新诊断2型糖尿病患者血骨髓源性生长因子水平与颈动脉粥样硬化的相关性研究

Association between serum myeloid-derived growth factor levels and carotid atherosclerosis in patients with newly diagnosed type 2 diabetes mellitus

目的探讨新诊断2型糖尿病(T2DM)患者血骨髓源性生长因子(MYDGF)水平与颈动脉粥样硬化(CAS)的关系。方法为横断面研究。选取2022年10月至2023年5月于解放军中部战区总医院内分泌科就诊的新诊断T2DM患者及同时期于该院体检中心进行体检的健康体检者为研究对象。根据颈动脉血管彩超的检查结果将新诊断T2DM患者分为无颈动脉粥样硬化(NCAS)组和CAS组,健康体检者纳入健康对照组。收集研究对象MYDGF、颈动脉内中膜厚度(CIMT)、舒张压(DBP)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2hPG)、空腹胰岛素(FINS)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(Apo A1),并根据FPG和FINS结果计算稳态模型评估胰岛素抵抗指数(HOMA-IR),测量其身高和体重并计算体重指数(BMI)。采用单因素方差分析、Kruskal-WallisH检验或χ^(2)检验进行组间比较,采用Spearman相关性分析法分析新诊断T2DM患者CIMT与其他指标的相关性,采用二元logistic回归分析法探讨新诊断T2DM患者合并CAS的影响因素。结果共纳入新诊断T2DM患者136例,其中,NCAS组62例,CAS组74例;健康对照组纳入60名研究对象。与健康对照者相比,NCAS组和CAS组新诊断T2DM患者血MYDGF均升高(均P<0.05)。在新诊断T2DM患者中,与NCAS组相比,CAS组BMI、DBP、HbA1c、FPG、2hPG、FINS、HOMA-IR、TC、CIMT均更高,HDL-C、Apo A1、MYDGF均更低,差异均有统计学意义(均P<0.05)。Spearman相关性分析结果显示,新诊断T2DM患者的CIMT与BMI(r=0.400,P<0.001)、DBP(r=0.240,P=0.005)、HbA1c(r=0.428,P<0.001)、FPG(r=0.253,P=0.003)、HOMA-IR(r=0.456,P<0.001)、TC(r=0.239,P=0.005)均呈正相关,与MYDGF(r=-0.789,P<0.001)呈负相关。二元logistic回归分析结果显示,DBP(OR=1.149,95%CI 1.057~1.249,P=0.001)、HbA1c(OR=1.604,95%CI 1.060~2.427,P=0.025)、HOMA-IR(OR=1.443,95%CI 1.034~2.015,P=0.031)、TC(OR=9.839,95%CI 2.830~34.201,P<0.001)、MYDGF(OR=0.935,95%CI 0.906~0.964,P<0.001)均为新诊断T2DM患者合并CAS的影响因素。结论在新诊断T2DM患者中,MYDGF与CIMT呈负相关,MYDGF是新诊断T2DM合并CAS的影响因素。

Objective To investigate the association between serum myeloid-derived growth factor(MYDGF)levels and carotid atherosclerosis(CAS)in newly diagnosed type 2 diabetes mellitus(T2DM).Methods This cross-sectional study screened newly diagnosed T2DM patients admitted to the Endocrinology Department of Central Theater General Hospital between October 2022 and May 2023,and healthy physical examination subjects who underwent physical examination in the physical examination center of the hospital at the same time were chosen as the study subjects.The newly diagnosed T2DM patients were divided into non-carotid atherosclerosis(NCAS)group and CAS group according to the results of carotid artery color doppler ultrasound,and the healthy individuals who underwent physical examinations during the same period were included as the healthy control group.MYDGF,carotid intimedia thickness(CIMT),diastolic blood pressure(DBP),glycated hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),2 h-postprandial plasma glucose(2hPG),fasting insulin(FINS),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(Apo A1)were collected.FPG and FINS were used to calculate homeostasis model assessment of insulin resistance(HOMA-IR).Height and weight were measured and the body mass index(BMI)was calculated.One-way analysis of variance,Kruskal-Wallis H test orχ^(2) test were used to compare the groups,Spearman correlation analysis was used to analyze the correlation between CIMT and other indicators in newly diagnosed T2DM patients,and binary logistic regression analysis was used to explore the factors influencing newly diagnosed T2DM patients with CAS.Results A total of 136 newly diagnosed T2DM patients were enrolled,including 62 in the NCAS group and 74 in the CAS group.The healthy control group consisted of 60 subjects.Serum MYDGF in newly diagnosed T2DM patients in both the NCAS group and the CAS group were elevated compared with healthy controls(both P<0.05).Among newly diagnosed T2DM patients,BMI,DBP,HbA1c,FPG,2hPG,FINS,HOMA-IR,TC and CIMT were higher in CAS group than in NCAS group,and HDL-C,Apo A1 and MYDGF were lower,with statistical significance(all P<0.05).Spearman correlation analysis showed that CIMT in newly diagnosed T2DM patients was positively correlated with BMI(r=0.400,P<0.001),DBP(r=0.240,P=0.005),HbA1c(r=0.428,P<0.001),FPG(r=0.253,P=0.003),HOMA-IR(r=0.456,P<0.001)and TC(r=0.239,P=0.005),and negatively correlated with MYDGF(r=-0.789,P<0.001).Binary logistic regression analysis showed that DBP(OR=1.149,95%CI 1.057-1.249,P=0.001),HbA1c(OR=1.604,95%CI 1.060-2.427,P=0.025),HOMA-IR(OR=1.443,95%CI 1.034-2.015,P=0.031),TC(OR=9.839,95%CI 2.830-34.201,P<0.001),MYDGF(OR=0.935,95%CI 0.906-0.964,P<0.001)were influential factors in newly diagnosed T2DM patients with CAS.Conclusion In newly diagnosed T2DM patients,serum MYDGF levels are negatively correlated with CIMT,and MYDGF is an influential factor in newly diagnosed T2DM complicated by CAS.