| Objective:By detecting the levels of angiopoietin like protein 6(ANGPTL6)and beta trophin in the serum of patients with type 2 diabetes mellitus complicated with different degrees of carotid artery stenosis(CAS),to explore the correlation between them and the degree of carotid artery stenosis and their predictive value,so as to provide new ideas for the diagnosis and treatment of carotid artery stenosis.Methods:144 patients with type 2 diabetes hospitalized in the Department of Endocrinology and Department of Neurology of our hospital from September 2021 to November 2022 were collected,with an average age of55.98 ± 10.35 years old;According to the results of color Doppler ultrasound of carotid artery,whether there is carotid artery stenosis and according to the degree of stenosis,the group with type 2 diabetes and no carotid artery stenosis is group A(n=46);Type 2 diabetes with mild carotid stenosis(carotid atherosclerotic plaque thickening,formation or stenosis degree<50%)was classified as group B(n=66);Type 2 diabetes with moderate and severe carotid stenosis(stenosis degree of 50%-70%,70%-99% and complete occlusion)was classified as group C(n=32).Antig PTL6 and Betatrohin were detected by enzyme-linked immunosorbent assay.SPSS 26.0 was used for statistical treatment.The differences of serum levels of ANGPTL6,Betaprohin and clinical biochemical indexes among the three groups were compared with single-factor ANOVA test or Kruskal-Wallis H test;The correlation between ANGPTL6,Betaprohin and clinical biochemical indexes was analyzed by Spearman correlation;The influence factors of combined CAS were analyzed by binary logistic regression;The ROC curve was drawn based on whether CAS was combined as a positive result,and the predictive value of ANGPTL6 and Betaprohin on CAS was evaluated by the area under the curve(AUC)and its 95%confidence interval(95%CI),sensitivity and specificity.Results:1.Comparison of general clinical characteristicsIn the baseline data,there were statistically significant differences among the three groups in terms of age,smoking,course of disease and course of hypertension.Compared with group A,the age of group B and group C [(50.11 ± 8.91)vs(56.67 ± 8.56),(63.00 ± 11.08)] increased significantly(P<0.05);Compared with group A,the proportion of patients in group B and group C with smoking history is higher;Compared with group A,the course of disease in group B and group C was longer {[7.00(2.75,0.25)vs 10.00(6.00,14.00),14.00(9.25,19.50)]},the difference was statistically significant(P < 0.05);Compared with Group A,patients in Group B and Group C also had a longer course of hypertension,{[0.00(0.00,3.00)vs 2.00(0.00,10.00),6.80(0.00,13.75)]} the difference was statistically significant(P < 0.05).There was no significant difference in gender,BMI,drinking history,family history,systolic blood pressure and diastolic blood pressure among the three groups(P>0.05).2.Comparison of serum levels of ANGPTL6 and Betaprohin among three groupsCompared with Group A,the level of ANGPTL6 in Group B and Group C increased 560.80(400.55927.0)vs [933.50(698.101208.15),1215.90(859.651453.55)pg/ml],with a statistically significant difference(P<0.05),and the comparison between the three groups was also statistically significant.The level of Betaprohin was increased [36.99(29.18,53.31)] vs[64.35(52.08,72.54),70.30(53.05,78.21)ng/ml],the difference was statistically significant(P < 0.05),and the difference between groups was also statistically significant.3.Comparison of biochemical indicators among the three groupsCompared with group A,there was no significant difference in Hb A1 c,ALT,CRE,C-P,FBG,TG,TC,LDL-C levels between group B and group C(P > 0.05).Compared with group A,the AST level in group B was significantly lower(P < 0.05).Compared with group A,the C-P level of group B and group C at 2h after meal decreased significantly(P < 0.05).Compared with group B,the HDL-C level in group C was significantly lower(P<0.05).Compared with group B,Hry in group C was significantly higher(P<0.05).4.Correlation analysis of serum ANGPTL6,Betaprohin and clinical biochemical indicators in patientsAccording to the data characteristics,Spearman analysis was used:ANGPTL6 was positively correlated with CASD,Betatrophin,AGE,BMI,diabetes duration,SBP,hypertension duration,smoking history,glycosylated hemoglobin,fasting blood glucose,triglyceride(r=0.558,r=0.669,r=0.320,r=0.572,r=0.248,r=0.231,r=0.330,r=0.179,r=0.426,r=0.363,r=0.236,P < 0.05 或 P < 0.01),and C-peptide 2 hours after meal High density lipoprotein was negatively correlated(r=-0.179,r=-0.215,P<0.01);Betatrophin was positively correlated with CASD,diabetes duration,hypertension duration,smoking history,glycosylated hemoglobin,fasting blood glucose,triglycerides,cholesterol and low-density lipoprotein(r=0.549,r=0.207,r=0.266,r=0.282,r=0.539,r=0.542,r=0.505,r=0.414,r=0.308,P<0.05 或 P<0.01);It was negatively correlated with C-peptide and ALT 2 hours after meal(r=-0.253,r=-0.189,P<0.05 or P<0.01).5.Carry out binary logistic regression analysis on CAS influencing factors5.1 Take whether CAS is combined as the dependent variable,and take age,sex,BMI,course of disease,course of hypertension,C-peptide,2-hour post-meal C-peptide,ANGPTL6,and Betatrohin as the independent variables for logistic regression analysis,when the partial coefficient(β)> 0,when the odds ratio(OR)> 1,the independent variable is considered as a risk factor.The original model results show that age,course of disease,course of hypertension,ANGPTL6,Betatrohin are risk factors for CAS;When deflection coefficient(β)<0,When the odds ratio(OR)<1,the independent variable is considered as a protective factor.The original model results show that C-peptide and 2-hour post-meal C-peptide are protective factors of CAS.(All P<0.05).5.2 After adjusting for age,sex,BMI,diabetes course,hypertension course,C-peptide,2-hour postprandial C-peptide and other confounding factors,ANGPTL6 is still an independent risk factor for CAS [OR: 1.007(95% CI: 1.004-1.009)];Similarly,Betatrohin is still an independent risk factor for CAS [OR: 1.069(95% CI: 1.039～1.101)](all P<0.05).6.Analysis of ROC curve of predicted CAS by ANGPTL6 and BetatrohinThrough ROC curve analysis,the effectiveness of ANGPTL6 and Betatrohin in predicting CAS alone and jointly are: ANGPTL6 [AUC: 0.782(95% CI: 0.698-0.866)],Betatrohin [AUC: 0.792(95% CI: 0.705-0.879)],ANGPTL6+Betatrohin [AUC: 0.816(95% CI: 0.736-0.896)];Both of them have certain diagnostic value for CAS,and the combined detection of AUC is higher than that of single detection,the difference is statistically significant(P<0.05);The specificity of combined detection is higher than that of single detection;Betatrophin has a high sensitivity for the diagnosis of CAS.Conclusions:1.The serum levels of ANGPTL6 and Betatrophin in patients with type2 diabetes combined with CAS were higher than those in patients with diabetes alone,and the levels in the group with severe stenosis closely related to CAS were higher than those in the group with mild stenosis.2.Serum ANGPTL6 and Betatrohin are independent risk factors of CAS3.Serum ANGPTL6 and Betatrohin have certain predictive diagnostic value for CAS,and their combined detection can improve the specificity of diagnosis. |
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