2型糖尿病患者葡萄糖范围内时间和血清ApoM水平与心脏自主神经病变的相关性  

Study on the relationship between time in glucose range and serum ApoM level and diabetic cardiac autonomic neuropathy in patients with type 2 diabetes

作　　者：刘丛 刘连勇[2] 史超 LIU Cong;LIU Lianyong;SHI Chao(Department of Endocrinology,Dahua Hospital,Xuhui District,Shanghai 200237,China;Department of Endocrinology,Punan Hospital,Pudong New Area,Shanghai 200125,China;Lingyun Community Health Center,Xuhui District,Shanghai 200237,China)

机构地区：[1]上海市徐汇区大华医院内分泌科,上海200237 [2]上海市浦东新区浦南医院内分泌科,上海200125 [3]徐汇区凌云街道社区卫生服务中心,上海200237

出　　处：《热带医学杂志》2024年第10期1432-1436,共5页Journal of Tropical Medicine

基　　金：上海市卫生健康委员会科研项目(202140467);徐汇区公共卫生科研培育专项(2022XHGWPY-PY01)。

摘　　要：目的分析2型糖尿病患者葡萄糖范围内时间(TIR)和血清载脂蛋白M(ApoM)水平与糖尿病心脏自主神经病变(DCAN)的相关性,为临床诊治DCNA提供依据。方法选取2020年10月-2022年10月在上海市徐汇区大华医院收治的2型糖尿病患者184例作为研究对象,根据是否发生DCAN分为DCAN组(n=109)和非DCAN组(n=75)。连续动态血糖监测,并计算TIR。采用ELISA检测血清ApoM水平;Pearson相关性分析TIR和血清ApoM与尿白蛋白肌酐比(UACR)、空腹血糖(FBG)和糖化血红蛋白(HbA1c)的相关性;采用受试者工作特征(ROC)曲线分析TIR和血清ApoM水平对DCAN的预测价值。结果DCAN组UACR、FBG和HbA1c分别为(14.35±2.01)mg/g、(12.25±2.61)mmol/L和(10.86±2.78)%,显著高于非DCAN组(8.05±1.98)mg/g、(9.67±1.57)mmol/L和(8.24±1.24)%,差异均有统计学意义(t=21.019、7.657、7.650,P均<0.001)。DCAN组TIR和血清ApoM水平分别为(72.46±13.54)%、(6.52±1.28)μg/mL,显著低于非DCAN组(85.25±14.57)%和(9.24±2.34)μg/mL,差异均有统计学意义(t=6.103、10.137,P均<0.001)。Pearson相关性分析显示,TIR和血清ApoM水平与UACR、FBG和HbA1c均成负相关(r=-0.503、-0.530、-0.534,-0.512、-0.548、0.558,P均<0.05)。ROC曲线显示,TIR预测DCAN的曲线下面积(AUC)为0.838,血清ApoM预测DCAN的AUC为0.808,二者联合预测的AUC为0.902,二者联合优于各自单独预测(Z_(联合vs.TIR)=1.909,Z_(联合vs.ApoM)=2.352;P均<0.05)。结论2型糖尿病患者TIR和血清ApoM水平显著降低,二者与DCAN密切相关,有助于临床评估DCAN发生风险。Objective To investigate the correlation between time in range(TIR)and serum apolipoprotein M(ApoM)levels in patients with type 2 diabetes mellitus and diabetic cardiac autonomic neuropathy(DCAN).Methods A total of 184 patients with type 2 diabetes admitted to the Dahua Hospital in Xuhui District,Shanghai from October 2020 to October 2022 were selected as the study subjects,and they were divided into DCAN group(n=109)and non-DCAN group(n=75)according to the occurrence of DCAN;continuous dynamic blood glucose monitoring was carried out and TIR was calculated;ELISA was applied to detect serum ApoM level;Pearson correlation was applied to analyze the correlation between TIR and serum ApoM and urinary albumin creatinine ratio(UACR),fasting blood sugar(FBG)and glycated hemoglobin(HbA1c);receiver operating characteristic(ROC)curve was applied to analyze the predictive value of TIR and serum ApoM levels for DCAN.Results UACR,FBG and HbA1c levels in the DCAN group were(14.35±2.01)mg/g,(12.25±2.61)mmol/L and(10.86±2.78)%,respectively,significantly higher than those in the non-DCAN group(8.05±1.98)mg/g,(9.67±1.57)mmol/L and(8.24±1.24)%(t=21.019,7.657,7.650;all P<0.001).TIR and serum ApoM levels in the DCAN group were(72.46±13.54)%and(6.52±1.28)μg/mL,respectively,significantly lower than those in the nonDCAN group(85.25±14.57)%and(9.24±2.34)μg/mL(t=6.103,10.137;all P<0.05).According to Pearson correlation analysis,TIR and serum ApoM levels were negatively correlated with UACR,FBG and HbA1c(r=-0.503,-0.530,-0.534,-0.512,-0.548,0.558;all P<0.05).According to the ROC,the area under the curve(AUC)of DCAN predicted by TIR was 0.838,the AUC of DCAN predicted by serum ApoM was 0.808,and the AUC of DCAN predicted by both of them was 0.902,the combination of the two was superior to their individual predictions(Z_(combination vs.TIR)=1.909,Z_(combination vs.ApoM)=2.352;all P<0.05).Conclusion The levels of TIR and serum ApoM in patients with type 2 diabetes were obviously reduced,which were closely related to DCAN,and both

关 键 词：2型糖尿病 葡萄糖范围内时间 载脂蛋白M 心脏自主神经病变 

分 类 号：R587.1[医药卫生—内分泌]