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中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 291 -296. doi: 10.3877/cma.j.issn.1674-0785.2023.03.010

临床研究

血清PECAM-1、Sirt1水平与2型糖尿病患者颈动脉粥样硬化的关系
陶璐†(), 初楠, 韩洁, 白春英, 逄雯丽, 余海源   
  1. 266003　山东青岛，青岛市海慈医院内分泌科
  • 收稿日期:2022-04-11 出版日期:2023-03-15
  • 通信作者: 陶璐
  • 基金资助:
    山东省中医药科技发展计划项目(2017-386)

Association of serum PECAM-1 and Sirt1 levels with carotid atherosclerosis in type 2 diabetic patients

Lu Tao†(), Nan Chu, Jie Han, Chunying Bai, Wenli Pang, Haiyuan Yu   

  1. Department of Endocrinology, Qingdao Haici Hospital, Qingdao 266003, China
  • Received:2022-04-11 Published:2023-03-15
  • Corresponding author: Lu Tao
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引用本文：

陶璐, 初楠, 韩洁, 白春英, 逄雯丽, 余海源. 血清PECAM-1、Sirt1水平与2型糖尿病患者颈动脉粥样硬化的关系[J/OL]. 中华临床医师杂志(电子版), 2023, 17(03): 291-296.

Lu Tao, Nan Chu, Jie Han, Chunying Bai, Wenli Pang, Haiyuan Yu. Association of serum PECAM-1 and Sirt1 levels with carotid atherosclerosis in type 2 diabetic patients[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(03): 291-296.

目的

探讨血清血小板内皮细胞粘附分子1（PECAM-1）、沉默信息调节因子2相关酶1（Sirt1）水平与2型糖尿病（T2DM）患者颈动脉粥样硬化（CAS）的关系。

方法

选取2021年1月~2022年2月青岛市海慈医院收治的165例T2DM患者（T2DM组），根据颈动脉内中膜厚度（CIMT）分为CAS组48例和非CAS组117例，选取同期61例体检健康者（对照组），采用酶联免疫吸附法检测血清PECAM-1、Sirt1水平。比较T2DM组与对照组的血清PECAM-1、Sirt1水平，采用多因素Logistic回归分析T2DM患者CAS的影响因素，多因素Logistic回归分析T2DM患者CAS的影响因素，受试者工作特征（ROC）曲线分析血清PECAM-1、Sirt1水平预测T2DM患者CAS的价值。

结果

与对照组比较，T2DM组血清PECAM-1水平更高，Sirt1水平更低（P＜0.05）。T2DM患者血清PECAM-1水平与CIMT呈正相关，Sirt1水平与CIMT呈负相关（rs＝0.789、-0.785，P均＜0.001）。T2DM病程（OR＝1.483，95％CI：1.090~2.017）、吸烟（OR＝1.408，95％CI：1.054~1.881）、糖化血红蛋白A1c（HbA1c）（OR＝2.900，95％CI：1.324~6.350）、低密度脂蛋白胆固醇（LDL-C）（OR＝1.474，95％CI：1.182~1.838）、PECAM-1（OR＝1.540，95％CI：1.191~1.990）为T2DM患者CAS的独立危险性因素，Sirt1（OR＝0.397，95％CI：0.256~0.617）为独立保护性因素（P＜0.05）。血清PECAM-1、Sirt1水平单独与联合预测T2DM患者CAS的曲线下面积（AUC）分别为0.795、0.797、0.893，血清PECAM-1、Sirt1水平联合预测T2DM患者CAS的AUC大于二者单独预测（P＜0.05）。

