【摘要】 目的 探讨外周血叉头盒O类转录因子-3a(Foxo3a)、血管细胞黏附分子-1(VCAM-1)评估2型糖尿病患者心血管病风险的价值。方法 前瞻性选择2020年3月至2022年3月青岛市城阳区人民医院收治的2型糖尿病患者120例作为研究组，将同期体检的正常者50名作为对照组。采集所有入组者外周血，检测并对比两组FOXO3a、VCAM-1水平。将120例2型糖尿病患者按有无发生心血管疾病分为CVD组(n=45)及非CVD组(n=75),统计CVD组和非CVD组的一般资料、VCAM-1、FOXO3a水平等差异。采用单因素、多因素分析两组影响2型糖尿病患者发生心血管疾病的危险因素。采用受试者工作特征(ROC)评估外周血FOXO3a、VCAM-1水平预测2型糖尿病患者发生心血管疾病的价值。结果 研究组患者VCAM-1水平(3.25±0.69) ng/mL,高于对照组[(1.76±0.59) ng/mL],FOXO3a水平为0.42±0.06,低于对照组(0.91±0.24),差异均有统计学意义(P<0.05)。CVD组体重指数≥24 kg/m~2占比、有心血管疾病家族史占比、收缩压≥140 mmHg占比、VCAM-1、甘油三酯、总胆固醇水平为66.67%、57.78%、62.22%、(4.02±1.02) ng/mL、(2.67±0.52) mmol/L、(5.36±1.02) mmol/L,均高于非CVD组[33.33%、37.33%、41.33%、(3.06±0.98) ng/mL、(2.01±0.50) mmol/L、(4.12±1.01) mmol/L],FOXO3a水平0.33±0.09,低于非CVD组(0.54±0.12),差异均有统计学意义(P<0.05)。多因素Logisitic回归分析发现，体重指数≥24 kg/m~2、有心血管疾病家族史、收缩压≥140 mmHg、VCAM-1≥3.817 ng/mL、FOXO3a≤0.440、甘油三酯≥2.338 mmol/L、总胆固醇≥4.483 mmol/L均是导致2型糖尿病患者发生心血管病的危险因素(P<0.05)。经过ROC曲线分析证实，VCAM-1、FOXO3a、甘油三酯、总胆固醇可用于2型糖尿病患者发生心血管病的预测，曲线下面积分别为0.735、0.936、0.893、0.833。结论 2型糖尿病患者外周血VCAM-1、FOXO3a水平存在异常表达，可用于2型糖尿病患者发生心血管病的预测。更多还原

【Abstract】 Objective To investigate the value of peripheral blood forkhead box type O transcription factor-3a(Foxo3a) and vascular cell adhesion molecule-1(VCAM-1) in assessing the risk of cardiovascular disease in patients with type 2 diabetes mellitus. Methods 120 patients with type 2 diabetes who were admitted to People’s Hospital of Chengyang District from March 2020 to March 2022 were selected as the study group, and 50 normal persons who came to our hospital for physical examination at the same time were selected as the control group. Peripheral blood of all enrolled persons was collected, FOXO3a and VCAM-1 levels were detected and compared between the two groups. 120 patients with type 2 diabetes were divided into CVD group(n=45) and non CVD group(n=75) according to whether they had cardiovascular disease. The general data of the two groups were statistically analyzed by single factor Multivariate analysis of the risk factors of cardiovascular disease in the two groups of patients with type 2 diabetes mellitus. Receiver operating characteristic(ROC) was used to evaluate the level of FOXO3a and VCAM-1 in peripheral blood to predict the value of cardiovascular disease in patients with type 2 diabetes mellitus. Results VCAM-1 level in the study group was(3.25±0.69) ng/mL, which was higher than that in the control group[(1.76±0.59) ng/mL], and FOXO3a level was 0.42±0.06, which was lower than that in the control group(0.91±0.24), the differences were statistically significant(P<0.05). Body mass index ≥24 kg/m~2, family history of cardiovascular disease, systolic blood pressure ≥ 140 mmHg, VCAM-1, triglyceride, total cholesterol in CVD group were 66.67%, 57.78%, 62.22%,(4.02±1.02) ng/mL,(2.67±0.52) mmol/L,(5.36±1.02) mmol/L, which were higher than those in non CVD group[33.33%, 37.33%, 41.33%,(3.06±0.98) ng/mL,(2.01±0.50) mmol/L,(4.12±1.01) mmol/L], and FOXO3a level was 0.33±0.09, which was lower than that in non CVD group(0.54±0.12), the differences were statistically significant(P<0.05). The ROC analysis confirmed that VCAM-1, FOXO3a, triglyceride and total cholesterol could be used to predict the occurrence of cardiovascular disease in patients with type 2 diabetes mellitus. The area under the curve was 0.735, 0.936, 0.893 and 0.833 respectively; Logistic regression analysis showed that body mass index ≥24 kg/m~2, family history of cardiovascular disease, systolic blood pressure ≥140 mmHg, VCAM-1≥3.817 ng/mL, FOXO3a≤0.440, triglyceride ≥2.338 mmol/L, total cholesterol≥4.483 mmol/L were all risk factors for cardiovascular disease in patients with type 2 diabetes(P<0.05). Conclusion The levels of VCAM-1 and FOXO3a in peripheral blood of patients with type 2 diabetes mellitus are abnormal, which can play an important role in predicting the occurrence of cardiovascular disease in patients with type 2 diabetes.更多还原