血清ESM1、DHEA-S水平与2型糖尿病患者心血管自主神经病变的相关性

Correlation between serum ESM1,DHEA-S and cardiac autonomic neuropathy in patients with type 2 diabetes mellitus

目的探讨血清内皮细胞特异性分子1(ESM1)、硫酸脱氢表雄酮(DHEA-S)与2型糖尿病(T2DM)患者心血管自主神经病变(CAN)的关系。方法选取2021年8月—2023年8月北京电力医院T2DM患者198例,根据标准心血管自主神经反射试验(CART)结果分为CAN组(96例)和无CAN组(102例)。收集所有患者的临床资料,并检测血清ESM1、DHEA-S、炎症因子[高敏C反应蛋白(hs-CRP)、白细胞介素-17(IL-17)]和常规生化指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清肌酐(SCr)、空腹血糖、糖化血红蛋白(HbA_(1c))、白蛋白(Alb)、同型半胱氨酸(Hcy)、心肌肌钙蛋白T(cTnT)、血红蛋白(Hb)]。采用Logistic回归分析评估T2DM患者发生CAN的影响因素。采用受试者工作特征(ROC)曲线评估血清ESM1、DHEA-S对T2DM患者发生CAN的诊断效能。结果CAN组血清ESM1水平显著高于无CAN组(P<0.05),血清DHEA-S水平显著低于无CAN组(P<0.05)。ESM1、HbA_(1c)、hs-CRP、cTnT是T2DM患者发生CAN的危险因素[比值比(OR)值分别为1.584、1.799、1.391、1.679,95%可信区间(CI)分别为1.023~2.452、1.087~2.977、1.013~1.911、1.027~2.746,P<0.05],DHEA-S、Alb是T2DM患者发生CAN的保护因素(OR值分别为0.793、0.907,95%CI分别为0.694~0.906、0.849~0.970,P<0.05)。血清ESM1、DHEA-S单项检测和联合检测诊断T2DM患者发生CAN的曲线下面积(AUC)分别为0.889、0.848、0.947;联合检测的敏感性为90.6%,特异性为76.4%。结论血清ESM1和DHEA-S或可作为诊断T2DM患者发生CAN的生物标志物。

Objective To investigate the correlation between serum endothelial cell-specific molecule 1(ESM1),dehydroepiandrosterone sulfate(DHEA-S)and cardiac autonomic neuropathy(CAN)in patients with type 2 diabetes mellitus(T2DM).Methods From August 2021 to August 2023,198 T2DM patients who were diagnosed and treated in Beijing Electric Power Hospital were enrolled.They were classified into CAN group(96 cases)and non-CAN group(102 cases)based on the standard cardiovascular autonomic reflex test(CART).The clinical data of all patients were collected.Serum ESM1,DHEA-S,inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-17(IL-17)]and routine biochemical indicators[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),serum creatinine(SCr),fasting blood glucose,glycated hemoglobin A1c(HbA_(1c)),albumin(Alb),homocysteine(Hcy),cardiac troponin T(cTnT),hemoglobin(Hb)]were determined.Logistic regression analysis was used to evaluate the influencing factors of CAN in T2DM patients.The diagnostic efficacy of serum ESM1 and DHEA-S for CAN in T2DM patients was evaluated by receiver operating characteristic(ROC)curve.Results The serum ESM1 level in CAN group was higher than that in non-CAN group(P<0.05),and the serum DHEA-S level was lower than that in non-CAN group(P<0.05).ESM1,HbA_(1c),hs-CRP and cTnT were the risk factors for CAN in T2DM patients[odds ratios(OR)were 1.584,1.799,1.391 and 1.679,95%confidence intervals(CI)were 1.023-2.452,1.087-2.977,1.013-1.911 and 1.027-2.746,respectively,P<0.05].DHEA-S and Alb were protective factors for CAN in T2DM patients(OR=0.793 and 0.907,95%CI 0.694-0.906 and 0.849-0.970,respectively,P<0.05).The areas under curves(AUC)of serum ESM1 and DHEA-S single and combined determinations for the diagnosis of CAN in T2DM patients were 0.889,0.848 and 0.947,respectively.The sensitivity and specificity of the combined determination were 90.6%and 76.4%,respectively.Conclusions Serum ESM1 and DHEA-S may serve as biomarkers for the diagnosis of CAN in patients with T2DM.