结论

T2DM患者血清PECAM-1水平升高，Sirt1水平降低，为CAS发生的独立影响因素，可作为T2DM患者CAS的辅助预测指标。

关键词: 2型糖尿病, 颈动脉粥样硬化, 血小板内皮细胞粘附分子1, 沉默信息调节因子2相关酶1
Objective

To investigate the relationship between serum platelet endothelial cell adhesion molecule 1 (PECAM-1) and silent information regulator factor 2-related enzyme 1 (Sirt1) levels and carotid atherosclerosis (CAS) in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 165 patients with T2DM admitted to our hospital from January 2021 to February 2022 (T2DM group) were selected and divided into either a CAS group (48 cases) or a non-CAS group (117 cases) according to the carotid intima-media thickness (CIMT), and 61 healthy individuals who underwent physical examination ring the same period were selected as a control group. Serum PECAM-1 and Sirt1 levels were measured by enzyme-linked immunosorbent assay and compared between the T2DM group and the control group. Multi-factor logistic regression was used to identify the factors influencing CAS in T2DM patients. The clinical value of serum PECAM-1 and Sirt1 levels in predicting CAS in T2DM patients was assessed by receiver operating characteristic (ROC) curve analysis.

Results

Compared with the control group, serum PECAM-1 level was higher and Sirt1 level was lower in the T2DM group (P＜0.05). Serum PECAM-1 levels were positively correlated with CIMT and Sirt1 levels were negatively correlated with CIMT in T2DM patients (rs=0.789 and -0.785, respectively; P＜0.001 for both). The duration of T2DM (odds ratio [OR]=1.483, 95% confidence interval [CI]: 1.090~2.017), smoking (OR=1.408, 95% CI: 1.054~1.881), glycated hemoglobin A1c (HbA1c) (OR=2.900, 95% CI: 1.324~6.350), low-density lipoprotein cholesterol (LDL-C) (OR=1.474, 95% CI: 1.182~1.838), and PECAM-1 (OR=1.540, 95% CI: 1.191~1.990) were independent risk factors for CAS in patients with T2DM, and Sirt1 (OR=0.397, 95% CI: 0.256~0.617) was an independent protective factor (P＜0.05). The area under the curve (AUC) values of serum PECAM-1 and Sirt1 levels alone and in combination to predict CAS in T2DM patients were 0.795, 0.797, and 0.893, respectively, and the AUC of serum PECAM-1 and Sirt1 levels in combination to predict CAS in T2DM patients was greater than that of either of them alone (P＜0.05).

Conclusion

Increased serum PECAM-1 levels and decreased Sirt1 levels in T2DM patients are independent influencing factors for the occurrence of CAS and can be used as an auxiliary predictor of CAS in T2DM patients.

