CysC水平与T2DM患者心室重构及预后关系探讨

摘要

Objective To investigate the relationship between serum cystatin C (CysC) level and ventricular remodeling and prognosis in patients with Type 2 diabetes mellitus (T2DM).Methods 106 T2DM patients were selected from January 2013 to June 2016 as study group, 90 healthy volunteers were selected as control group during the same period. CysC levels, body mass index (BMI) and blood pressure were measured in both groups. According to CysC level, the study group was then divided into elevated group (CysC>1.09 mg/L) and normal group (CysC ≤ 1.09 mg/L). Fasting blood glucose (FPG), triglyceride (TG), creatinine (SCr), urea nitrogen (BUN), high density lipoprotein (HDL-C), insulin resistance (HOMA-IR), glycosylated hemoglobin (HbA1C) in study group were measured by automatic biochemistry analyzer. Left ventricular posterior wall thickness (LVPW), left ventricular end diastolic diameter (LVDD), interventricular septum thickness (IVS), calculate left ventricular mass (LVM), left ventricular mass index (LVMI) were measured in echocardiographic examination. Patients were followed up within 6 months for cardiovascular adverse events.Results The detection rate of high CysC level in the study group was significantly higher than that in the control group (P<0.05). There was no significant difference in general data between the general group and the normal group (P>0.05). LVPW, LVM and LVMI in the elevated group were significantly higher than those in the normal group (P<0.05). In the elevated group, 1 case of heart failure, 3 cases of arrhythmia, 1 case of myocardial infarction, 3 cases of angina and 1 case of death were recorded. The incidence of cardiovascular events in the elevated group was significantly higher than that in the control group (P<0.05). Pearson correlation analysis result showed that CysC levels were positively correlated with LVPW, LVM, LVMI and cardiovascular events, and had no correlation with LVD and IVS.Conclusion CysC levels are positively related to ventricular remodeling and cardiovascular adverse events in patients with T2DM. Higher CysC level leads to ventricular remodeling, and is prone to cardiovascular adverse events with poor prognosis.%目的 探讨血清胱抑素C(CysC)水平与2型糖尿病(T2DM)患者心室重构及预后关系.方法 选择2013年1月~2016年6月于四川省科学城医院心内科就诊的T2DM患者106例作为研究组,选择同期在我院体检的健康者90例作为对照组,检测两组纳入者CysC水平、体质指数(BMI)、血压.根据研究组患者CysC水平将其分为升高组(CysC>1.09 mg/L)和正常组(CysC≤1.09 mg/L),采用全自动血液生化分析仪检测研究组患者的空腹血糖(FPG)、三酰甘油(TG)、肌酐(SCr)、尿素氮(BUN)、高密度脂蛋白(HDL-C)、胰岛素抵抗水平(HOMA-IR)、糖化血红蛋白(HbA1C);超声心动图检查:测量患者左心室后壁厚度(LVPW)、左心室舒张末期内径(LVDD)、室间隔厚度(IVS),计算左心室质量(LVM)、左心室质量指数(LVMI),并对患者6个月内发生心血管不良事件进行随访.结果 研究组患者的高CysC检出率显著较对照组高,差异有统计学意义(P<0.05),CysC升高组和CysC正常组一般资料比较差异无统计学意义(P>0.05),CysC升高组的LVPW、LVM、LVMI显著高于CysC正常组,差异均有统计学意义(P<0.05),CysC升高组出现1例心力衰竭、3例心律失常、1例心肌梗死、3例心绞痛、1例死亡,心血管不良事件发生率显著高于对照组,差异有统计学意义(P<0.05),Pearson相关性分析结果显示,CysC水平与LVPW、LVM、LVMI、心血管不良事件呈正相关,与LVD、IVS无相关性.结论 CysC水平与T2DM患者心室重构和心血管不良事件具有正相关,CysC水平较高导致患者心室重构,且患者易发生心血管不良事件,预后较差.