糖尿病合并冠心病患者血浆组织蛋白酶S和血小板反应蛋白-1浓度与心力衰竭的关系

目的探讨糖尿病合并冠状动脉粥样硬化性心脏病(冠心病)患者血浆组织蛋白酶S(cathepsin S,CatS)和血小板反应蛋白-1(thrombospondin-1,TSP-1)浓度与心力衰竭的关系。方法将浦东新区人民医院2016年9月至2019年1月间收治的197例糖尿病患者根据临床情况及冠状动脉造影检查结果院体检健康者80名为对照组。测定各组低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(highdensity lipoprotein cholesterol,HDL-C)、糖化血红蛋白(hemoglobin A1c,HbA1c)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2 h postprandial blood sugar,2 hPBG)浓度、射血分数(ejection fraction,EF)、左心室舒张末期容积(end-diastolic volume,EDV)、左心室收缩末容积(end systole vol⁃ume,ESV)及血浆CatS和TSP-1浓度,并对两组相关指标进行比较和相关性分析。结果与对照组相比,合并组及单纯组患者ESV、EDV、HbA1c、LDL-C、FPG、2 hPBG、TC、TG、DBP、SBP显著升高,EF、HDL-C则明显下降,差异有统计学意义(P<0.05)。合并组与单纯组比较,除LDL-C、FPG、SBP比较差异无统计学意义(P>0.05)外,合并组ESV、EDV、HbA1c、HDL-C、2 hPBG、TC、TG及DBP均较单纯组高,EF较单纯组低,差异均有统计学意义(P<0.05)。单纯组及合并组CatS和TSP-1浓度高于对照组,差异有统计学意义(P<0.05);合并组CatS和TSP-1浓度明显高于单纯组,差异有统计学意义(P<0.05)。相关分析结果:TSP-1与LDL-C(r=0.453,P<0.01)、HbA1c(r=0.629,P<0.01)、HDL-C(r=0.435,P<0.01)、EDV(r=0.364,P<0.01)、ESV(r=0.408,P<0.01)呈正相关;与EF(r=-0.317,P<0.01)呈负相关。CatS与LDL-C(r=0.426,P<0.01)、HbA1c(r=0.530,P<0.01)、HDL-C(r=0.345,P<0.01)、EDV(r=0.380,P<0.01)、ESV(r=0.395,P<0.01)呈正相关;与EF(r=-0.465,P<0.01)呈负相关。结论糖尿病合并冠心病及心力衰竭患者血浆CatS和TSP-1浓度较单纯糖尿病患者高,可通过检测血浆CatS和TSP-1浓度来预测患者的心功能情况。

Correlation between plasma concentrations of cathepsin S,thrombospondin-1 and heart failure in patients with diabetes mellitus complicated with coronary heart disease

Objectives To investigate the correlation between plasma concentrations of cathepsin S(CatS),thrombos⁃pondin-1(TSP-1)and heart failure in patients with diabetes mellitus complicated with coronary heart disease.Methods One hundred and ninety-seven patients with diabetes mellitus underwent coronary angiography,including 98 cases of simple diabetes mellitus(simple group)and 99 cases of diabetes mellitus complicated with coronary heart disease and heart failure(combined group),as well as 80 cases of health examinees(control group)from September 2016 to January 2019 in Pudong New District People′s Hospital were enrolled.Various indicators were detected among the 3 groups,including plasma hemoglobin A1c(HbA1c),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),2 h postprandial plasma glucose(2 hPBG),left ventricular end-systolic volume(ESV),left ventricular end-diastolic volume(EDV),ejection fraction(EF)and plasma concentrations of CatS and TSP-1.The correlations among relevant indicators of each group were compared and analyzed.Results Compared with control group,ESV,EDV,HbA1c,FPG,LDL-C,FPG,2 hPBG,TC,TG,DBP and SBP in combined group and simple group increased significantly,while EF,HDL-C decreased significantly(P<0.05).Compared with simple group,LDL-C,FPG,SBP in combined group were not significantly different(P>0.05);ESV,EDV,HbA1c,HDL-C,2 hPBG,TC,TG and DBP in combined group were significantly higher than those in simple group,and EF in combined group was significantly lower than that in simple group(P<0.05).Plasma concentrations of CatS and TSP-1 in simple group and combined group were significantly higher than those in control group(P<0.05);plasma concentrations of CatS and TSP-1 in combined group were significantly higher than those in simple group(P<0.05).Correlation analysis results:TSP-1 positively correlated with LDL-C(r=0.453,P<0.01),HbA1c(r=0.629,P<0.01),HDL-C(r=0.435,P<0.01),EDV(r=0.364,P<0.01)and ESV(r=0.408,P<0.01);negatively correlated with EF(r=-0.317,P<0.01).CatS positively correlated with LDL-C(r=0.426,P<0.01),HbA1c(r=0.530,P<0.01),HDL-C(r=0.345,P<0.01),EDV(r=0.380,P<0.01)and ESV(r=0.395,P<0.01);negatively correlated with EF(r=-0.465,P<0.01).Conclusions Plasma concentrations of CatS and TSP-1 in diabetic patients with coronary heart disease and heart failure are higher than those in patients with diabetic alone,which can be used to predict the cardiac function.