Key words: Type 2 diabetes mellitus, Carotid atherosclerosis, Platelet endothelial cell adhesion molecule 1, Silent information regulator factor 2-related enzyme 1
表1 T2DM患者CAS的单因素分析
因素 CAS组（n＝48） 非CAS组（n＝117） χ2/t/Z值 P值
男/女（n/n） 31/17 65/52 1.140 0.286
年龄（岁，
x¯
±s）		 58.65±8.44 55.94±8.11 1.923 0.056
体质指数（kg/m2，
x¯
±s）		 22.55±1.95 22.44±2.01 0.334 0.739
T2DM病程［年，M（P25，P75）］ 10.00（8.00，11.00） 8.00（7.00，10.00） 3.683 ＜0.001
吸烟［n（％）］ 21（43.75） 27（23.08） 7.052 0.008
收缩压（mmHg，
x¯
±s）		 119.73±14.81 119.17±15.31 0.215 0.830
舒张压（mmHg，
x¯
±s）		 84.46±12.49 82.57±10.60 0.984 0.326
空腹血糖［mmol/L，M（P25，P75）］ 10.07（8.89，10.95） 9.28（8.14，10.30） 3.191 0.001
HbA1c［％，M（P25，P75）］ 7.94（7.37，8.36） 7.50（7.10，7.83） 4.293 ＜0.001
TC（mmol/L，
x¯
±s）		 4.46±0.69 4.31±0.89 1.074 0.285
TG（mmol/L，
x¯
±s）		 1.96±0.44 1.82±0.50 1.716 0.088
HDL-C（mmol/L，
x¯
±s）		 0.98±0.26 1.10±0.31 2.388 0.018
LDL-C（mmol/L，
x¯
±s）		 3.30±0.40 2.95±0.45 4.607 ＜0.001
PECAM-1（mg/L，
x¯
±s）		 14.69±2.84 11.34±2.79 6.973 ＜0.001
Sirt1（ng/ml，
x¯
±s）		 4.61±1.71 6.94±2.12 6.758 ＜0.001
图1 T2DM患者血清PECAM-1、Sirt1水平与CIMT的线性散点图
表2 T2DM患者CAS的多因素Logistic回归分析
因素 b值 SE值 Wald χ2值 P值 OR值 95％CI值
T2DM病程 0.394 0.157 6.292 0.012 1.483 1.090~2.017
吸烟 0.342 0.148 9.209 0.002 1.408 1.054~1.881
空腹血糖 0.163 0.232 0.492 0.483 1.177 0.747~1.854
HbA1c 1.065 0.400 10.291 0.001 2.900 1.324~6.350
HDL-C -1.260 1.072 1.381 0.240 0.284 0.035~2.319
LDL-C 0.388 0.113 10.215 0.001 1.474 1.182~1.838
PECAM-1 0.432 0.131 10.864 0.001 1.540 1.191~1.990
Sirt1 -0.924 0.225 16.916 ＜0.001 0.397 0.256~0.617
图2 血清PECAM-1、Sirt1水平预测T2DM患者CAS的ROC曲线
1
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版) [J]. 中华糖尿病杂志, 2021, 13(4): 315-409.
2
Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045 [J]. Diabetes Res Clin Pract, 2022, 183(2022): 109119.
3
中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国头颈部动脉粥样硬化诊治共识 [J]. 中华神经科杂志, 2017, 50(8): 572-578.
4
Botts SR, Fish JE, Howe KL. Dysfunctional vascular endothelium as a driver of atherosclerosis: Emerging insights into pathogenesis and treatment [J]. Front Pharmacol, 2021, 12(2021): 787541.
5
王怡茹, 张一凡, 韦婧, 等. 动脉粥样硬化炎症相关信号通路的研究进展 [J]. 中西医结合心脑血管病杂志, 2021, 19(23): 4077-4080.
6
黄利强, 程道宾, 叶子明, 等. 血小板内皮细胞黏附分子1联合血清脂蛋白相关磷脂酶A2对颈动脉粥样硬化斑块稳定性的诊断价值 [J]. 中国全科医学, 2021, 24(2): 170-175.
7
Winneberger J, Schöls S, Lessmann K, et al. Platelet endothelial cell adhesion molecule-1 is a gatekeeper of neutrophil transendothelial migration in ischemic stroke [J]. Brain Behav Immun, 2021, 93(2021): 277-287.
8
艾晨牧, 雷小保, 李桂成, 等. GLP-1受体通过SIRT3减轻脓毒症急性肾损伤炎症反应及细胞凋亡 [J]. 热带医学杂志, 2020, 20(7): 870-874.
9
张爱宁, 吴科帆, 张艺, 等. 高糖致心肌微血管内皮细胞损伤时SIRT1与STAT3乙酰化的关系 [J]. 中华麻醉学杂志, 2021, 41(3): 291-294.
10
刘前, 邓倩, 陈凯. 活化白细胞黏附分子与血小板内皮细胞黏附分子-1在2型糖尿病并发急性脑梗死患者中的变化及意义 [J]. 中国实用神经疾病杂志, 2021, 24(7): 578-584.
11
夏瑞雪, 李阔, 王丽轩, 等. 急性脑梗死病人血清ANGPTL4、SIRT1水平与颈动脉粥样硬化斑块稳定性的关系 [J]. 中西医结合心脑血管病杂志, 2021, 19(24): 4375-4378.
12
陈亚荣, 尹春, 黄佩瑶, 等. 糖尿病与脑卒中发病风险的前瞻性研究 [J]. 中华疾病控制杂志, 2022, 26(1): 74-79.
13
