糖尿病心肌病患者HbA_(1c)、NT-proBNP、Hcy、SOD和TC水平的变化及其临床意义

Changes and clinical significance of HbA_(1c),NT-proBNP,Hcy,SOD and TC levels in patients with diabetes cardiomyopathy

目的探讨糖代谢指标[糖化血红蛋白(HbA_(1c))]、脂代谢指标[总胆固醇(TC)、三酰甘油(TG)]、氧化应激指标[同型半胱氨酸(Hcy)、β-羟丁酸(β-HB)、超氧化物歧化酶(SOD)]、炎症指标[C反应蛋白(CRP)]和心功能损伤指标[氨基末端B型钠尿肽原(NT-proBNP)]在糖尿病心肌病(DCM)中的临床应用价值。方法选取2018年12月—2022年1月合肥市第一人民医院滨湖医院DCM患者60例(DCM组)、单纯糖尿病患者60例(对照组)。收集所有患者的一般资料,并检测HbA_(1c)、NT-proBNP、Hcy、TC、TG、CRP、β-HB、SOD水平。采用Logistic回归分析评估发生DCM的危险因素。采用受试者工作特征(ROC)曲线评价各项指标单项检测和联合检测在鉴别诊断DCM中的效能。结果DCM组HbA_(1c)、NT-proBNP、Hcy、TC、TG、CRP和β-HB水平均显著高于对照组(P<0.05),SOD水平显著低于对照组(P<0.05)。Logistic回归分析结果显示,HbA_(1c)、NT-proBNP、Hcy、SOD和TC均是糖尿病患者发生DCM的危险因素[比值比(OR)值分别为3.092、1.003、1.349、0.969、2.947,95%可信区间分别为1.187~8.051、1.000~1.006、1.088~1.673、0.943~0.995、1.159~7.494]。ROC曲线分析结果显示,HbA_(1c)、NT-proBNP、Hcy、SOD、TC单项检测和5项指标联合检测鉴别诊断DCM的曲线下面积分别为0.615、0.613、0.650、0.608、0.603和0.683。结论HbA_(1c)、NT-proBNP、Hcy、SOD和TC在DCM的风险评估中有一定的价值。

Objective To investigate glucose metabolism[glycated hemoglobin A_(1c)(HbA_(1c))],lipid metabolism[total cholesterol(TC)and triglyceride(TG)],oxidative stress[homocysteine(Hcy),betahydroxybutyric acid(beta-hydroxybutyrate,β-HB),superoxide dismutase(SOD)],inflammation[C-reactive protein(CRP)]and myocardial injury[amino-terminal B-type natriuretic peptide(NT-proBNP)]indicators in diabetes cardiomyopathy(DCM).Methods From December 2018 to January 2022,60 patients with DCM(DCM group)and 60 patients with simple diabetes(control group)from Binhu Hospital of Hefei First People's Hospital were enrolled,and the general data of all the patients were collected.HbA_(1c),NT-proBNP,Hcy,TC,TG,CRP,β-HB and SOD levels were determined.Logistic regression analysis was used to evaluate the risk factors of DCM.Receiver operating characteristic(ROC)curve was used to evaluate the value and predictive efficacy of various influencing factors in the auxiliary diagnosis of DCM.Results HbA_(1c),NT-proBNP,Hcy,TC,TG,CRP andβ-HB levels were higher than those in control group(P<0.05).The level of SOD was lower than that in control group(P<0.05).Logistic regression analysis showed that HbA_(1c)[odds ratio(OR)=3.092,95%confidence interval(CI)1.187-8.051],NT-proBNP(OR=1.003,95%CI 1.000-1.006),Hcy(OR=1.349,95%CI 1.088-1.673),SOD(OR=0.969,95%CI 0.943-0.995)and TC(OR=2.947,95%CI 1.159-7.494)were risk factors for DCM.The areas under curves of HbA_(1c),NT-proBNP,Hcy,SOD and TC single determinations and the combined determination were 0.615,0.613,0.650,0.608,0.603 and 0.683 in the differential diagnosis of DCM,respectively.Conclusions HbA_(1c),NT-proBNP,Hcy,SOD and TC are related to the occurrence of DCM.