巨噬细胞移动抑制因子与老年2型糖尿病患者颈动脉血管钙化的关系

Relationship between macrophage migration inhibitory factor and carotid vascular calcification in elderly patients with type 2 diabetes mellitus

目的探讨巨噬细胞移动抑制因子(MIF)与老年2型糖尿病(T2DM)患者颈动脉血管钙化的关系。方法选取2018年4月—2019年8月江门市人民医院老年T2DM患者164例,根据患者颈动脉血管钙化情况分为无钙化组、低钙化组和高钙化组,根据患者血清MIF水平分为高MIF组和低MIF组。收集所有患者的临床资料和实验室检测结果,并采用酶联免疫吸附试验检测血清MIF水平。对所有患者随访12个月,统计患者不良血管事件的发生率。采用多因素Logistic回归分析评估T2DM患者颈动脉血管钙化的危险因素。采用Pearson相关分析评估各项指标之间的相关性。采用受试者工作特征(ROC)曲线评估血清MIF判断T2DM患者颈动脉血管钙化的效能。采用Kaplan-Meier生存曲线分析老年T2DM患者不良血管事件的发生情况。采用Cox比例风险回归分析评估T2DM患者不良血管事件发生的危险因素。结果高钙化组和低钙化组糖尿病病程、收缩压、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、高敏C反应蛋白(hs-CRP)和MIF均高于无钙化组(P<0.05),高钙化组糖尿病病程、TC、LDL-C、hs-CRP和MIF均高于低钙化组(P<0.05),3个组之间性别、年龄、BMI、吸烟史比例、舒张压、肌酐、尿素、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,糖尿病病程、TC、LDL-C、hs-CRP、MIF均是老年T2DM患者颈动脉血管钙化的危险因素[比值比(OR)值分别为3.473、2.077、2.230、2.581、3.171,95%可信区间(CI)分别为1.940~6.216、1.179~3.660、1.074~4.632、1.419~4.692、1.425~7.055,P<0.05]。Pearson相关分析结果显示,老年T2DM患者MIF与糖尿病病程、TC、LDL-C、hs-CRP均呈正相关(r值分别为0.389、0.271、0.282、0.486,P<0.05)。ROC曲线分析结果显示,MIF判断老年T2DM患者颈动脉血管钙化的曲线下面积(AUC)为0.881。高MIF组的不良血管事件发生率高于低MIF组(χ^(2)=4.261,P=0.039)。Cox比例风险回归分析结果显示,hs-CRP、LDL-C、MIF是影响老年T2DM颈动脉血管钙化患者发生不良血管事件的的独立危险因素[风险比(HR)分别为3.091、3.597、3.311,95%CI分别为1.628~3.862、3.174~4.928、2.497~3.653,P<0.001]。结论MIF水平与老年T2DM患者颈动脉血管钙化密切相关,高水平MIF是老年T2DM颈动脉血管钙化患者发生不良血管事件的独立危险因素。

Objective To investigate the relationship between macrophage migration inhibitory factor(MIF)and carotid vascular calcification in elderly patients with type 2 diabetes mellitus(T2DM).Methods Totally,164 patients with T2DM from Jiangmen People's Hospital from April 2018 to August 2019 were enrolled.According to the vascular calcification of carotid artery,they were classified into non-calcification group,hypocalcification group and hypercalcification group.According to the expressions of MIF,they were classified into high MIF expression group and low MIF expression group.Enzyme-linked immunosorbent assay was used to determine the level of serum MIF.All the patients were followed up for 12 months to understand the incidence of major adverse cardiovascular events.Multivariate Logistic regression analysis was used to evaluate the risk factors of carotid vascular calcification in patients with T2DM.Pearson correlation analysis was used to evaluate the correlation among the indicators.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of serum MIF in judging carotid vascular calcification in patients with T2DM.Kaplan-Meier survival curve was used to analyze the incidence of major adverse cardiovascular events in elder T2DM patients.Cox proportional hazard regression analysis were used to evaluate the influencing factors of major adverse cardiovascular events in patients with T2DM.Results The course of T2DM,systolic blood pressure,total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),fasting blood glucose,high-sensitivity C-reactive protein(hs-CRP)and MIF levels in hypercalcification group and hypocalcification group were higher than those in non-calcification group(P<0.05).The course of T2DM,TC,LDL-C,hs-CRP and MIF levels in hypercalcification group were higher than those in hypocalcification group(P<0.05).There was no statistical significance in sex,age,body mass index(BMI),proportion of smoking history,diastolic blood pressure,creatinine,urea,aspartate aminotransferase(AST)and alanine aminotransferase(ALT)among the 3 groups(P>0.05).The results of multivariate Logistic regression analysis showed that the course of T2DM,TC,LDL-C,hs-CRP and MIF were risk factors of carotid vascular calcification in elderly patients with T2DM[odds ratios(OR)were 3.473,2.077,2.230,2.581 and 3.171,95%confidence intervals(CI)were 1.940-6.216,1.179-3.660,1.074-4.632,1.419-4.692 and 1.425-7.055,respectively,P<0.05].The results of Pearson correlation analysis showed that MIF in elderly patients with T2DM was positively correlated with the course of T2DM,TC,LDL-C and hs-CRP(r=0.389,0.271,0.282 and 0.486,P<0.05).ROC curve analysis showed that the area under curve(AUC)of MIF in judging carotid vascular calcification in elderly patients with T2DM was 0.881.The incidence of major adverse cardiovascular events in high MIF expression group was higher than that in low MIF expression group(χ^(2)=4.261,P=0.039).The results of Cox proportional hazard regression analysis showed that hs-CRP,LDL-C and MIF were independent risk factors for major adverse cardiovascular events in elderly T2DM patients with carotid vascular calcification[hazard ratios(HR)were 3.091,3.597 and 3.311,95%CI were 1.628-3.862,3.174-4.928 and 2.497-3.653,respectively,P<0.001].Conclusions The level of MIF is related to carotid vascular calcification in elderly patients with T2DM,and the high expression of MIF may affect the prognosis of patients by promoting carotid vascular calcification.