Ueki K, Sasako T, Okazaki Y, et al. Multifactorial intervention has a significant effect on diabetic kidney disease in patients with type 2 diabetes [J]. Kidney Int, 2021, 99(1): 256-266.
14
Nguyen NT, Chau HN, Le NH, et al. Impact of novel guidelines on multifactorial control and Its association with mortality in adult patients with hypertension and newly diagnosed type 2 diabetes: A 4-year prospective multicenter study [J]. Int J Endocrinol, 2021, 28(2021): 9977840.
15
Liu X, Bragg F, Yang L, et al. Smoking and smoking cessation in relation to risk of diabetes in Chinese men and women: a 9-year prospective study of 0·5 million people [J]. Lancet Public Health, 2018, 3(4): e167-e176.
16
中国医师协会中西医结合分会心血管专业委员会,中华中医药学会心血管病分会. 动脉粥样硬化中西医防治专家共识(2021年) [J]. 中国中西医结合杂志, 2022, 42(3): 287-293.
17
Gasmi A, Noor S, Menzel A, et al. Obesity and insulin resistance: Associations with chronic inflammation, genetic and epigenetic factors [J]. Curr Med Chem, 2021, 28(4): 800-826.
18
Huang HW, Chang CC, Wang CS, et al. Association between inflammation and function of cell adhesion molecules influence on gastrointestinal cancer development [J]. Cells, 2021, 10(1): 67.
19
Winneberger J, Schöls S, Lessmann K, et al. Platelet endothelial cell adhesion molecule-1 is a gatekeeper of neutrophil transendothelial migration in ischemic stroke [J]. Brain Behav Immun, 2021, 93(2021): 277-287.
20
Tzima E, Irani-Tehrani M, Kiosses WB, et al. A mechanosensory complex that mediates the endothelial cell response to fluid shear stress [J]. Nature, 2005, 437(7057): 426-431.
21
Kiseleva RY, Greineder CF, Villa CH, et al. Vascular endothelial effects of collaborative binding to platelet/endothelial cell adhesion molecule-1 (PECAM-1) [J]. Sci Rep, 2018, 8(1): 1510.
22
Lertkiatmongkol P, Liao D, Mei H, et al. Endothelial functions of platelet/endothelial cell adhesion molecule-1 (CD31) [J]. Curr Opin Hematol, 2016, 23(3): 253-259.
23
Zhang Y, Sun Z, Jia J, et al. Overview of histone modification [J]. Adv Exp Med Biol, 2021, 1283(2021): 1-16.
24
Shen P, Deng X, Chen Z, et al. SIRT1: A potential therapeutic target in autoimmune diseases [J]. Front Immunol, 2021, 12(2021): 779177.
25
刘首明, 江小萍, 沈祖泓, 等. 氧化型低密度脂蛋白和核因子-κB在颈动脉粥样硬化中的应用 [J]. 检验医学与临床, 2021, 18(3): 304-307.
26
Wu BW, Wu MS, Liu Y, et al. SIRT1-mediated deacetylation of NF-κB inhibits the MLCK/MLC2 pathway and the expression of ET-1, thus alleviating the development of coronary artery spasm [J]. Am J Physiol Heart Circ Physiol, 2021, 320(1): H458-H468.
27
Cantó C, Gerhart-Hines Z, Feige JN, et al. AMPK regulates energy expenditure by modulating NAD+ metabolism and SIRT1 activity [J]. Nature, 2009, 458(7241): 1056-1060.
28
刘子歌, 刘洋, 宋国瑞, 等. 泡沫细胞在动脉粥样硬化形成过程中的作用研究进展 [J]. 陕西医学杂志, 2020, 49(10): 1363-1366.
29
Chen Z, Xue Q, Cao L, et al. Toll-like receptor 4 mediated oxidized low-density lipoprotein-induced foam cell formation in vascular smooth muscle cells via src and sirt1/3 pathway [J]. Mediators Inflamm, 2021, 2021(1): 6639252.
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