社区2型糖尿病患者胱抑素C水平与颈动脉粥样硬化的相关性

Correlation between cystatin C and carotid atherosclerosis in patients with type 2 diabetes mellitus in community

关键词:  胱抑素C  2型糖尿病  颈动脉粥样硬化

Key words:  cystatin C  type 2 diabetes mellitus  carotid atherosclerosis

摘要:

目的分析社区T2DM患者胱抑素C水平（Cys C）与颈动脉粥样硬化之间的关系。方法收集2018年1月—2019年12月281例门诊就诊的非新诊断且血糖控制稳定的T2DM患者，血管超声测得的颈动脉内膜中层厚度（carotid intima-media thickness， CIMT），以CIMT<0.9 mm或CIMT≥0.9 mm分组作为是否合并动脉粥样硬化的标准，以t检验分析两组血压、血脂、血糖、糖化血红蛋白（HbA1c）、同型半胱氨酸、阻力指数（resistant index, RI）、肌酐等相关指标。Logistic回归分析颈动脉粥样硬化发生的危险因素，并采用受试者工作特征曲线（ROC）进行危险因素的模型预测。结果CIMT≥0.9 mm组的年龄、尿酸、同型半胱氨酸、Cys C、RI显著高于CIMT<0.9 mm组,高密度脂蛋白值显著低于CIMT<0.9 mm组（P<0.05）；两组间的糖尿病病程、BMI、血压、空腹血糖、HbA1c、总胆固醇、三酰甘油、低密度脂蛋白、肌酐无明显差异（P＞0.05）。Pearson相关分析结果显示，T2DM患者Cys C水平与年龄、BMI、同型半胱氨酸、尿酸、三酰甘油、CIMT（r=0.249、0.341、0.416、0.416、0.133、0.219，P<0.001）、RI（r=0.153， P<0.010）、肌酐（r=0.585，P<0.001）呈正相关，与高密度脂蛋白呈负相关（r=-0.245，P<0.001）。Logistic多因素回归分析显示，Cys C（OR=2.013，95%CI： 1.097~3.693）、糖尿病患者年龄≥65岁（OR=3.014，95%CI： 1.586~5.726），HbA1c≥6.5%（OR=1.719，95%CI： 1.003~2.946），RI>0.75（OR=3.109，95%CI： 1.621~5.961），性别（男）（OR=1.524，95%CI： 0.822~2.828）为颈动脉粥样硬化发生的主要危险因素。ROC曲线分析显示： Cys C联合多因素（RI、HbA1c、年龄、性别）预测颈动脉硬化有意义（AUC=0.752，95%CI： 0.684~0.820）。结论 T2DM患者中血清Cys C水平与颈动脉粥样硬化的发生具有相关性。对于社区50岁以上非新诊断且血糖控制稳定的T2DM患者，运用风险预测模型，有助于筛查有无颈动脉粥样硬化的发生。

Abstract:

ObjectiveTo analyze the relationship between cystatin C（Cys C) and carotid atherosclerosis in patients with type 2 diabetes mellitus（T2DM) in the community. MethodsClinical data of 281 T2DM patients with stable blood glucose, who visited Pengpu Xincun Community Health Service Center from January 2018 to December 2019, were collected. The carotid intima-media thickness（CIMT) was measured by vascular ultrasonography, there were 49 patients with CIMT<0.9 mm and 232 patients with CIMT≥0.9 mm. The blood pressure, blood lipid, blood glucose, glycosylated hemoglobin, homocysteine, resistance index and creatinine were compared between two groups. Logistic regression was used to analyze the risk factors of carotid atherosclerosis, and receiver operating characteristic curve（ROC) was used to predict the risk of carotid atherosclerosis. ResultsThe age, uric acid, homocysteine, Cys C and resistance index of CIMT≥0.9 mm group were significantly higher than those of CIMT<0.9 mm group, and high-density lipoprotein value was significantly lower than that of CIMT<0.9 mm group（P<0.05). There were no significant differences in diabetes duration, body mass index, blood pressure, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride and low-density lipoprotein between the two groups（P>0.05). Pearson correlation analysis showed that Cys C was positively correlated with age, BMI, homocysteine, uric acid, triglyceride, carotid intimal thickness（r=0.249, 0.341, 0.416, 0.416, 0.133, 0.219, P<0.001), resistance index（r=0.153, P<0.010), creatinine（r=0.585, P<0.001) in T2DM patients, but negatively correlated with HDL（r=-0.245, P<0.001). ROC curve analysis showed that the area under the curve was 0.632（95%CI： 0.552-0.712, P=0.004) when Cys C was 0.845 mg/L as the diagnostic cut-off value. The sensitivity was 36.3% and the specificity was 87.2%. Logistic regression analysis showed that age≥65 years（OR=3.014, 95%CI： 1.586-5.726), HbA1c≥6.5%（OR=1.719,95%CI： 1.003-2.946), resistance index≥0.75（OR=3.109,95%CI： 1.621-5.961), serum Cys C≥0.845（OR=2.013,95%CI： 1.097-3.693) were independent risk factors for carotid atherosclerosis. The area under ROC curve（AUC) of Cyst combined multiple indicators for predicting risk of carotid atherosclerosis was 0.752（95%CI： 0.684-0.82) . ConclusionThere is a correlation between serum Cys C and carotid atherosclerosis in T2DM patients. The established model consisted of Cyst and other indicators can be used to predict risk of carotid atherosclerosis in T2DM patients with stable blood glucose.