辣椒素受体激活水平对冠心病合并糖尿病患者炎性程度及预后的评估价值

    Value of activation level of transient receptor potential cation channel subfamily V member 1 for inflammatory degree and prognosis in coronary heart disease patients combined with diabetes

    • 摘要:
      目的 分析冠心病合并糖尿病患者体内辣椒素受体(TRPV1)的激活水平及其与炎性因子表达的相关性,评估其对患者发生主要不良心血管事件(MACEs)风险的临床价值。
      方法 选择2022年10月~2023年10月在新疆医科大学第二附属医院住院患者,按照临床诊断分为:合并组(诊断为稳定性心绞痛合并2型糖尿病)、心绞痛组(诊断为稳定性心绞痛,排除2型糖尿病)、糖尿病组(诊断为2型糖尿病,排除冠心病),每组各60例。另选60例同时期健康体检者为对照组。应用Western blot法检测外周血单核细胞中TRPV1表达水平,ELISA法检测血清肿瘤坏死因子(TNF)-α、干扰素(IFN)-γ、白细胞介素(IL)-2、IL-6、IL-10、单核细胞趋化蛋白(MCP)-1和巨噬细胞炎症蛋白(MIP)-2浓度。合并组患者出院后常规随访并记录MACE,多因素Logistic回归分析影响患者MACE的危险因素。受试者工作特征(ROC)曲线评估TRPV1激活水平对患者预后的预测价值。
      结果 与对照组相比,糖尿病组与合并组空腹血糖和糖化血红蛋白升高,两组间无显著差异,但均高于心绞痛组(均P<0.01)。与对照组相比,糖尿病组、 心绞痛组与合并组TNF-α、IFN-γ、IL-2、IL-6、IL-10、MCP-1、MCP-2 和TRPV1升高,且合并组高于糖尿病组与心绞痛组(均P<0.01),但糖尿病组与心绞痛组间无显著差异。 Pearson检验显示,TRPV1水平与TNF-α、IFN-γ、IL-2、IL-6、IL-10、MCP-1和MIP-2浓度呈正相关(均P<0.01)。合并组共记录6例MACE(10%)。多因素Logistic回归显示,TRPV1水平是MACEs发生的独立预测因子(OR=2.913,95%CI:2.462~3.423,P<0.05)。ROC曲线显示,TRPV1激活水平预测慢性稳定性心绞痛合并糖尿病患者随访1年MACEs发生的曲线下面积(AUC)为0.856(95%CI:0.801~0.923,P<0.01)。
      结论 冠心病合并糖尿病患者体内TRPV1呈过度激活状态,与多种炎性因子高表达以及随访1年MACEs发生风险密切相关,有望成为预测临床预后的重要无创性生化标志物。

       

      Abstract:
      AIM To investigate the activation level of transient receptor potential cation channel subfamily V member 1 (TRPV1) in patients of coronary heart disease combined with diabetes and its correlation with the expressions of inflammatory factors and evaluate its risk value for major adverse cardiovascular events (MACEs).
      METHODS From October 2022 to October 2023, 60 patients with chronic stable angina pectoris complicated with type 2 diabetes (combined group), 60 patients with angina pectoris alone, 60 patients with diabetes alone, and 60 healthy controls were selected consecutively. Western blot was used to detect the expression level of TRPV1 in peripheral blood monocytes, and ELISA was used to detect serum concentrations of tumor necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin-2 (IL-2), IL-6, IL-10, monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein (MIP)-2. The median follow-up time in the combined group after discharge was 12.5 months and MACEs (mainly including malignant arrhythmias, acute heart failure attacks, cardiac function deterioration to stage D, sudden cardiac death, etc.) were recorded.
      RESULTS Compared with the control group, the fasting blood glucose and glycosylated hemoglobin in the diabetes group and the combined group increased. There was no significant difference between the two groups, but both were higher than those in the angina pectoris group (both P<0.01). Compared with the control group, the levels of TNF - α, IFN - γ, IL-2, IL-6, IL-10, MCP-1, MCP-2 and TRPV1 in the diabetes group, angina pectoris group and the combination group were higher than those in the diabetes group and angina pectoris group (both P<0.01), but there was no significant difference between diabetes group and angina pectoris group. Pearson test showed that TRPV1 levels were positively correlated with the concentrations of TNF - α, IFN - γ, IL-2, IL-6, IL-10, MCP-1, and MIP-2 (both P<0.01). Six cases of MACE (10%) were recorded in the merged group. Multivariate logistic regression showed that TRPV1 level was an independent predictor of MACEs (OR=2.913,95% CI: 2.462~3.423, P<0.05). ROC curve showed that the area under the curve (AUC) predicted by TRPV1 activation level for the occurrence of MACEs in patients with chronic stable angina pectoris and diabetes at 1 year follow-up was 0.856 (95% CI: 0.801~0.923, P<0.01).
      CONCLUSION TRPV1 may be over activated in patients of coronary heart disease complicated with diabetes, which is closely related to the high expressions of multiful inflammatory factors and the risk of MACEs during 1 year follow-up. TRPV1 is expected to become an important non-invasive biochemical marker for predicting clinical prognosis.

       

    /

    返回文章
    返回