诊断糖尿病患者合并颈动脉斑块标志物的研究

Research of the biomarkers in diagnosis of patients with diabetes mellitus and carotid plaque

目的 探讨检测血清脂蛋白残粒(RLP)、低密度脂蛋白颗粒浓度(LDL-P)、小而密低密度脂蛋白颗粒浓度(sdLDL-P)及壳多糖酶3样蛋白1(CHI3L1)变化,对诊断DM患者合并颈动脉斑块的临床意义。方法 选取2020年12月至2022年12月于宁波鄞州中医院内分泌科治疗的DM患者455例,根据是否合并颈动脉斑块分为单纯DM组(n=152)、合并不稳定型颈动脉斑块组(不稳定型组,n=153)、合并稳定型颈动脉斑块组(稳定型组,n=150)。另同期选取我院体检健康者154名作为正常对照(NC)组。结果 NC、DM、稳定型、不稳定型组的年龄、吸烟史、高血压、FPG、HbA1c、TG、LDL-C、sdLDL-C、RLP、LDL-P、sdLDL-P及CHI3L1依次升高(P<0.05)。NC、DM组血清sdLDL-C、RLP及LDL-P诊断假阳性率低于TG、LDL-C(P<0.05)。Pearson相关分析显示,血清CHI3L1与TG、RLP、LDL-C、LDL-P、sdLDL-C、sdLDL-P呈正相关(P<0.05)。受试者工作特征曲线分析显示,血清TG、LDL-C、sdLDL-C、RLP、LDL-P、sdLDL-P及CHI3L1诊断稳定型和不稳定型颈动脉斑块的曲线下面积为0.697和0.695,0.715和0.708,0.790和0.728,0.816和0.848,0.824和0.857,0.903和0.909,0.915和0.971。结论 血清RLP、LDL-P、sdLDL-P及CHI3L1升高可诊断DM合并颈动脉斑块,检测RLP优于TG,检测LDL-P、sdLDL-P优于LDL-C、sdLDL-C。血清CHI3L1升高可鉴别诊断DM合并不稳定型颈动脉斑块。

Objective To explore the clinical significance of changes in serum lipoprotein residual particles(RLP),low-density lipoprotein particle concentration(LDL-P),small and dense low-density lipoprotein particle concentration(sdLDL-P)and chitinase 3-like protein 1(CHI3L1)in patients with diabetes mellitus(DM)complicated with carotid artery plaques.Methods A total of 455 patients with DM who were treated in the Endocrinology Department of Ningbo Yinzhou Hospital of Traditional Chinese Medicine were enrolled in this study from December 2020 to December 2022.All the subjects were divided into three groups based on whether they had carotid artery plaques:simple DM group(DM,n=152),unstable carotid artery plaques group(Unstable group,n=153),and stable carotid artery plaques group(Stable group,n=150).During the same period,154 healthy individuals who underwent physical examination in our hospital were selected as the normal control(NC)group.Results Age,smoking history,hypertension,FPG,HbA1c,TG,LDL-C,sdLDL-C,RLP,LDL-P,sdLDL-P and CHI3L1 levels increased sequentially in the four groups of NC,DM,stable and unstable group.The false positive rates of serum sdLDL-C,RLP,and LDL-P were lower than TG and LDL-C in NC and DM group(P<0.05).Pearson correlation analysis showed that serum CHI3L1 was positively correlated with TG,RLP,LDL-C,LDL-P,sdLDL-C,and sdLDL-P (P<0. 05). The analysis of the working characteristic curves of thesubjects showed that the AUC of serum TG,LDL-C,sdLDL-C,RLP,LDL-P,sdLDL-P,and CHI3L1 fordiagnosing stable and unstable carotid artery plaques was 0. 697 and 0. 695,0. 715 and 0. 708,0. 790 and0. 728,0. 816 and 0. 848,0. 824 and 0. 857,0. 903 and 0. 909,0. 915 and 0. 971. Conclusion Increasedserum RLP,LDL-P,sdLDL-P and CHI3L1 levels can diagnose DM combined with carotid plaque. The detectionof RLP is better than TG,and the detection of LDL-P and sdLDL-P is better than LDL-C and sdLDL-C. Elevatedserum CHI3L1 can be used in the differential diagnosis of DM combined with unstable carotid plaque.