文章摘要
血清MMP2/TIMP2比值与老年2型糖尿病患者并发AS的相关性分析
Correlation analysis between serum matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-2 ratio and concurrent aortic stiffness in elderly patients with type 2 diabetes mellitus
投稿时间:2023-06-12  
DOI:10.3969/j.issn.1000-0399.2024.01.013
中文关键词: 糖尿病,2型  基质金属蛋白酶-2/金属蛋白酶组织抑制因子-2比值  主动脉僵硬度  脉搏波分析
英文关键词: Diabetes mellitus,type 2  Matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-2 ratio  Aortic stiffness  Pulse wave analysis
基金项目:
作者单位
田小波 571500 海南万宁 万宁市人民医院综合内科 
梁振花 571500 海南万宁 万宁市人民医院综合内科 
蔡天聪 571500 海南万宁 万宁市人民医院综合内科 
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中文摘要:
      目的 探讨血清基质金属蛋白酶-2/金属蛋白酶组织抑制因子-2(MMP2/TIMP2)比值与老年2型糖尿病(T2DM)患者并发主动脉硬化(AS)之间的关系。方法 回顾性分析2022年1月至2023年4月万宁市人民医院收治的180例初次诊断为T2DM的老年患者的临床资料,并根据是否并发AS[颈动脉-股动脉脉搏波传导速度(cfPWV)>10 m/s]分为AS组(n=69)和非AS组(n=111)。另选取同时期来院体检健康者采用倾向性评分法匹配90例为对照组。比较3组对象的一般资料、实验室指标以及血清MMP2、TIMP2水平和MMP2/TIMP2比值。采用Spearman相关分析探究老年T2DM患者cfPWV与各项指标的相关性。采用多因素logistic回归模型分析,老年T2DM患者并发AS的影响因素。绘制受试者工作特征(ROC)曲线,分析并比较MMP2/TIMP2比值与多指标联合检测对老年T2DM患者并发AS的诊断价值。结果 非AS组稳态模型胰岛素抵抗指数(HOMA-IR)、血清三酰甘油(TG)、MMP2水平及MMP2/TIMP2比值高于对照组,血清TIMP2水平低于对照组,差异有统计学意义(P<0.05)。AS组年龄、合并高血压比例高于非AS组(P<0.05)。AS组HOMA-IR、血清TG、MMP2水平及MMP2/TIMP2比值高于对照组和非AS组,血清TIMP2水平低于对照组和非AS组,差异均有统计学意义(P<0.05)。相关性分析结果显示,非AS组患者的cfPWV与HOMA-IR、TC、LDL-C、MMP2、MMP2/TIMP2比值呈正相关(r=0.217、0.264、0.216、0.197、0.703,P<0.05),与TIMP2呈负相关(r=-0.524,P<0.01);AS组患者cfPWV与MMP2、MMP2/TIMP2比值呈正相关(r=0.659、0.857,P<0.01),与TIMP2呈负相关(r=-0.532,P<0.01)。logistic回归分析显示,年龄增长(OR=1.108,95% CI:1.022~1.201,P=0.012)、高血压病(OR=2.877,95% CI:1.174~7.051,P=0.021)及MMP2/TIMP2比值升高(OR=5.147,95% CI:2.392~11.074,P<0.001)是老年T2DM患者并发AS的的独立危险因素。ROC曲线分析结果显示,MMP2/TIMP2比值及多指标联合检测诊断老年T2DM患者并发AS的曲线下面积分别为0.850(95% CI:0.789~0.899,P<0.01)和0.886(95% CI:0.831~0.929,P<0.01),灵敏度分别为73.91%、82.61%,特异度分别为89.19%、82.88%,约登指数分别为0.631、0.655。多指标联合检测的诊断效能明显大于MMP2/TIMP2比值,差异具有统计学意义(Z=2.233,P=0.026)。MMP2/TIMP2比值诊断老年T2DM患者并发AS的最佳截断值为3.23。结论 MMP2/TIMP2比值升高为老年T2DM患者并发AS的独立危险因素,对老年T2DM并发AS的诊断有辅助价值,多指标联合检测可提高诊断效能。
英文摘要:
      Objective To investigate the relationship between serum matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-2(MMP-2/TIMP2) ratio and concurrent aortic sclerosis(AS) in elderly patients with type 2 diabetes mellitus(T2DM).Methods The clinical data of 180 elderly patients with newly diagnosed T2DM admitted to Wanning People's Hospital from January 2022 to April 2023 were analyzed retrospectively, and the patients were divided into AS group(n=69) and non-AS group(n=111) according to whether complicated with AS [carotid femoral pulse wave velocity(cfPWV)>10 m/s]. And by means of propensity score matching, other 90 healthy people undergoing physical examination in the hospital during the same period were assigned simultaneously to the control group. The general information, laboratory indicators, and serum MMP2, TIMP2 levels, and MMP2/TIMP2 ratio of subjects in the