基于血清miR-351、miR-638水平构建2型糖尿病患者颈动脉粥样硬化的影响因素列线图预测模型与评价  

Construct a nomogram prediction model and evaluation of influencing factors of carotid atherosclerosis in type 2 diabetes mellitus patients base on serum miR-351 and miR-638 levels

作　　者：关晓燕[1] 曹玲[1] 闫雪梅[1] 宁聪华 伊力多斯·阿里什[2] Guan Xiaoyan;Cao Ling;Yan Xuemei;Ning Conghua;Yiliduosi·Alishi(Department of Clinical Laboratory,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang Province,Urumqi 830054,China;不详)

机构地区：[1]新疆医科大学第一附属医院检验科,乌鲁木齐830054 [2]新疆医科大学第一附属医院内分泌科,乌鲁木齐830054

出　　处：《疑难病杂志》2024年第5期569-574,580,共7页Chinese Journal of Difficult and Complicated Cases

基　　金：2022年新疆生产建设兵团指导性科技计划项目(2022D72)。

摘　　要：目的基于血清微小核糖核酸(miR)-351、miR-638水平构建2型糖尿病(T2DM)患者颈动脉粥样硬化(CAS)的影响因素列线图预测模型并予评价。方法选取2021年3月—2022年12月新疆医科大学第一附属医院内分泌科收治的T2DM患者182例作为观察组,另选医院同期体检健康者91例作为健康对照组。比较2组血清miR-351、miR-638及血糖、血脂水平差异;T2DM患者根据是否合并CAS分为CAS亚组(n=79)和非CAS亚组(n=103),并比较2亚组临床特点差异;多因素Logistic回归分析T2DM合并CAS的危险因素;依据危险因素构建T2DM合并CAS发生风险列线图预测模型;受试者工作特征(ROC)曲线分析预测效能,以Bootstrap法、决策曲线分析该模型校准度与决策能力。结果观察组血清miR-351水平高于健康对照组,血清miR-638水平低于健康对照组(t/P=9.999/<0.001、12.051/<0.001)。观察组高密度脂蛋白胆固醇(HDL-C)水平低于健康对照组(t/P=11.060/<0.001),空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA 1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均高于健康对照组(t=18.034、20.355、21.744、7.991、20.682、13.256,P均<0.001);多因素Logistic回归分析显示,HbA 1c、TC、TG、LDL-C、miR-351升高为T2DM合并CAS的独立危险因素[OR(95%CI)=8.129(3.377~19.567)、1.444(1.093~1.908)、7.868(2.254~27.459)、2.728(1.241~5.997)、1.337(1.039~1.721)],而miR-638升高为其保护因素[OR(95%CI)=0.046(0.006~0.337)]。ROC分析显示,HbA 1c、TC、TG、LDL-C、miR-351、miR-638水平及预测模型的曲线下面积(AUC)为0.863、0.670、0.693、0.726、0.776、0.655、0.936,以预测模型的AUC最大(Z=3.468、6.602、5.832、5.599、5.064、6.674,P均<0.001);采用Bootstrap法对列线图模型进行内部验证,重复抽样1000次(B=1000)显示,C-index为0.871,提示该列线图模型预测能力较好。决策分析显示,该模型的阈值概率0.01~0.97,净收益率>0,高于两条无效线。结论T2DMObjective To construct and evaluate a nomogram prediction model of influencing factors of carotid atherosclerosis(CAS)in patients with type 2 diabetes mellitus(T2DM)base on serum microribonucleic acid(miR)-351 and miR-638 levels.Methods One hundred and eighty-two T2DM patients admitted to the Department of Endocrinology of The First Affiliated Hospital of Xinjiang Medical University from March 2021 to December 2022 were selected as observation group,and 91 healthy cases who underwent physical examination in the hospital during the same period were selected as healthy control group.The expression levels of serum miR-351 and miR-638,as well as differences in blood glucose and blood lipid were compared between two groups.T2DM patients were divided into CAS subgroup and non-CAS subgroup according to whether they were combined with CAS,and the differences in clinical characteristics in two subgroups were compared.The risk factors of T2DM combined with CAS were analyzed by multivariate Logistic regression.The risk nomogram prediction model of T2DM combined with CAS was constructed according to the risk factors.The predictive efficacy was analyzed by receiver operating characteristic(ROC)curve,and the calibration and decision-making ability of the model were analyzed by Bootstrap method and decision curve.Results The serum miR-638 level in observation group was lower than that in control group,and the serum miR-351 level was higher than that in control group(t/P=9.999/<0.001,12.051/<0.001).The level of high-density lipoprotein cholesterol(HDL-C)in observation group was lower than that in control group(t/P=11.060/<0.001),and the levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA 1c),total cholesterol(TC),triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)were higher than those in control group(t=18.034,20.355,21.744,7.991,20.682,13.256,P<0.001);Multivariate Logistic regression analysis showed that,elevated HbA 1c,TC,TG,LDL-C and miR-351 were independent ris

关 键 词：2型糖尿病 颈动脉粥样硬化 微小核糖核酸-351 微小核糖核酸-638 影响因素 列线图预测模型 

分 类 号：R587.1[医药卫生—内分泌] R543.4[医药卫生—内科学]