Study On The Relationship Between Adropin,TLR4 And Macroangiopathy In Type 2 Diabetes Mellitus Abstract

Objective:To observe the change of serum Adropin and TOLL-like receptor 4(TLR4)in type 2 diabetes mellitus,and to explore the relationship between Adropin and TLR4 with macroangiopathy in type 2 diabetes mellitus,to clarify the role of Adropin and TLR4 in the occurrence and development of type 2 diabetes mellitus and its macroangiopathy.Methods:Seventy-three patients with type 2 diabetes mellitus from March 2017 to March 2018 in the outpatient and in-patient department of endocrinology of our hospital were selected as the study subjects,and assigned to the diabetes group.According to Doppler ultrasound detection of cervical macrovascular lesions were further divided into simple type 2 diabetes mellitus group(Group A,34 cases)and type 2 diabetes mellitus with macrovascular lesions group(Group B,39 cases),meanwhile,Thirty-five healthy persons were selected as control group(Group C,35 cases).Serum Adropin,TLR4 and IL-6 were detected by enzyme-linked immunosorbent assay(ELISA).Metabolic indexes(TG、Hey、fasting blood glucose(FBG)、fasting insulin(FINS)、Hs-CRP、HbA1c)were also determined The homeostasis model assessment index-insulin resistance(HOMA-IR)was calculated.HOMA-IR=fasting blood glucose(mmol/Lx fasting insulin(mU/L)/22.5.Meanwhile,the height and weight of each participant were measured and the body mass index(BMI)=body weight(Kg)/height m2.To observe and analyze the difference of experimental indexes between group A,group B and group C and to analyze the clinical evaluation value of Adropin,TLR4 and other indexes for insulin resistance and type 2 diabetes mellitus with macroangiopathy by multiple linear regression and ROC curve.Results:1.The levels of TLR4,IL-6,Hs-CRP,FBG,FINS,TG,Hey,BMI,HOMA-IR and HbAlc in diabetic group A and B were significantly higher than those in control group(P<0.05),while the levels of serum Adropin protein were lower than those in control group(P<0.05).The indexes of TLR4,IL-6,Hs-CRP,FINS,Hcy,HOMA-IR and HbA1c in group B were significantly higher than those in group A(P<0.05),while the level of serum Adropin protein was lower than that in group A(P<0.05).There was no significant difference in serum FBG,TG and BMI between groups A and B(P>0.05).2.Spearman correlation analysis showed that serum Adropin protein was negatively correlated with TLR4,IL-6,Hs-CRP,FBG,FINS,TG,Hcy,BMI and HOMA-IR(r=-0.685,-0.587,-0.612,-0.216,-0.452,-0.284,-0.553,-0.312,-0.634)(P<0.05),and Serum TLR4 was significantly correlated with Adropin,IL-6,Hs-CRP,FBG,FINS,TG,Hcy,BMI and HOMA-IR(r=-0.685,0.581,0.605,0.207,0.442,0.251,0.463,0.342,0.624)(P<0.05).3.Multivariate linear regression analysis showed that Adropin,TLR4,IL-6 and Hcy were included in the linear regression model for predicting insulin resistance index.The adjusted determinant coefficient R2 was 0.486.According to the standardized regression coefficient,the degree of influence on HOMA-IR is Adropin,TLR4,IL-6 and Hcy,respectively.Adropin is negatively correlated with HOMA-IR.4.ROC curve analysis showed that Adropin and TLR4 had the highest AUC area for predicting macroangiopathy in type 2 diabetes mellitus,which was 0.864(95%CI:0.775-0.943)and 0.837(95%CI:0.745-0.925),The sensitivity and specificity of 89.3%and 88.7%,88.4%and 87.5%,respectively.The AUC area predicted by Adropin and TLR4 is 0.904(95%CI:0.812-0.973),and the AUC area is further increased.The sensitivity and specificity are 80.1%and 93.6%respectively.Conclusion:1.For type 2 diabetes mellitus patients with macroangiopathy,serum Adropin level was lower than pure 2 diabetes mellitus,while serum TLR4 level was higher than pure 2 diabetes mellitus.2.Serum Adropin and TLR4 were significantly correlated with insulin resistance,which were important factors that affecting the change of insulin resistance index.3.Serum Adropin and TLR4 have important clinical predictive value for type 2 diabetes mellitus with macroangiopathy,and the clinical value of multi-index combined prediction will be better.