2型糖尿病患者Hcy、Met、CysC水平与室间隔肥厚的相关性

Correlation between Hcy,Met,CysC and ventricular septal hypertrophy in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者同型半胱氨酸(Hcy)、甲硫氨酸(Met)、胱抑素C(CysC)与室间隔肥厚的相关性,为防治T2DM并发心血管疾病提供一定的理论依据。方法选取2022年1月-2023年9月中国人民解放军联勤保障部队第九六七医院内分泌科收治的T2DM患者129例作为研究对象,根据超声心动图测量后的室间隔厚度将其分为肥厚组(n=62)和无肥厚组(n=67),分析两组患者的一般资料、生化指标等相关指标与室间隔肥厚的相关性。绘制受试者工作特征(ROC)曲线评价Hcy、CysC、餐后2 h血糖(PBG)、糖化血红蛋白(HbA1c)对T2DM合并室间隔肥厚的预测价值。结果肥厚组患者年龄、Hcy、CysC、PBG、HbA1c、胰岛素抵抗指数(HOMA-IR)水平均高于无肥厚组,Met水平低于无肥厚组,差异均有统计学意义(t/Z=-4.326、-2.557、-3.428、-2.143、-2.068、-2.003、-2.725,P均<0.05)。Spearman相关性分析结果显示,肥厚组患者室间隔厚度与年龄、Hcy、CysC、PBG、HbA1c、HOMA-IR水平成正相关(r=0.358、0.226、0.303、0.189、0.183、0.177,P均<0.05),与Met水平成负相关(r=-0.241,P<0.05)。二元logistic回归分析结果显示,年龄、HOMA-IR是T2DM合并室间隔肥厚的独立危险因素(OR=1.072,95%CI:1.011~1.136;OR=1.125,95%CI:1.011~1.251,P均<0.05),Met是T2DM合并室间隔肥厚的保护性因素(OR=0.870,95%CI:0.783~0.975,P<0.05)。ROC曲线分析显示,Hcy、CysC、PBG、HbA1c诊断T2DM合并室间隔肥厚曲线下面积分别为0.631、0.675、0.609、0.606,其中CysC诊断价值最高。结论Hcy、Met、CysC等水平与T2DM合并室间隔肥厚的发生密切相关;CysC水平对T2DM合并室间隔肥厚的诊断具有一定的辅助价值。

Objective To investigate the correlation between homocysteine(Hcy), methionine(Met), cystatin C(CysC) and ventricular septal hypertrophy in patients with type 2 diabetes mellitus(T2DM), so as to provide a theoretical basis for the prevention and treatment of cardiovascular diseases complicated by T2DM. Methods A total of 129 T2DM patients admitted to Department of Endocrinology in The 967th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army from January 2022 to September 2023 were selected as the study objects. According to the ventricular septal thickness measured by echocardiography, they were divided into hypertrophia group(n=62) and non-hypertrophia group(n=67). The correlation between the general data, biochemical indicators and other relevant indicators of the two groups of patients and ventricular septal hypertrophia was analyzed. Receiver operating characteristic(ROC) curves were drawn to evaluate the predictive value of Hcy,CysC,2-hour postprandial blood glucose(PBG),glycosylated hemoglobin(HbA1c) in the diagnosis of ventricular septal hypertrophy in patients with T2DM. Results The levels of age, Hcy, CysC, PBG, HbA1c and homeostasis model assessment for insulin resistance(HOMA-IR) in the hypertrophic group were higher than those in the non-hypertrophic group, and Met levels in hypertrophic group were lower than those in non-hypertrophic group;the differences were statistically significant(t/Z=-4.326,-2.557,-3.428,-2.143,-2.068,-2.003,-2.725;all P<0.05).Spearman correlation analysis showed that in the hypertrophic group, the ventricular septal thickness was positively correlated with age, Hcy, CysC, PBG, HbA1c, HOMA-IR(r=0.358, 0.226, 0.303, 0.189, 0.183, 0.177;all P<0.05), and negatively correlated with Met(r=-0.241,P<0.05). Binary logistic regression analysis showed that age and HOMA-IR were independent risk factors for T2DM with ventricular septal hypertrophy(OR=1.072, 95%CI:1.011-1.136;OR=1.125,95%CI:1.011-1.251;both P<0.05), and Met was a protective factor for T2DM with ventricular septal hypertrophy(OR=0.870, 95%CI:0.783-0.975, P<0.05). The area under the curve of Hcy, CysC, PBG and HbA1c were 0.631, 0.675, 0.609 and 0.606, respectively in the diagnosis of T2DM with ventricular septal hypertrophy, and CysC had the highest diagnostic value. Conclusion The levels of Hcy, Met and CysC were closely related to the occurrence of ventricular septal hypertrophy in T2DM;The level of CysC had a certain auxiliary value in the diagnosis of T2DM with ventricular septal hypertrophy.