目的:探讨老年II型糖尿病患者血清胱抑素C与心室重构的相关性。方法:筛选就诊于我院的老年II型糖尿病患者140例(年龄均 ≥ 65岁),检测患者血清胱抑素C浓度,根据老年II型糖尿病患者血清胱抑素C浓度,将全部患者分为胱抑素C正常组(胱抑素C ≤ 1.03 mg/L) 60例,胱抑素C升高组(胱抑素C > 1.03 mg/L) 71例。使用超声心动图测量两组患者左室射血分数(left ventricular ejection fraction, EF)、左房内径(left atrial diameter, LAD)、左室舒张末内径(left ventricular end-diastolic diameter, LVD)、左室后壁厚度(left ventricular posterior wall thickness, LVPWT)、室间隔厚度(ventricular septal thickness, IVST)并计算左室质量指数(left ventricular mass index, LVMI)。对这些指标进行组间比较,并分析血清胱抑素C与心室重构的相关性。结果:与胱抑素C正常组相比,胱抑素C升高组的LVMI、IVST显著增高(P < 0.01)。相关分析显示:血清胱抑素C含量与LVMI、IVST呈正相关,并具有统计学意义(P < 0.01)。结论:血清胱抑素C浓度与老年II型糖尿病患者心室重构具有显著相关性,可作为衡量II型糖尿病患者心室重构程度的一项指标。 Objective: To explore the correlation between serum cystatin C and ventricular remodeling in elderly type 2 diabetic patients. Method: 140 elderly patients with type 2 diabetes who admitted to our hospital (age ≥ 65 years old) were screened, the serum cystatin C level of whom was measured. According to the patients’ serum cystatin C concentration, all patients were divided into the normal cystatin C group (cystatin C ≤ 1.03 mg/L) 60 cases and the higher cystatin C group (cystatin C > 1.03 mg/L) 71 cases. Left ventricular ejection fraction (EF), left atrial diameter (LAD), left ventricular end-diastolic diameter (LVD), left ventricular posterior wall thickness (LVPWT), and ventricular septal thickness (IVST) were measured by echocardiography in both groups, then left ventricular mass index (LVMI) was calculated. These indexes were compared between groups, and the correlation between serum cystatin C and ventricular remodeling was analyzed. Results: Compared to the normal cystatin C group, the LVMI and IVST of the higher cystatin C group were significantly increased (P < 0.01). Correlation analysis showed that serum cystatin C content was positively correlated with LVMI and IVST, and it was statistically significant (P < 0.01). Conclusion: The serum cystatin C level and ventricular remodeling in elderly type 2 diabetic patients have significant correlation. Cystatin C can be used as an index to measure the degree of ventricular remodeling in elderly type 2 diabetic patients.
