前列环素联合神经肽Y对糖尿病肾病心血管不良事件的预测价值  

Value of Prostacyclin Combined with Neuropeptide Y in Prediction of Cardiovascular Adverse Events in Patients with Diabetic Nephropathy

作　　者：董小伟 齐琳 房勃龙 郝玉 贾慧彦 朱永栋 顾红兰[5] 刘红梅[6] DONG Xiao-wei;QI Lin;FANG Bo-long;HAO Yu;JIA Hui-yan;ZHU Yong-dong;GU Hong-lan;LIU Hong-mei(Department of Cardiology and Nephrology,the 82 Group Army Hospital of PLA,Baoding,Hebei 071000,China;Department of Dermatology,People's Hospital of Zhengding County,Zhengding,Hebei 050800 China;Department of Hemodialysis,People's Hospital of Zhengding County,Zhengding,Hebei 050800 China;the First Department of Internal Medicine,People's Hospital of Zhengding County,Zhengding,Hebei 050800 China;Department of Cardiology,the Third Central Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Endocrinology,Tangshan Hospital of TCM,Tangshan,Hebei 063000,China)

机构地区：[1]解放军陆军第八十二集团军医院心肾内科肾脏病区,河北保定071000 [2]正定县人民医院皮肤科,河北正定050800 [3]正定县人民医院血透科,河北正定050800 [4]正定县人民医院内一科,河北正定050800 [5]保定市第三中心医院心内科,河北保定071000 [6]唐山市中医医院内分泌科,河北唐山063000

出　　处：《临床误诊误治》2022年第3期27-31,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局计划项目(2020385);保定市科学技术局科研计划项目(2041ZF337)。

摘　　要：目的分析前列环素(PGI_(2))联合神经肽Y(NPY)对糖尿病肾病患者发生心血管不良事件的预测价值。方法选择2017年1月—2018年5月收治的糖尿病肾病196例作为研究对象。根据随访期间是否发生心血管不良事件分为发生心血管不良事件组34例和未发生心血管不良事件组162例。比较两组血浆PGI_(2)、NPY、动脉粥样硬化指标及其他临床资料。分析血浆PGI_(2)、NPY水平与动脉粥样硬化指标的相关性及糖尿病肾病患者发生心血管不良事件的影响因素,评价血浆PGI_(2)联合NPY对糖尿病肾病患者心血管不良事件的预测效能。结果发生心血管不良事件组与未发生心血管不良事件组在冠心病、三酰甘油、PGI_(2)、NPY、动脉内-中膜厚度(CIMT)、颈-股动脉脉搏波速度(CFPWV)和股动脉内-中膜厚度(FIMT)方面比较差异均有统计学意义(P<0.05,P<0.01)。血浆PGI_(2)、NPY和CFPWV均是糖尿病肾病患者发生心血管不良事件的独立危险因素(P<0.05,P<0.01)。糖尿病肾病患者CIMT、FIMT、CFPWV均与血浆PGI_(2)水平呈负相关(r=-0.271、-0.325、-0.431,P<0.05),与NPY水平呈正相关(r=0.250、0.290、0.395,P<0.05)。血浆PGI_(2)联合NPY预测心血管不良事件发生的AUC均大于血浆PGI_(2)、NPY单独检测及CFPWV(P<0.01)。结论血浆PGI_(2)水平下降和NPY水平升高与糖尿病肾病患者心血管病变有关,二者联合预测心血管不良事件发生的效能较好。Objective To analyze the value of prostacyclin(PGI_(2))combined with neuropeptide Y(NPY)in prediction of cardiovascular adverse events in patients with diabetic nephropathy(DN).Methods A total of 196 patients with DN admitted between January 2017 and May 2018 were selected as research subjects,and the patients were divided into cardiovascular adverse event group(n=34)and non-cardiovascular adverse events group(n=162)according to the occurrence of cardiovascular adverse events during the follow-up period.Plasma PGI_(2),NPY,atherosclerosis indexes and other clinical data were compared between two groups.Correlations between plasma levels of PGI_(2) and NPY with atherosclerotic indexes and the influencing factors of cardiovascular adverse events in patients with DN were analyzed,and the efficacy of plasma PGI_(2) combined with NPY in prediction of cardiovascular adverse events in patients with DN was evaluated.Results There were statistically significant differences in coronary heart disease,triacylglycerol,PGI_(2),NPY,carotid intima-media thickness(CIMT),carotid femoral pulse wave velocity(CFPWV)and femoral intima-media thickness(FIMT)between cardiovascular adverse event group and non-cardiovascular adverse event group(P<0.05,P<0.01).Plasma PGI_(2),NPY and CFPWV were independent risk factors for adverse cardiovascular events in DN patients(P<0.05,P<0.01).CIMT,FIMT and CFPWV were negatively correlated with plasma PGI_(2) level in DN patients(r=-0.271,-0.325,-0.431,P<0.05),and they were positively correlated with plasma NPY level(r=0.250,0.290,0.395,P<0.05).The AUC of plasma PGI_(2) combined with NPY in prediction of cardiovascular adverse events was significantly higher than those by plasma PGI_(2),NPY alone and CFPWV detections(P<0.01).Conclusion The decrease of plasma PGI_(2) level and the increase of NPY level relate to cardiovascular lesions in patients with DN,and combined detection of PGI_(2) and NPY levels is effective in prediction of the occurrence of cardiovascular adverse events.

关 键 词：糖尿病肾病 前列环素 神经肽Y 动脉内-中膜厚度 颈-股动脉脉搏波速度 股动脉内-中膜厚度 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]