three groups were compared. Spearman correlation analysis was used to explore the correlation of cfPWV with various indicators in elderly patients with T2DM. Multivariate logistic regression model was used to analyze the influencing factors of concurrent AS in elderly patients with T2DM. Receiver operating characteristic(ROC) curve was drawn to analyze and compare the diagnostic value of MMP2/TIMP2 ratio and multi-index combined detection for concurrent AS in elderly patients with T2DM.Results The homeostasis model insulin resistance index(HOMA-IR), serum triglyceride(TG), MMP2 levels, and MMP2/TIMP2 ratio in the non-AS group were higher than those in the control group, while serum TIMP2 level was lower than that in the control group(P<0.05). The age, proportion of hypertension in the AS group were higher than those in the non-AS group(P<0.05). The HOMA-IR, TG, MMP2 levels, and MMP2/TIMP2 ratio in the AS group were higher than those in the control group or non-AS group, while serum TIMP2 level was lower than that in the control group or non-AS group(P<0.05). The correlation analysis results showed that the cfPWV of patients in the non-AS group was positively correlated with HOMA-IR, TC, LDL-C, MMP2 and MMP2/TIMP2 ratio(r=0.217, 0.264, 0.216, 0.197, 0.703, P<0.05), and negatively correlated with TIMP2(r=-0.524, P<0.01). The cfPWV of patients in the AS group was positively correlated with MMP2and MMP2/TIMP2 ratio(r=0.659, 0.857, P<0.01), and negatively correlated with TIMP2(r=-0.532, P<0.01). Logistic regression analysis showed that ageing(OR=1.108, 95%CI:1.022~1.201, P=0.012), hypertension(OR=2.877, 95%CI:1.174~7.051, P=0.021), and elevated value of MMP2/TIMP2 ratio(OR=5.147, 95%CI:2.392~11.074, P<0.001) were independent risk factors for concurrent AS in elderly patients with T2DM. The ROC analysis results showed that the area under the curve of MMP2/TIMP2 ratio and multi-index combined detection for diagnosing concurrent AS in elderly patients with T2DM were 0.850(95%CI:0.789~0.899, P<0.01) and 0.886(95%CI:0.831~0.929, P<0.01), respectively, the sensitivity was 73.91% and 82.61%, respectively, the specificity was 89.19% and 82.88%, respectively, and the Youden index was 0.631 and 0.655, respectively. The diagnostic efficiency of multi-index combined detection was significantly higher than that of MMP2/TIMP2 ratio, and the difference was statistically significant(Z=2.233, P=0.026). The optimal cut-off value of MMP2/TIMP2 ratio for diagnosing concurrent AS in elderly patients with T2DM was 3.23.Conclusion The elevated value of MMP2/TIMP2 ratio is an independent risk factor for concurrent AS in elderly patients with T2DM, which has auxiliary value for diagnosing concurrent AS in elderly patients with T2DM, and multiindex combined detection can improve the diagnostic efficiency.
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