目的:探讨老年II型糖尿病患者血清胱抑素C与心室重构的相关性。方法:筛选就诊于我院的老年II型糖尿病患者140例(年龄均 ≥ 65岁),检测患者血清胱抑素C浓度,根据老年II型糖尿病患者血清胱抑素C浓度,将全部患者分为胱抑素C正常组(胱抑素C ≤ 1.03 mg/L) 60例,胱抑素C升高组(胱抑素C > 1.03 mg/L) 71例。使用超声心动图测量两组患者左室射血分数(left ventricular ejection fraction, EF)、左房内径(left atrial diameter, LAD)、左室舒张末内径(left ventricular end-diastolic diameter, LVD)、左室后壁厚度(left ventricular posterior wall thickness, LVPWT)、室间隔厚度(ventricular septal thickness, IVST)并计算左室质量指数(left ventricular mass index, LVMI)。对这些指标进行组间比较,并分析血清胱抑素C与心室重构的相关性。结果:与胱抑素C正常组相比,胱抑素C升高组的LVMI、IVST显著增高(P < 0.01)。相关分析显示:血清胱抑素C含量与LVMI、IVST呈正相关,并具有统计学意义(P < 0.01)。结论:血清胱抑素C浓度与老年II型糖尿病患者心室重构具有显著相关性,可作为衡量II型糖尿病患者心室重构程度的一项指标。
胱抑素C,II型糖尿病,心室重构
Yu Xiao1*, Shanshan Yuan1, Ting Zhao2, Hongyan Dai1#
1Department of Healthcare Cardiology, Affiliated Qingdao Municipal Hospital of Qingdao University, Qingdao Shandong
2Outpatient Programme, Affiliated Qingdao Municipal Hospital of Qingdao University, Qingdao Shandong
Received: Dec. 28th, 2020; accepted: Jan. 21st, 2021; published: Jan. 29th, 2021
Objective: To explore the correlation between serum cystatin C and ventricular remodeling in elderly type 2 diabetic patients. Method: 140 elderly patients with type 2 diabetes who admitted to our hospital (age ≥ 65 years old) were screened, the serum cystatin C level of whom was measured. According to the patients’ serum cystatin C concentration, all patients were divided into the normal cystatin C group (cystatin C ≤ 1.03 mg/L) 60 cases and the higher cystatin C group (cystatin C > 1.03 mg/L) 71 cases. Left ventricular ejection fraction (EF), left atrial diameter (LAD), left ventricular end-diastolic diameter (LVD), left ventricular posterior wall thickness (LVPWT), and ventricular septal thickness (IVST) were measured by echocardiography in both groups, then left ventricular mass index (LVMI) was calculated. These indexes were compared between groups, and the correlation between serum cystatin C and ventricular remodeling was analyzed. Results: Compared to the normal cystatin C group, the LVMI and IVST of the higher cystatin C group were significantly increased (P < 0.01). Correlation analysis showed that serum cystatin C content was positively correlated with LVMI and IVST, and it was statistically significant (P < 0.01). Conclusion: The serum cystatin C level and ventricular remodeling in elderly type 2 diabetic patients have significant correlation. Cystatin C can be used as an index to measure the degree of ventricular remodeling in elderly type 2 diabetic patients.
Keywords:Cystatin C, Type 2 Diabetes, Ventricular Remodeling
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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胱抑素C (Cystatin C, Cys-C)是一种半胱氨酸蛋白酶抑制剂,其在临床上作为评估肾小球滤过率(glomerular filtration rate, eGFR)的一种内源性物质被广泛应用,此外,目前已有研究证实,Cys-C与心血管事件(如中风、心力衰竭、心肌梗死和心血管死亡)有较强的相关性 [
