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生长停滞特异性蛋白6和C1q/肿瘤坏死因子相关蛋白4水平与2型糖尿病患者颈动脉粥样硬化的关联

Correlations of growth arrest specific 6 and C1q/TNF-related protein 4 with carotid atherosclerosis in patients with type 2 diabetes

    摘要
  • 摘要:
    目的 探讨血浆生长停滞特异性蛋白6(GAS6)、血清C1q/肿瘤坏死因子相关蛋白4(CTRP4)水平与2型糖尿病(T2DM)患者颈动脉粥样硬化(CAS)的关联。
    方法 回顾性选取经超声检查确诊CAS的60例T2DM患者并纳入T2DM+CAS组，按照年龄(±2岁)、性别进行1∶1匹配后选取经超声检查确认无CAS的60例T2DM患者并纳入T2DM组。制订资料调查问卷收集患者的临床资料，采用酶联免疫吸附试验(ELISA)法检测患者血浆GAS6水平和血清CTRP4水平。采用Logistic回归分析评估T2DM患者发生CAS的危险因素; 绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC), 评估血浆GAS6水平、血清CTRP4水平对T2DM患者发生CAS的预测效能。
    结果 2组患者在年龄、体质量指数、腰围、是否吸烟、血压和相关生化指标水平方面比较，差异无统计学意义(P>0.05); T2DM+CAS组高血压病患病率高于T2DM组, GAS6、CTRP4水平低于T2DM组，差异有统计学意义(P < 0.05)。Logistic回归分析结果显示, GAS6、CTRP4水平每升高1 ng/mL, T2DM患者发生CAS的风险分别降低0.508倍(OR=0.508, 95%CI: 0.345~0.747, P=0.001)、0.883倍(OR=0.883, 95%CI: 0.819~0.952, P=0.001), 高血压病使T2DM患者发生CAS的风险增加3.051倍(OR=3.051, 95%CI: 1.438~6.473, P=0.004)。GAS6、CTRP4单独和联合预测T2DM患者发生CAS的最大约登指数分别为0.417、0.384和0.517, 对应的敏感度分别为85.0%、81.7%和81.7%, 特异度分别为58.3%、56.7%和70.0%。
    结论 T2DM患者血浆GAS6水平、血清CTRP4水平与CAS发生风险呈负相关，且血浆GAS6联合血清CTRP4对T2DM患者发生CAS的预测效能良好。

     

    Abstract:
    Objective To evaluate the correlations of growth arrest specific 6 (GAS6) and C1q/TNF-related protein 4 (CTRP4) levels with carotid atherosclerosis (CAS) in patients with type 2 diabetes (T2DM).
    Methods A total of 60 T2DM patients with CAS confirmed by ultrasound were retrospectively selected as T2DM+CAS group, and 60 T2DM patients without CAS confirmed by ultrasound were selected as T2DM group according to a matching ratio of 1 to 1 in gender as well as addition and subtraction of age for 2 years. A questionnaire was developed to collect clinical data of the patients. Plasma GAS6 and serum CTRP4 levels were measured by enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was used to evaluate the risk factors of CAS in T2DM patients. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of plasma GAS6 level and serum CTRP4 level for CAS in T2DM patients.
    Results There were no significant differences in age, body mass index, waist circumference, smoking, blood pressure and levels of relevant biochemical indicators between the two groups (P>0.05). The prevalence of hypertension in the T2DM+CAS group was higher than that in the T2DM group, and the levels of GAS6 and CTRP4 were lower than those in the T2DM group, and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that increase of every 1 ng/mL in GAS6 and CTRP4 levels respectively leaded to 0.508 times (OR=0.508, 95%CI, 0.345 to 0.747, P=0.001) and 0.883 times of decrease in the risk of CAS in T2DM patients (OR=0.883, 95%CI, 0.819 to 0.952, P=0.001). Hypertension increased the risk of CAS in T2DM patients by 3.051 times (OR=3.051, 95%CI, 1.438 to 6.473, P=0.004). The maximum Youden index of GAS6 or CTRP4 alone and their combination in predicting CAS in T2DM patients was 0.417, 0.384 and 0.517, respectively, with the corresponding sensitivity of 85.0%, 81.7% and 81.7%, and the specificity of 58.3%, 56.7% and 70.0%, respectively.
    Conclusion Plasma GAS6 and CTRP4 levels are negatively correlated with the risk of CAS in T2DM patients, and the combination of plasma GAS6 and CTRP4 has a good predictive value for CAS in T2DM patients.

     

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