女性2型糖尿病合并冠心病的影响因素和患者肠道菌群特点及其与糖脂代谢的关系分析

The influence factors of female type 2 diabetes mellitus complicated with coronary heart disease and the characteristics of intestinal flora and its relationship with glucose and lipid metabolism

目的分析女性2型糖尿病(T2DM)合并冠心病的影响因素和患者肠道菌群特点及其与糖脂代谢的关系。方法回顾性分析2019年1月至2021年12月九江市第一人民医院收治的60例T2DM女性患者的临床资料,其中合并冠心病(CHD)20例,单纯T2DM40例。所有患者均检测总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、载脂蛋白-B(APOB)、糖化血红蛋白A1c(HbA1c)及空腹血糖(FBG)水平。比较合并CHD与单纯T2DM患者肠道菌群相对含量、糖脂代谢相关指标,单因素及多因素Logistic回归分析女性T2DM合并CHD的影响因素,采用Pearson相关性分析T2DM合并CHD患者肠道菌群与糖脂代谢指标的关系。结果合并CHD患者拟杆菌属相对含量低于单纯T2DM患者,肠球菌属相对含量高于单纯T2DM患者,差异有统计学意义(P<0.05)。合并CHD患者HbA1c、TC、TG、LDL-C、HDL-C、APOB水平均高于单纯T2DM患者,差异有统计学意义(P<0.05)。单因素分析结果显示,合并CHD患者糖尿病病程≥10年、有高血压病史、有吸烟史、有高血脂病史、有CHD家族遗传史及HbA1c≥8%、TC≥5.72mmol/L、HDL-C<1mmol/L、LDL-C≥3.12mmol/L、TG≥2.25mmol/L、APOB>1.2g/L、拟杆菌属与肠球菌属相对含量异常均为女性T2DM合并CHD的影响因素(P<0.05)。多因素Logistis回归分析结果显示,有高血压病史、高血脂病史、TC≥5.72 mmol/L、LDL-C≥3.12 mmol/L、拟杆菌属和肠球菌属相对含量异常是女性T2DM合并CHD的独立危险因素(OR>1,P<0.05)。Pearson相关性分析结果显示,罗氏菌属与HbA1c、FBG均呈负相关(r<0,P<0.05),与HDL-C、LDL-C、TC、TG、APOB均无相关性;拟杆菌属与HbA1c、FBG、TC、TG均呈负相关(r<0,P<0.05),与HDL-C、LDL-C、APOB均无相关性;肠球菌属与HbA1c、FBG均呈正相关(r>0,P<0.05),与HDL-C、LDL-C、TC、TG、APOB均无相关性;乳酸杆菌属、双歧杆菌属、普雷沃菌属与糖脂代谢相关指标均无相关性。结论女性T2DM合并CHD患者存在糖脂代谢及肠道拟杆菌属、肠球菌属相对含量异常,且有高血压病史、有高血脂病史、TC≥5.72mmol/L、LDL-C≥3.12mmol/L、拟杆菌属和肠球菌属相对含量异常是女性T2DM患者合并CHD的独立危险因素,临床应根据上述因素制订相关预防措施。

Objective To analyze the influence factors of female type 2 diabetes mellitus(T2DM)complicated with coronary heart disease,the characteristics of intestinal flora and its relationship with glucose and lipid metabolism.Methods The clinical data of 60 female patients with T2DM admitted to Jiujiang No.1 People's Hospital from January 2019 to December 2021 were retrospectively analyzed,including 20 patients with coronary heart disease(CHD)and 40 patients with T2DM alone.The levels of total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low densi-ty lipoprotein cholesterol(LDL-C),triglyceride(TG),apolipoprotein-B(APOB),glycosylated hemoglobin A1c(HbA1c)and fasting blood glucose(FBG)were detected in all patients.The relative content of intestinal flora and related indexes of glucose and lipid metabolism in patients with CHD and simple T2DM were compared,univariate and multivariate Logistic regression were used to analyze the influencing factors of female T2DM com-plicated with CHD,Pearson correlation was used to analyze the relationship between intestinal flora and glucose and lipid metabolism indexes in pa-tients with T2DM complicated with CHD.Results The relative content of Bacteroides in patients with CHD was lower than that in patients with simple T2DM,and the relative content of Enterococcus was higher than that in patients with simple T2DM,the differences were statistically signifi-cant(P<0.05).The levels of HbA1c,TC,TG,LDL-C,HDL-C and APOB in patients with CHD were higher than those in patients with simple T2DM,and the differences were statistically significant(P<0.05).The results of univariate analysis showed that the course of diabetes≥10 years,history of hypertension,history of smoking,history of hyperlipidemia,family genetic history of CHD,HbA1c≥8%,TC≥5.72 mmol/L,HDL-C<1 mmol/L,LDL-C≥3.12 mmol/L,TG≥2.25 mmol/L,APOB>1.2 g/L,and abnormal relative content of Bacteroides and Enterococcus were the in-fluencing factors of female T2DM complicated with CHD(P<0.05).Multivariate Logistis regression analysis showed that history of hypertension,history of hyperlipidemia,TC≥5.72 mmol/L,LDL-C≥3.12 mmol/L,abnormal relative contents of Bacteroides and Enterococcus were independent risk factors for female T2DM with CHD(OR>1,P<0.05).Pearson correlation analysis showed that Rothia was negatively correlated with HbA1c and FBG(r<0,P<0.05),but no correlation with HDL-C,LDL-C,TC,TG and APOB;Bacteroides was negatively correlated with HbA1c,FBG,TC and TG(r<0,P<0.05),but no correlation with HDL-C,LDL-C,TC,TG and APOB;Enterococcus was negatively correlated with HbA1c and FBG(r>0,P<0.05),but no correlation with HDL-C,LDL-C,TC,TG and APOB;there was no correlation between Lactobacillus,Bifidobacterium,Prevotella and relevant indexes of glucose and lipid metabolism.Conclusion Female T2DM patients with CHD have abnormal glucose and lipid metabolism and abnormal relative contents of Bacteroides and Enterococcus,and the history of hypertension,the history of hyperlipidemia,TC≥5.72 mmol/L,LDL-C≥3.12 mmol/L,bacteroides and enterococcus abnormalities are independent risk factors for female T2DM patients with CHD,clinically,rele-vant preventive measures should be formulated based on the above factors.