收集2020年10月至2020年12月就诊于青岛市市立医院且符合II型糖尿病诊断标准的年龄大于65岁的患者140例作为研究对象,按照血清Cys C水平高低将其分为:胱抑素C正常组(胱抑素C ≤ 1.03 mg/L) 60例,胱抑素C升高组(胱抑素C > 1.03 mg/L) 71例 [
记录符合筛选标准的入选患者的年龄、性别、身高、体重、心率(HR)并于入院当日测量患者收缩压、舒张压。于入院第2天早晨采集空腹静脉血,于医院常规实验室检测总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol, HDL-C)、空腹血糖(fasting blood glucose, FBG)、糖化血红蛋白(HemoglobinA1c, HbA1c)、Cys-C水平。
BMI计算公式为: BMI = 体 重 ( kg ) ÷ 身 高 ( m ) 2 。
由经验丰富的专科医生采用Philips公司生产的IE33彩色超声诊断仪测量左室射血分数(EF)、左房内径(LAD)、左室舒张末内径(LVD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST),上述测量均取自患者同一时间段的3个不同心动周期并求得平均值,两组患者EF值均大于55%。
LVMI ( g / m 2 ) = 心 室 重 量 LVMg 体 表 面 积 BSAm 2 = 0.8 × 1.04 [ ( IVST + LVPWT + LVD ) 3 − LVD 3 ] + 0.6 0.0061 × 身 高 ( cm ) + 0.0128 × 体 重 ( kg ) − 0.1529 [
所得实验数据使用SPSS 26.0统计软件进行统计分析。计量资料用均数 ± 标准差( x ¯ ± s )表示,两组间的比较采用t检验;组间两两比较采用LSD-t检验;计数资料比较采用卡方检验;应用Pearson相关性分析分析正态分布变量之间相关性,当P < 0.05时有统计学意义。
Cys-C正常组与Cys-C升高组患者的年龄、身高、体重、BMI、收缩压、舒张压、TC、TG、LDL-C、HDL-C、FBG、HbA1c值均无明显差异(P > 0.05),见表1。
组别 | 例数 (人) | 年龄 (岁) | BMI (kg/m2) | HR (次/min) | 收缩压 (mmHg) | 舒张压 (mmHg) | |
---|---|---|---|---|---|---|---|
Cys-C升高组 | 71 | 72.79 ± 5.72 | 26.39 ± 3.38 | 76.00 ± 10.28 | 147.55 ± 18.77 | 75.99 ± 12.02 | |
Cys-C正常组 | 60 | 70.67 ± 5.81 | 25.66 ± 2.74 | 77.00 ± 8.38 | 139.38 ± 20.64 | 80.85 ± 11.93 | |
t | 2.10 | 1.35 | −0.60 | 2.37 | −2.32 | ||
P | 0.403 | 0.391 | 0.072 | 0.709 | 0.294 |
组别 | HDL-C (mmol/L) | LDL-C (mmol/L) | TC (mmol/L) | TG (mmol/L) | FBG (mmol/L) |
---|---|---|---|---|---|
Cys-C升高组 | 1.00 ± 0.28 | 2.66 ± 0.90 | 4.43 ± 1.23 | 1.57 ± 0.71 | 8.73 ± 3.35 |
Cys-C正常组 | 1.11 ± 0.27 | 2.64 ± 0.78 | 4.59 ± 1.14 | 1.61 ± 1.44 | 9.34 ± 3.41 |
t | −2.40 | 0.115 | −0.783 | −0.194 | −1.02 |
P | 0.494 | 0.301 | 0.494 | 0.217 | 0.294 |
表1. 两组一般临床资料比较
注:BMI:身体质量指数;HR:心率;HDL-C:高密度脂蛋白胆固醇;LDL-C:低密度脂蛋白胆固醇;TC:总胆固醇;TG甘油三酯;FBG:空腹血糖。
Cys-C升高组与Cys-C正常组相比,两组间LAD、LVD、LVPWT及EF值未见明显差异(P > 0.05),而Cys-C升高组的IVST、LVMI较Cys-C正常组明显升高,差异具有统计学意义(P < 0.05),见表2。
组别 | Cys-C (mg/L) | LAD (cm) | LVD (cm) | IVST (cm) | LVPWT (cm) | LVMI (g/m2) | EF % |
---|---|---|---|---|---|---|---|
Cys-C升高组 | 2.32 ± 1.78 | 3.87 ± 0.45 | 4.57 ± 0.41 | 1.06 ± 0.17 | 0.97 ± 0.11 | 92.50 ± 21.94 | 59.82 ± 1.26 |
Cys-C正常组 | 0.77 ± 0.17 | 3.67 ± 0.42 | 4.28 ± 0.56 | 0.89 ± 0.07 | 0.89 ± 0.08 | 69.17 ± 14.02 | 59.90 ± 1.04 |
t | 6.76 | 2.75 | 3.45 | 7.23 | 5.12 | 7.10 | −0.408 |
