血清PCSK9、vWF和apoM水平在2型糖尿病并发大血管病变中的诊断价值  

Diagnostic value of serum PCSK9,vWF and apoM levels in type 2 diabetes mellitus complicated with macrovascular disease

作　　者：刘志文[1] 那日苏[1] 马聪[1] LIU Zhiwen;NA Risu;MA Cong(Department of Endocrinology,Central Hospital of Xuhui District,Shanghai 200031,China)

机构地区：[1]上海市徐汇区中心医院内分泌科,上海200031

出　　处：《检验医学与临床》2023年第4期500-505,共6页Laboratory Medicine and Clinic

基　　金：上海市徐汇区中心医院院级重点项目(XHYY2007)。

摘　　要：目的观察血清转化酶枯草溶菌素9(PCSK9)、血管性假血友病因子(vWF)和载脂蛋白M(apoM)水平在2型糖尿病并发大血管病变中的诊断价值。方法选择2018年1月至2021年6月在该院就诊的210例2型糖尿病患者纳入2型糖尿病组。选择同期在该院行健康体检的75例健康者纳入健康对照组。根据大血管病变的诊断标准将2型糖尿病患者分为单纯糖尿病组(118例)和大血管病变组(92例)。观察各组血清PCSK9、vWF和apoM水平变化,对2型糖尿病并发大血管病变进行单因素和多因素分析,比较2型糖尿病患者治疗前后血清PCSK9、vWF和apoM水平变化,并分析3项指标在2型糖尿病并发大血管病变中的诊断效能。结果2型糖尿病组血清PCSK9和vWF水平明显高于健康对照组,而血清apoM水平明显低于健康对照组,差异有统计学意义(P<0.05)。治疗前大血管病变组血清PCSK9和vWF水平明显高于单纯糖尿病组,差异有统计学意义(P<0.05);治疗后两组血清PCSK9和vWF水平均较治疗前明显降低,但大血管病变组仍高于单纯糖尿病组,差异有统计学意义(P<0.05)。治疗前大血管病变组血清apoM水平明显低于单纯糖尿病组,差异有统计学意义(P<0.05);治疗后两组血清apoM水平均较治疗前明显升高,但大血管病变组仍低于单纯糖尿病组,差异有统计学意义(P<0.05)。单因素分析显示,大血管病变组年龄≥60岁及糖尿病病程≥10年比例、甘油三酯和低密度脂蛋白胆固醇水平明显高于单纯糖尿病组,差异有统计学意义(P<0.05)。多因素分析显示PCSK9、vWF水平升高是2型糖尿病并发大血管病变的独立危险因素(P<0.05),血清apoM水平升高是2型糖尿病并发大血管病变的保护因素(P<0.05)。血清PCSK9、vWF和apoM联合检测诊断2型糖尿病并发大血管病变的灵敏度为89.1%,特异度为90.7%,曲线下面积(AUC)为0.956,AUC明显高于PCSK9(Z=4.167,P<0.01)、vWF(Z=4.056,P<0.01)和apoM(Z=5.183,P<0.01)单项指�Objective To observe the diagnostic value of proprotein convertase subtilisin/kexin type 9(PCSK9),von Willebrand factor(vWF)and apolipoprotein M(apoM)levels in type 2 diabetes mellitus complicated with macrovascular disease.Methods A total of 210 patients with type 2 diabetes mellitus who were treated in Central Hospital of Xuhui District from January 2018 to June 2021 were selected as the type 2 diabetes group.A total of 75 healthy persons who underwent physical examination in this hospital during the same period were selected as the healthy control group.According to the diagnostic criteria of macrovascular disease,type 2 diabetes mellitus patients were divided into simple diabetes group(118 cases)and macrovascular disease group(92 cases).Serum PCSK9,vWF and apoM levels were observed in each group,the univariate and multivariate analysis of macrovascular disease in type 2 diabetes mellitus were conducted.The diagnostic efficacy of macrovascular disease was valued in patients with type 2 diabetes mellitus.Results The levels of serum PCSK9 and vWF in type 2 diabetes group were significant higher than those in healthy control group,while the level of serum apoM was significant lower than that in healthy control group(P<0.05).Before treatment,the serum levels of PCSK9 and vWF in macrovascular disease group were significant higher than those in simple diabetes group(P<0.05),after treatment,the levels of serum PCSK9 and vWF in the two groups were significantly lower than those before treatment,and the levels in macrovascular disease group were still higher than those in simple diabetes group(P<0.05).Before treatment,the serum apoM level in macrovascular disease group was significant lower than that in simple diabetes group(P<0.05).After treatment,the level of serum apoM in the two groups was significantly higher than that before treatment,but the level in macrovascular disease group was still lower than that in simple diabetes group(P<0.05).Univariate analysis showed that the porpotions of age≥60 years old and diab

关 键 词：2型糖尿病 大血管病变 转化酶枯草溶菌素9 血管性假血友病因子 载脂蛋白M 

分 类 号：R589[医药卫生—内分泌]