671)是T2DM患者并发CHD的独立危险因素,血清Metrnl水平升高(OR=0.893,95%CI:0.867~0.919)为其独立保护因素(P均<0.05)。ROC曲线分析显示,血清Metrnl、RANTES水平单独与联合预测T2DM患者并发CHD的曲线下面积分别为0.774、0.760、0.855,二者联合预测的曲线下面积大于单独预测(P均<0.05)。结论 血清Metrnl水平、RANTES水平变化与T2DM患者冠脉病变程度密切相关,二者是T2DM合并CHD的独立影响因素,可作为T2DM患者并发CHD的预测指标。

Objective To investigate the relationships between the levels of serum meteorin-like glial cell differentiation regulator(Metrnl),regulated upon activation,normal T-cell expressed and secreted(RANTES) and type 2 diabetes mellitus(T2 DM) complicated with coronary heart disease(CHD).Methods A total of 240 patients with T2 DM who had coronary angiography(T2 DM group) were selected and divided into the CHD group of 129 cases and non-CHD group of 111 cases according to the coronary angiography results,and another 64 healthy volunteers with physical examination were selected during the same period(control group).The clinical data of T2 DM patients were collected and serum Metrnl and RANTES levels were measured by enzyme-linked immunosorbent assay.Spearman’ s correlation coefficient was used to analyze the correlations between serum Metrnl and RANTES levels and Gensini score in T2 DM patients,and multifactor Logistic regression was used to analyze the factors influencing T2 DM complicated with CHD,and receiver operating characteristic(ROC) curves were used to analyze the predictive value of serum Metrnl and RANTES levels on T2 DM complicated with CHD.Results Compared with the control group,serum Metrnl levels decreased and RANTES levels increased in the T2 DM group(both P<0.05).Serum Metrnl levels were lower and RANTES levels were higher in the CHD group than in the non-CHD group(both P<0.05).Spearman’s correlation analysis showed a negative correlation between Gensini score and serum Metrnl level and a positive correlation with RANTES level in T2 DM patients(r_(s)=-0.657,0.683,both P<0.05).Multi-factor Logistic regression analysis showed that increased body mass index(OR=1.145,95%CI:1.008 to 1.300),prolonged duration of T2 DM(OR=1.120,95% CI:1.038 to 1.208),elevated LDL cholesterol(OR=1.959,95% CI:1.009 to 3.805),elevated glycated hemoglobin A1 c(OR=1.361,95% CI:1.079 to 1.718),and elevated RANTES(OR=1.329,95% CI:1.057 to 1.671) were independent risk factors for T2 DM complicated with CHD;and elevated Metrnl(OR=0.893,95% CI:0.867 to 0.919) was an independent protective factor(all P<0.05).ROC curve analysis showed that the area under the curve(AUC) of serum Metrnl and RANTES levels alone and in combination in predicting T2 DM complicated with CHD were 0.774,0.760,and 0.855,respectively,and the AUC of the combination of the two was greater than that of either index alone(all P<0.05).Conclusion The serum Metrnl and RANTES levels are closely related to the degree of coronary artery disease in T2 DM patients,and are independent influencing factors for T2 DM combined with CHD,which can be used as the predictors of T2 DM patients with CHD.