Relationship Of Epicardial Adipose Tissue With Brachial-ankle Pulse Wave Velocity In Type 2 Diabetic Macrovascular Complication

[Objective] To observe the characteristics of epicardial adipose tissue(EAT)in patients with type 2 diabetes and normal control group,investigate the relationship of EAT with brachial-ankle pulse wave velocity in type 2 diabetic macrovascular complication and the significance of epicardial adipose tissue in diabetic macrovascular complication.And explore the mechanism of diabetic macrovascular complication with the increasing thickness of EAT in diabetes,providing a new idea to the prevention and treatment of diabetic macrovascular complication.[Methods]Collect 101 cases with type 2 diabetes who was hospitalized in the Department of Endocrinology ward of Fujian Medical University Affiliated Union Hospital from August 2015 to November 2015,and 91 were included according to exclusion criteria.Collect 40 cases of control people who healthy examination and not dignosis of diabetes and complications.People were divided into three groups :40 cases of normal control group(NC group),the average age was(58.98±9.11)years old;17 cases of type 2 diabetes without macroangiopathy(DM1 group),the average age was(57.35±7.77)years old;74 cases of type 2 diabetes with macroangiopathy(DM2 group),the average age was(61.41±8.47)years old.Collecting the data of height,weight,waist circumference(WC),hip circumference(HIP),systolic blood pressure(SBP),diastolic blood pressure(DBP)and recording the course of diabetes,smoking history.Then calculating the body mass index(BMI=body weight(kg)/height2(m2)),waist-hip ratio(WHR).Detecting some hematological biochemical parameter: such as fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),cholesterol(CHOL),triglyceride(TG),free fatty acid(FFA),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),blood uric acid,high-sensitivity C-reactive protein(hs-CRP),homocysteine(Hyc),interleukin-6(IL-6),fast insulin(FINS),and brachical-ankle artery pulse wave velocity(baPWV).Vivid 7 ultrasound diagnostic apparatus was used with the probe 4 MHz Frequency.The measurements were performed in 5 cardiac cycles and thickness of the EAT was calculated the average of 5 measurements.Statistical analysis was performed using SPSS 19.0 statistical software,the measurement data results expressed in mean ±standard deviation;The measurement data were compared using T test between the two independent samples;Single factor variance analysis was used for multiple sets comparison;chi-square test for count data;differences and correlation among the indexes were using Person correlation analysis and multiple linear regression analysis;using the receiver operating characteristic curve to acquaintance the forecast value of EAT in diabetic macrovascular complication,according the maximum about Youden Index to determine the cut-off point.Two-sided P-values <0.05 was considered statistically significant.[Results]1.The correlation analysis between EAT and insulin resistance: The EAT of group IR and group High-IR was significantly higher than that of group IS.2.The Person correlation analysis between EAT and various indicators in diabetes: EAT was positively correlated with BMI,WC,WHR,SBP,DBP,TG,FFA,blood uric acid,hs-CRP,Hyc,fibrinogen,baPWV.3.The multiple linear regression analysis to analyze the relationship between EAT and grouping : There was significantly effect on EAT in grouping,it means that the EAT thickness was increased with NC,DM1,DM2 grouping sequence.4.The correlation analysis between baPWV and various indicators in type 2 diabetic macrovascular complication: the Pearson correlation analysis showed that baPWV was positively correlated with hs-CRP,Hyc,fibrinogen,EAT.Then the multiple linear regression analysis showed: EAT was independently associated with baPWV.5.The forecast value of measure thickness of EAT by echocardiographic in diabetic macrovascular complication: ROC curve AUC =0.653(95% CI=0.515-0.790),cut-off value=4.46 mm,sensitivity=0.649,Specificity=0.706.[Conclusion]1.The EAT thickness of diabetes was higher than normal control group,and the indicator of High-IR and IR group was significantly higher than group IS.It shows that EAT affect the insulin sensitivity and result in insulin resistance and type 2diabetes by secreting bioactive molecules.2.In terms of the thickness of EAT,the normal group thickness was the minimum,followed by the type 2 diabetes without macroangiopathy and the type 2 diabetes with macroangiopathy group ranking at the first position,and that EAT thickness were found to be independently associated with baPWV in type 2 diabetic macrovascular complications.Therefore,the thickening of EAT may play an important role in the occur of diabetes and diabetic macrovascular complication.3.EAT thickness was independently associated with baPWV in type 2 diabetes,declared that measure thickness of EAT by echocardiographic can predict the diabetic macrovascular,the cut-off value was 4.46 mm.4.EAT was positive correlated with BMI,WC,WHR,illustrated EAT was closely associated with central obesity.EAT was positive correlated with FFA,TG,illustrated EAT was closely associated with lipid metabolic disorder.The lipid disorder can cause endothelial dysfunction,then to promote the development of atherosclerosis.5.EAT was positively correlated with inflammatory cytokine(hs-CRP,Hyc,fibrinogen),baPWV was positively correlated with hs-CRP,Hyc,fibrinogen,and EAT was independently associated with baPWV,illustrated the thickening of EAT can release inflammatory cytokine,then to stimulate the development of diabetic macrovascular complication.