血清胱抑素C與2型糖尿病亞臨床心血管疾病相關(guān)性的臨床研究
發(fā)布時(shí)間：2018-08-06 18:23
【摘要】：目的:本研究選取頸部動(dòng)脈粥樣硬化斑塊(carotid atherosclerotic plaques,CAP)作為亞臨床心血管疾病的標(biāo)志,旨在探討血清胱抑素C(cystatin C,CysC)與2型糖尿病(type 2 diabetes,T2DM)亞臨床心血管疾病的相關(guān)性。方法:選擇2016年6月-7月于沈陽軍區(qū)總醫(yī)院體檢中心行體檢的人群及同時(shí)期內(nèi)分泌科住院的T2DM患者,共1020名(大于18周歲),其中男866名,女154名。收集性別、年齡、身高、體重、體重指數(shù)(BMI)、腰圍(WC)、臀圍(HC)、既往病史及用藥情況、主要生化指標(biāo)包括空腹血糖(FPG)、糖化血紅蛋白(Hb A1C)、血尿素、血肌酐(Scr)、CysC及血甘油三酯(TG)、膽固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)等生化指標(biāo)及頸部動(dòng)脈超聲檢查結(jié)果的相關(guān)信息,并計(jì)算腎小球?yàn)V過率(e GFR)。根據(jù)是否有T2DM及CAP的形成,在上述體檢人群中,以性別一致、年齡±5歲、病例數(shù)為1:1的比例進(jìn)行匹配,檢出T2DM-CAP組(T2DM-CAP,n=111)、T2DM非CAP組(T2DM-NCAP,n=111)、非T2DM-CAP組(NT2DM-CAP,n=111)及非T2DM非CAP組(NT2DM-NCAP,n=111)。結(jié)果:1.與T2DM-NCAP、NT2DM-CAP、NT2DM-NCAP組相比,T2DM-CAP組Hb A1C、e GFR、CysC均高于其他三組,并且均有統(tǒng)計(jì)學(xué)差異(P0.05)。2.與T2DM-CAP組相比,T2DM-NCAP組Hb A1C、e GFR、CysC均較低,并且均有統(tǒng)計(jì)學(xué)差異(P0.05),血脂、同型半胱氨酸(HCY)、超敏C反應(yīng)蛋白(HCY)、LC、WC無統(tǒng)計(jì)學(xué)差異;NT2DM-CAP、NT2DM-NCAP組有統(tǒng)計(jì)學(xué)差異的是WC、Hb A1C、FPG、TG、TC、Scr、e GFR、CysC(P0.05)。3.T2DM患者發(fā)生CAP的獨(dú)立危險(xiǎn)因素:以T2DM組是否合并CAP為因變量,以T2DM-CAP與T2DM-NCAP組有差異的Hb A1c、e GFR、Scr、CysC自變量進(jìn)行二元logistic回歸分析,CysC(OR=4.759,P=0.001)是其發(fā)生的獨(dú)立預(yù)測(cè)因子。4.T2DM組(T2DM-NCAP+T2DM-CAP組)血糖控制水平與CAP形成的關(guān)系:血糖控制不達(dá)標(biāo)組CAP形成人數(shù)為66/109(60.6%),而血糖控制達(dá)標(biāo)組為41/108(38.3%)。5.各組間CysC濃度變化的比較:T2DM-CAP明顯高于其他三組,且均有統(tǒng)計(jì)學(xué)差異(P0.05);非糖尿病組,NT2DM-CAP組濃度高于NT2DM-NCAP組,有統(tǒng)計(jì)學(xué)差異(P0.05)。6.CysC水平與年齡、WC、LC、Scr、Hs-CRP呈正相關(guān),與e GFR及HDL呈負(fù)相關(guān)。7.以CysC為檢驗(yàn)變量,以T2DM-CAP為因變量制作ROC曲線圖,曲線下面積0.552,P值0.189。結(jié)論:1.低e GFR、高CysC、Hb A1c(≥7%)與T2DM患者形成CAP有關(guān)。2.在T2DM組與NT2DM組,CysC可能與CAP形成均有關(guān)。3.CysC可能是T2DM患者形成CAP的獨(dú)立預(yù)測(cè)因子。4.CysC可能與炎癥反應(yīng)、腹型肥胖有關(guān)。5.T2DM患者中,CysC對(duì)CAP的形成無診斷價(jià)值。
[Abstract]:Objective: to select carotid atherosclerotic plaques (CAP) as a marker of subclinical cardiovascular disease, and to explore the correlation between serum cystatin C (cystatin C, CysC) and type 2 diabetes (type 2 diabetes, T2DM) subclinical cardiovascular disease. Methods: to select the June 2016 -7 month in Shenyang military area general medicine. The population of the physical examination center and the T2DM patients in the same period Department of Endocrinology were 1020 (more than 18 years old), including 866 men and 154 women, including sex, age, height, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), past medical history and drug use, the main biochemical indexes including fasting blood glucose (FPG), glycated hemoglobin (Hb A1C). ) blood urea, serum creatinine (Scr), CysC and blood triglyceride (TG), cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and other biochemical parameters of the carotid artery ultrasound, and calculate the glomerular filtration rate (E GFR). According to whether there is the formation of T2DM and CAP, the sex is the same, the age is 5. The number of cases was matched with the proportion of 1:1, T2DM-CAP group (T2DM-CAP, n=111), T2DM non CAP group (T2DM-NCAP, n=111), non T2DM-CAP group (NT2DM-CAP, n=111) and non T2DM, and the results were all higher than those of the other three groups, and all were statistically significant. Compared with the T2DM-CAP group, the T2DM-NCAP group Hb A1C, e GFR, CysC are all lower, and there are statistical differences (P0.05), blood lipid, homocysteine (HCY) and the hypersensitivity C reactive protein (P0.05). Independent risk factors of AP: two yuan logistic regression analysis was carried out in group T2DM, Hb A1c, e GFR, Scr, CysC independent variable, with whether the group of T2DM was combined with CAP as the dependent