P | 0.001 | 0.327 | 0.801 | 0.001 | 0.325 | 0.001 | 0.054 |
表2. 两组心脏结构比较
注:Cys C:胱抑素C;LAD:左房内径;LVD:左室舒张末内径;LVPWT:左室后壁厚度;IVST:室间隔厚度;LVMI:左室质量指数;EF:左室射血分数。
对II型糖尿病患者IVST、LVMI与临床指标进行Pearson相关性分析,当r < 0.3时不考虑相关性。
结果显示:IVST与Cys-C、LVPWT呈正相关,相关系数为0.53、0.76,具有统计学意义(P均 < 0.05),见表3;而LVMI与Cys-C、LVD、IVST、LVPWT均呈正相关,相关系数分别为0.39、0.68、0.76、0.66,具有统计学意义(P均 < 0.05),见表4。
变量 | r值 | P值 |
---|---|---|
年龄 | 0.12 | 0.175 |
身高 | 0.02 | 0.809 |
体重 | 0.05 | 0.574 |
BMI | 0.06 | 0.473 |
收缩压 | 0.07 | 0.430 |
舒张压 | −0.21 | 0.019 |
HR | 0.02 | 0.859 |
LDL-C | −0.05 | 0.552 |
---|---|---|
TG | 0.01 | 0.88 |
TC | −0.14 | 0.110 |
FBG | 0.10 | 0.259 |
HDL-C | −0.13 | 0.130 |
HbA1c | 0.05 | 0.594 |
LAD | 0.24 | 0.001 |
Cys-C | 0.53 | 0.001 |
EF | 0.067 | 0.446 |
LVD | 0.25 | 0.040 |
LVPWT | 0.76 | 0.001 |
表3. IVST与各临床指标相关性分析
注:BMI:身体质量指数;HR:心率;HDL-C:高密度脂蛋白胆固醇;LDL-C:低密度脂蛋白胆固醇;TC:总胆固醇;TG甘油三酯;FBG:空腹血糖;Cys-C:胱抑素C;LAD:左房内径;LVD:左室舒张末内径;LVPWT:左室后壁厚度;IVST:室间隔厚度;LVMI:左室质量指数;EF:左室射血分数。
变量 | r值 | P值 |
---|---|---|
年龄 | 0.15 | 0.085 |
身高 | −0.08 | 0.341 |
体重 | −0.14 | 0.113 |
BMI | −0.09 | 0.284 |
收缩压 | 0.07 | 0.413 |
舒张压 | −0.01 | 0.984 |
HR | −0.16 | 0.065 |
LDL-C | −0.03 | 0.759 |
TG | 0.04 | 0.639 |
TC | −0.13 | 0.134 |
FBG | 0.04 | 0.658 |
HDL-C | −0.10 | 0.271 |
HbA1c | 0.04 | 0.695 |
LAD | 0.25 | 0.003 |
Cys-C | 0.39 | 0.001 |
EF | −0.07 | 0.426 |
LVD | 0.68 | 0.000 |
IVST | 0.76 | 0.000 |
LVPWT | 0.66 | 0.000 |
表4. LVMI与各临床指标相关性分析
注:BMI:身体质量指数;HR:心率;HDL-C:高密度脂蛋白胆固醇;LDL-C:低密度脂蛋白胆固醇;TC:总胆固醇;TG甘油三酯;FBG:空腹血糖;Cys-C:胱抑素C;LAD:左房内径;LVD:左室舒张末内径;LVPWT:左室后壁厚度;IVST:室间隔厚度;LVMI:左室质量指数;EF:左室射血分数。
II型糖尿病是多种心血管疾病高危因素,临床上糖尿病患者常合并有不同程度的各种心血管疾病,其中心室重构是是慢性心力衰竭等心血管疾病的主要发病机制之一,II型糖尿病且伴有早期肾功能损害的患者易发生心室重构 [
本次研究对老年II型糖尿病患者血清Cys-C水平与心室重构相关指标之间的关系进行了初步探索,研究结果显示:与Cys-C正常的老年II型糖尿病患者相比,Cys C升高患者的IVST及LVMI明显升高,呈现正相关关系。
近年来许多研究证实Cys-C除与肾小球滤过率密切相关外 [
目前对老年II型糖尿病患者Cys-C与心室重构之间关系的研究较少,本研究发现Cys-C与老年II型糖尿病患者的IVST和LVMI升高呈正相关,这与2016年姜巍娇等人的实验结果一致,该研究发现合并慢性心力衰竭的糖尿病患者血清中Cys-C与左心室重构密切相关,证实Cys-C参与了慢性心力衰竭的发生,可以用于慢性心力衰竭患者心功能的评估 [
综上所述,我们的研究证实Cys-C与老年II型糖尿病患者心室重构严重程度密切相关,II型糖尿病患者出现早期肾脏损害时伴有血清中Cys-C的升高,长期Cys-C升高可能导致心室重构的发生发展,临床上可以通过动态监测患者血清中Cys-C水平来评估糖尿病患者心室重构的程度,重点关注伴有Cys-C升高的糖尿病高危人群,采取针对性措施予以干预从而减少老年II型糖尿病患者并发的心室重构和心血管疾病风险,达到改善患者的预后的目的。
青岛市医疗卫生优秀学科带头人计划(青卫科教字[
肖 瑜,苑姗姗,赵 婷,戴红艳. 老年II型糖尿病患者血清胱抑素C与心室重构的相关性Correlation between Serum Cystatin C and Ventricular Remodeling in Elderly Type 2 Diabetic Patients[J]. 临床医学进展, 2021, 11(01): 396-402. https://doi.org/10.12677/ACM.2021.111056