2型糖尿病患者单核细胞/高密度脂蛋白胆固醇比值与颈动脉粥样硬化的关系

Relationship between monocyte/high density lipoprotein ratio and carotid atherosclerosis in patients with type 2 diabetes mellitus

目的 探讨T2DM患者单核细胞/HDL-C比值(MHR)与颈动脉粥样硬化(CAS)的关系。方法 选取2021年1月至2022年1月于上海中医药大学附属普陀医院内分泌科收治的T2DM患者221例,根据颈动脉内膜中层厚度(CIMT)分为CIMT<1.0 mm组(n=66)、1.0≤CIMT<1.5 mm组(n=76)和CIMT≥1.5 mm组(n=79)。收集各组一般临床资料及实验室生化指标,并计算MHR。结果 CIMT<1.0 mm、1.0≤CIMT<1.5 mm、CIMT≥1.5 mm组年龄、DM病程、高血压病、胰岛素使用、BMI、SBP、脉压、血肌酐(Scr)、血尿酸(SUA)、MHR逐渐升高(P<0.05),血红蛋白、eGFR、HDL-C逐渐降低(P<0.05)。Spearman相关分析显示,MHR与男性、DM病程、吸烟史、饮酒史、高血压病、BMI、HbA1c、白细胞计数、单核细胞计数、TG、C-RP、Scr、SUA呈正相关(P<0.05),与TC、HDL-C、LDL-C呈负相关(P<0.05)。Logistic回归分析显示,年龄、DM病程、SUA、BMI、HDL-C及MHR是T2DM患者CAS的影响因素。受试者工作特征(ROC)曲线显示,MHR预测T2DM患者CAS的ROC曲线下面积为0.717,敏感度为63.9%,特异度为74.2%,最佳截断值为0.45。结论 MHR与T2DM患者CAS严重程度密切相关,可能对CAS斑块形成有预测价值,临床应及时监测MHR以评估CAS。

Objective To investigate the relationship between monocyte count/high-density lipoprotein cholesterol ratio(MHR)and carotid atherosclerosis(CAS)lesions in patients with type 2 diabetes mellitus(T2DM).Methods The clinical data of 221 cases of T2DM admitted to the department of endocrinology,Putuo Hospital affiliated to Shanghai University of Traditional Chinese Medicine from January 2021 to January2022 were retrospectively collected. According to the carotid intimamedia thickness(CIMT),these T2DM patients were divided into CIMT<1. 0 mm group(n=66),1. 0≤CIMT<1. 5 mm group(n=76)and CIMT≥1. 5 mm group(n=79). The general clinical data and laboratory test indexes were collected.Results The age,DM duration,hypertension,insulin use,BMI,SBP,pulse pressure,serum creatinine(Scr),serum uric acid(SUA)and MHR of the groups with CIMT<1. 0 mm,1. 0≤CIMT<1. 5 mm and CIMT≥1. 5 mm increased gradually(P<0. 05),while hemoglobin,eGFR and HDL-C decreased gradually(P<0. 05).Spearman correlation analysis showed that MHR was positively correlated with male,DM duration,smoking history,drinking history,hypertension,BMI,HbA1c,WBC,monocyte,C-RP,Scr,SUA and TG(P<0. 05),and negatively correlated with TC,HDL-C and LDL-C(P<0. 05). Logistic regression analysis showed that age,duration of DM,SUA,BMI,HDL-C and MHR were the influencing factors of CAS in T2DM patients. The ROC curve analysis showed that AUC predicted by MHR for CAS was 0. 717,with the sensitivity 63. 9%,the specificity 74. 2% and the optimal cut-off value 0. 45.Conclusion MHR is closely related to the severity of carotid atherosclerosis in patients with T2DM. The monitoring and evaluation of MHR may have a certain clinical predictive value for CAS plaque formation.