糖尿病患者血清Nε-羧甲基赖氨酸水平与颈动脉钙化关系的临床研究  

Associations between serum level of Nε-carboxymethy lysine and carotid calcification in diabetes mellitus patients:A clinical research

作　　者：耿跃 杜睿[2] 赵江波[3] 冯国全 李丽华[5] 孙振 毛翔 严金川[1] 王中群[1] GENG Yue;DU Rui;ZHAO Jiangbo;FENG Guoquan;LI Lihua;SUN Zhen;MAO Xiang;YAN Jinchuan;WANG Zhongqun(Department of Cardiology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China;Department of Ultrasound Medicine,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China;Department of Endocrinology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China;Department of Imaging,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China;Department of Pathology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院心内科,江苏省镇江市212001 [2]江苏大学附属医院超声医学科,江苏省镇江市212001 [3]江苏大学附属医院内分泌科,江苏省镇江市212001 [4]江苏大学附属医院影像科,江苏省镇江市212001 [5]江苏大学附属医院病理科,江苏省镇江市212001

出　　处：《中国动脉硬化杂志》2020年第4期316-321,共6页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金(81770450、81370408);江苏省“六大人才高峰”项目(WSN-044);江苏省高层次卫生人才“六个一工程”拔尖人才项目(LGY2018092);江苏省青年医学人才项目(QNRC2016836);镇江市心血管病临床医学研究中心项目(SS2018008)。

摘　　要：目的探究血清Nε-羧甲基赖氨酸(CML)对1型糖尿病和2型糖尿病患者不同程度颈动脉钙化的影响。方法选取2016年1月至2017年6月在江苏大学附属医院就诊患者506例,其中1型糖尿病148例,2型糖尿病191例,无糖尿病者167例,所有患者均行彩色多普勒超声检测双侧颈动脉。将颈动脉钙化严重程度按照0~8分予以评估,以1~4分为低钙化组,5~8分为高钙化组。记录患者一般临床资料、体格检查结果、实验室检查结果,并通过酶联免疫吸附实验测量血清CML水平。进行多因素Logistic回归分析,以确定1型糖尿病、2型糖尿病患者不同程度颈动脉钙化的独立预测因子。随访复测CML并追踪主要不良心脑血管事件(MACCE);分析CML变化与MACCE的关系。结果在颈动脉高钙化组和低钙化组,糖尿病患者的CML、颈动脉内膜中膜厚度和低密度脂蛋白胆固醇水平均高于无糖尿病者(P<0.05),且2型糖尿病患者高于1型糖尿病患者(P<0.05)。多因素Logistic回归分析显示,CML是1型糖尿病患者颈动脉钙化程度的独立预测因子(OR 2.025,95%CI 1.368~2.996,P<0.05),也是2型糖尿病患者颈动脉钙化程度的独立预测因子(OR 2.485,95%CI 1.481~4.171,P<0.05)。随访期CML水平明显升高与MACCE相关。结论CML是1型和2型糖尿病患者不同程度颈动脉钙化的独立预测因子,并在一定程度上预测糖尿病性心脑血管事件的发生。Aim To investigate the effect of serum Nε-carboxymethy lysine(CML)on different degrees of carotid calcification in patients with type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM).Methods From January 2016 to June 2017,506 patients were selected from the Affiliated Hospital of Jiangsu University,including148 T1DM patients,191 T2DM patients and 167 patients without diabetes.Color Doppler ultrasound was used to detect bilateral carotid arteries in all patients.The severity of carotid calcification was evaluated according to 0-8 points.The patients were divided into low calcification group(scores:1-4)and high calcification group(scores:5-8).The general clinical data,physical examination results and laboratory examination results were recorded,and the serum CML level was measured by enzyme-linked immunosorbent assay.Multivariate Logistic regression analysis was conducted to determine independent predictors of carotid calcification in T1DM and T2DM patients.During follow-up,CML was retested and major adverse cardiac and cerebrovascular event(MACCE)were followed up.Results In the high calcification group and low calcification group,the CML,carotid intima-media thickness and low density lipoprotein cholesterol level of diabetic patients were higher than those of non-diabetic patients(P<0.05),and the levels of T2DM patients were higher than levels of T1DM patients(P<0.05).Multivariate Logistic regression analysis showed that CML was an independent predictor of carotid calcification degree in T1DM patients(OR 2.025,95%CI 1.368-2.996,P<0.05),and also an independent predictor of carotid calcification degree in T2DM patients(OR 2.485,95%CI 1.481-4.171,P<0.05).The significant increase of CML during follow-up was correlated with MACCE.Conclusion CML is an independent predictor of different degrees of carotid calcification in T1DM and T2DM patients,and to some extent,it can predict the occurrence of diabetic cardiovascular and cerebrovascular events.

关 键 词：颈动脉钙化 Nε-羧甲基赖氨酸 1型糖尿病 2型糖尿病 超声 主要不良心脑血管事件 

分 类 号：R5[医药卫生—内科学]