NE在预测糖尿病所致大血管病变中的作用
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摘要
目的探讨中性粒细胞弹性蛋白酶(NE)在预测糖尿病大血管病变中的作用及预测价值。方法选取2016年6月-2017年12月于彭州市人民医院内分泌科收治住院的181例糖尿病未合并大血管病变患者为A组,88例糖尿病合并大血管病变患者为B组,同期选取32名健康体检者作为对照组。采集并比较各组血清NE水平差异,并按是否发生大血管病变为因变量构建Logistic回归模型以筛选糖尿病患者发生大血管病变的危险因素。使用ROC曲线判定不同截断值时曲线下面积的变化。结果 B组NE水平明显高于A组和对照组[(136.76±20.55)μg/L vs.(23.29±2.27)μg/L vs.(21.78±6.79)μg/L],差异有统计学意义(P<0.05),而A组与对照组间比较差异无统计学意义(P>0.05)。Logistic分析结果显示,血NE水平(OR=1.96,95%CI:1.21～3.18)与病程(OR=4.08,95%CI:1.57～10.57)均为糖尿病患者并发大血管病变的危险因素。ROC曲线结果显示,NE截断点取8μg/L时曲线下面积取最大值0.94,此时灵敏度为96.6%,特异度为90.1%。结论血NE作为糖尿病患者大血管病变诊断标准的灵敏度、特异度均较高,具有一定的临床价值。
Objective To investigate the role and diagnostic value of neutrophil elastase(NE) in predicting diabetic macroangiopathy. Methods 181 patients with diabetes mellitus without macrovascular disease(group A)and 88 patients with diabetes mellitus and macrovascular disease(group B)admitted to the People.s Hospital of Pengzhou during June 2016 to December 2017 were selected for the study,and 32 healthy persons were selected as control group. All the participants accepted the B-type ultrasound examination,and participants with or without macroangiopathy were divided into two groups.Then the level of serum neutrophil elastase was examined and compared among 3 groups. The multivariate analysis was performed by logistic regression analysis. ROC curve was used to determine the change in area under the curve for different cutoff values. Results The level of serum NE in diabetic patients with macroangiopathy was significantly higher than that in patients with non-diabetic macroangiopathy and in control group[(136.76±20.55)μg/L vs.(23.29±2.27)μg/L vs.(21.78±6.79)μg/L](P<0.05),but the difference of NE between diabetes mellitus patients without macroangiopathy and control group shows no statistical significance(P>0.05). The results of logistic model showed that high level of serum NE(OR=1.96,95%CI: 1.21～3.18)and period of disease(OR=4.08,95%CI: 1.57～10.57)were risk factors for DB macrovascular. The ROC showed that when the cut-off value of serum NE was set at 8 μg/L the AUC reach the peak of 0.94;sensitivity and specificity were 96.6% and 90.1%,respectively. Conclusion The sensitivity and specificity of neutrophil elastase in the diagnosis of macrovascular lesions in diabetic patients were high and had some clinical value.
Objective To investigate the role and diagnostic value of neutrophil elastase(NE) in predicting diabetic macroangiopathy. Methods 181 patients with diabetes mellitus without macrovascular disease(group A)and 88 patients with diabetes mellitus and macrovascular disease(group B)admitted to the People.s Hospital of Pengzhou during June 2016 to December 2017 were selected for the study,and 32 healthy persons were selected as control group. All the participants accepted the B-type ultrasound examination,and participants with or without macroangiopathy were divided into two groups.Then the level of serum neutrophil elastase was examined and compared among 3 groups. The multivariate analysis was performed by logistic regression analysis. ROC curve was used to determine the change in area under the curve for different cutoff values. Results The level of serum NE in diabetic patients with macroangiopathy was significantly higher than that in patients with non-diabetic macroangiopathy and in control group[(136.76±20.55)μg/L vs.(23.29±2.27)μg/L vs.(21.78±6.79)μg/L](P<0.05),but the difference of NE between diabetes mellitus patients without macroangiopathy and control group shows no statistical significance(P>0.05). The results of logistic model showed that high level of serum NE(OR=1.96,95%CI: 1.21～3.18)and period of disease(OR=4.08,95%CI: 1.57～10.57)were risk factors for DB macrovascular. The ROC showed that when the cut-off value of serum NE was set at 8 μg/L the AUC reach the peak of 0.94;sensitivity and specificity were 96.6% and 90.1%,respectively. Conclusion The sensitivity and specificity of neutrophil elastase in the diagnosis of macrovascular lesions in diabetic patients were high and had some clinical value.
引文
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[3]徐海声,宁四清.中性粒细胞弹性蛋白酶与结肠癌肝、肺转移的关系[J].实用癌症杂志,2016,31(9):1420-1422.
[4]汪强,汤小芳,王寅,等.高迁移率族蛋白-1和中性粒细胞弹性蛋白酶在老年COPD患者体内的变化及临床意义[J].中华全科医学,2017,15(3):375-377.
[5]夏天放,徐果.中性粒细胞弹性蛋白酶对HepG2细胞增殖的影响及其机制的研究[J].胃肠病学和肝病学杂志,2016,25(9):1009-1013.
[6]曾春芳,王笑,何清.中性粒细胞弹性蛋白酶在慢性阻塞性肺疾病患者肺组织中的表达及其与气流受限的关系[J].四川医学,2017,38(10):1109-1111.
[7]安家晨,曾秋棠,曹林生,等.血浆中性粒细胞弹性蛋白酶与冠心病的关系[J].临床心血管病杂志,2004,20(7):388-390.
[8]林云,姚震,顾申红,等.急性冠脉综合征中性粒细胞弹性蛋白酶浓度在他仃类药物干预下的变化研究[J].现代预防医学,2011,38(8):1597-1598.
[9]刘婷,赖惠婷.中性粒细胞及细胞毒T细胞在抗结核感染免疫中的作用[J].中国热带医学,2018,18(2):188-191.
[10]蔡玉兴,刘慧中,胡优敏,等.莨菪烷类化合物拮抗M_3受体、抑制中性粒细胞弹性蛋白酶活性的研究[J].上海交通大学学报:医学版,2017,37(8):1059-1063.
[11]王巍.中性粒细胞弹性蛋白酶与冠心病的相关性[D].南京:南京医科大学,2007.
[12]张捷,谭俊杰,李医明.多疾病相关人中性粒细胞弹性蛋白酶抑制剂研究进展[J].中国药学杂志,2017,52(21):1873-1878.
[13] Kosar F,Varol E,Ayaz S,et al. Plasma leukocyte elastase concentration and coronary artery disease[J].Angiology,1998,49(3):193-201.
[14] Ippolito DL,Abdulhameed MD,Tawa GJ,et al. Gene expression patterns associated with histopathology in toxic liver fibrosis[J].Toxicol Sci,2016,149(1):67-88.