variable. The number of CAP formation in the control group was 66/109 (60.6%), while the blood glucose control group was compared with the CysC concentration in each group of 41/108 (38.3%).5.: T2DM-CAP was significantly higher than the other three groups, and there were statistical differences (P0.05). The concentration of NT2DM-CAP group was higher than that of the NT2DM-NCAP group, and there was a statistical difference (P0.05).6.CysC level and age, WC. C, Scr, Hs-CRP are positively correlated, and E GFR and HDL are negatively correlated.7. with CysC as the test variable, ROC curves are made with T2DM-CAP as the dependent variable. The area under the curve is 0.552, the P 0.189. conclusion is 1.. CysC may be associated with inflammation and abdominal obesity. 5. CysC has no diagnostic value for CAP formation in T2DM patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R54
本文編號(hào)：2168596
[Abstract]:Objective: to select carotid atherosclerotic plaques (CAP) as a marker of subclinical cardiovascular disease, and to explore the correlation between serum cystatin C (cystatin C, CysC) and type 2 diabetes (type 2 diabetes, T2DM) subclinical cardiovascular disease. Methods: to select the June 2016 -7 month in Shenyang military area general medicine. The population of the physical examination center and the T2DM patients in the same period Department of Endocrinology were 1020 (more than 18 years old), including 866 men and 154 women, including sex, age, height, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), past medical history and drug use, the main biochemical indexes including fasting blood glucose (FPG), glycated hemoglobin (Hb A1C). ) blood urea, serum creatinine (Scr), CysC and blood triglyceride (TG), cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and other biochemical parameters of the carotid artery ultrasound, and calculate the glomerular filtration rate (E GFR). According to whether there is the formation of T2DM and CAP, the sex is the same, the age is 5. The number of cases was matched with the proportion of 1:1, T2DM-CAP group (T2DM-CAP, n=111), T2DM non CAP group (T2DM-NCAP, n=111), non T2DM-CAP group (NT2DM-CAP, n=111) and non T2DM, and the results were all higher than those of the other three groups, and all were statistically significant. Compared with the T2DM-CAP group, the T2DM-NCAP group Hb A1C, e GFR, CysC are all lower, and there are statistical differences (P0.05), blood lipid, homocysteine (HCY) and the hypersensitivity C reactive protein (P0.05). Independent risk factors of AP: two yuan logistic regression analysis was carried out in group T2DM, Hb A1c, e GFR, Scr, CysC independent variable, with whether the group of T2DM was combined with CAP as the dependent variable. The number of CAP formation in the control group was 66/109 (60.6%), while the blood glucose control group was compared with the CysC concentration in each group of 41/108 (38.3%).5.: T2DM-CAP was significantly higher than the other three groups, and there were statistical differences (P0.05). The concentration of NT2DM-CAP group was higher than that of the NT2DM-NCAP group, and there was a statistical difference (P0.05).6.CysC level and age, WC. C, Scr, Hs-CRP are positively correlated, and E GFR and HDL are negatively correlated.7. with CysC as the test variable, ROC curves are made with T2DM-CAP as the dependent variable. The area under the curve is 0.552, the P 0.189. conclusion is 1.. CysC may be associated with inflammation and abdominal obesity. 5. CysC has no diagnostic value for CAP formation in T2DM patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R54
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