2型糖尿病合并冠心病老年患者外周血微小RNA-4465和微小RNA-6089水平变化及临床意义

Changes and clinical significance of microRNA-4465 and microRNA-6089 levels in peripheral blood of elderly patients with type 2 diabetes mellitus and coronary atherosclerotic heart disease

目的探讨2型糖尿病合并冠心病(冠状动脉粥样硬化性心脏病)老年患者外周血微小RNA(miR)-4465和miR-6089水平变化及临床意义。方法选取河北省唐山市人民医院2020年11月至2021年1月收集的90例受试者,包括30例T_(2)DM不合并冠心病(非冠心病组)、30例T_(2)DM合并冠心病(冠心病组)以及30例健康受试者(对照组)。分析3组临床资料、外周血miR-4465和miR-6089水平。采用多因素Logistic回归模型分析T_(2)DM合并冠心病的危险因素。采用Pearson相关性分析法分析外周血miR-4465和miR-6089水平与Gensini评分的相关性。绘制受试者工作特征(ROC)曲线分析外周血miR-4465和miR-6089对T_(2)DM合并冠心病的诊断价值。结果冠心病组空腹血糖、糖化血红蛋白、收缩压、低密度脂蛋白胆固醇(LDL-C)、总胆固醇水平及血糖控制不佳比例均高于非冠心病组和对照组,高密度脂蛋白胆固醇、三酰甘油水平均低于非冠心病组和对照组,差异均有统计学意义(均P<0.05)。冠心病组外周血miR-4465、miR-6089水平均高于非冠心病组和对照组[(17.6±3.4)比(8.4±2.6)、(3.1±0.8),(33.1±4.5)比(19.5±2.8)、(4.2±1.3)](均P<0.05);非冠心病组miR-4465、miR-6089水平均高于对照组(均P<0.05)。多因素Logistic回归分析结果显示,miR-4465、miR-6089、LDL-C水平升高、高血压病、血糖控制不佳均是T_(2)DM合并冠心病的独立危险因素(均P<0.05)。Pearson相关性分析结果显示,T_(2)DM合并冠心病患者外周血miR-4465和miR-6089水平均与Gensini评分呈正相关(均P<0.001)。受试者工作特征曲线分析结果显示,外周血miR-4465和miR-6089诊断T_(2)DM合并冠心病的曲线下面积为0.912(0.806~0.956)、0.920(0.823~0.987)。结论T_(2)DM合并冠心病的老年患者外周血miR-4465和miR-6089水平均明显增高,二者可作为评估T_(2)DM患者冠心病风险的参考指标。

Objective To investigate the changes and clinical significance of microRNA(miR)-4465 and miR-6089 levels in peripheral blood of elderly patients with type 2 diabetes mellitus(T_(2)DM)and coronary atherosclerotic heart disease(CHD).Methods From November 2020 to January 2021,90 subjects were enrolled in this study in Tangshan People′s Hospital,Hebei Province,including 30 cases of T_(2)DM without CHD(non-CHD group),30 cases of T_(2)DM with CHD(CHD group),and 30 cases of healthy subjects(control group).Clinical data,peripheral miR-4465 and miR-6089 levels of three groups were analyzed.Multivariate Logistic regression model was used to analyze the risk factors of T_(2)DM with CHD.Pearson correlation analysis was used to analyze the correlation of the levels of miR-4465 and miR-6089 in peripheral blood with Gensini scores.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of peripheral blood miR-4465 and miR-6089 in T_(2)DM patients with CHD.Results Levels of fasting glucose,glycosylated hemoglobin,systolic blood pressure,low-density lipoprotein cholesterol(LDL-C),total cholesterol and the proportion of poor glucose control in CHD group were higher than those in non-CHD group and control group,while high-density lipoprotein cholesterol and triacylglycerol levels were lower than those in non-CHD group and control group(all P<0.05).Levels of miR-4465 and miR-6089 in CHD group were higher than those in non-CHD group and control group[(17.6±3.4)vs(8.4±2.6),(3.1±0.8);(33.1±4.5)vs(19.5±2.8),(4.2±1.3)](all P<0.05);levels of miR-4465 and miR-6089 in non-CHD group were higher than those in control group(both P<0.05).Multivariate Logistic regression analysis showed that elevated miR-4465,miR-6089,LDL-C,hypertension,and poor glycemic control were independent risk factors for T_(2)DM combined with CHD(all P<0.05).Pearson correlation analysis showed that peripheral miR-4465 and miR-6089 levels were positively correlated with Gensini scores(both P<0.001).ROC curve analysis showed that the area under the curve of peripheral miR-4465 and miR-6089 in the diagnosis of T_(2)DM combined with CHD were 0.912(0.806-0.956)and 0.920(0.823-0.987),respectively.Conclusion Levels of miR-4465 and miR-6089 in peripheral blood of elderly patients with T_(2)DM and CHD are significantly higher.Both of them can be used as reference indicators to evaluate the risk of CHD in T_(2)DM patients.