2型糖尿病患者骨保护素和NF-κB受体活化因子配体与左室舒张功能障碍的相关研究

Correlation between Serum Osteoprotegerin/Soluble Receptor Activator of Nuclear Factor-κβLigand Levels and the Left Ventricular Diastolic Dysfunction in Type 2 Diabetes

【目的】探讨2型糖尿病(T2DM)患者血清骨保护素(OPG)和可溶性NF-κB受体活化因子配体(sRANKL)水平与可能左室舒张功能障碍(LADD)的相关性。【方法】本研究纳入68例T2DM患者和37例健康对照者,利用ELISA方法测定血清OPG和sRANKL水平,同时利用心脏彩超测定T2DM患者左室舒张功能,E/A<1定义为LADD。进一步将T2DM患者分为E/A≥1和E/A<1两个亚组。采用Spearman相关性分析、logistics回归分析和ROC曲线评估血清OPG和sRANKL与T2DM患者可能LADD的相关性。【结果】与健康对照者相比,T2DM患者血清OPG水平明显升高,差异有统计意义(P<0.01),而sRANKL水平降低,但无统计学意义(P=0.032)。亚组分析则显示E/A<1组的OPG水平较E/A≥1组升高(P<0.01),而sRANKL降低(P<0.01)。Spearman相关性分析显示,血清OPG水平与E/A比值呈负相关,而sRANKL则与E/A比值呈正相关。单因素logistics回归分析显示,血清OPG水平[OR(95%CI)=1.068(1.031,1.106),P<0.001]和sRANKL水平[OR(95%CI)=0.976(0.959,0.992),P=0.003]与T2DM患者可能LVDD显著相关。ROC曲线分析显示,联合OPG与sRANKL诊断糖尿病患者可能LADD的敏感性为78.13%,特异性为88.3%(曲线下面积:0.857;95%CI=(0.768,0.946);P<0.001)。【结论】T2DM患者血清中升高的OPG和降低的sRANKL水平提示其可能与LADD相关。

【Objective】To study the possible correlation between serum osteoprotegerin(OPG)/soluble receptor acti⁃vator of the nuclear factorκB ligand(sRANKL)levels and the left ventricular diastolic dysfunction(LADD)in patients with type 2 diabetes mellitus(T2DM).【Methods】Totally 68 T2DM patients and 37 healthy controls were selected.Serum OPG and sRANKL were determined by solid-phase enzyme-linked immunosorbent assay(ELISA).The left ventricular di⁃astolic function of T2DM patients was measured by transthoracic echocardiography,where E/A<1 were regarded as LVDD.T2DM patients were further divided into two subgroups according to E/A ratio(E/A≥1.0 and E/A<1).Spearman correlation analysis,logistic regression and ROC curves were used to assess the possible correlation between serum OPG/sRANKL and LADD in T2DM patients.【Results】Compared with the healthy controls,serum OPG level in T2DM patients was higher with statistically significant difference(P<0.01),while serum sRANKL level was lower without statistically significant difference(P=0.32).T 2 DM patients with E/A<1 had significantly higher OPG level and lower sRANKL level than those with E/A≥1(P<0.01)in subgroup analysis.Spearman correlation analysis showed serum OPG level was nega⁃tively correlated with E/A ratio,while sRANKL was positively related with E/A ratio.In single factor logistic regression analyses,serum OPG[OR(95%CI)=1.068(1.031,1.106),P<0.001]and sRANKL[OR(95%CI)=0.976(0.959,0.992),P=0.003]were significant correlation with LVDD in T 2 DM patients.ROC curve analysis showed that the sensitivi⁃ty and specificity of combined OPG and sRANKL in diagnosing T 2 DM patients LADD were 78.13%and 88.3%,respec⁃tively(area under the curve:0.857;95%CI=(0.768,0.946);P<0.001).【Conclusions】The elevated OPG and decreased sRANKL levels may be associated with LADD in T 2 DM patients.