Study On The Relationship Between Inflammatory Response State And Diabetic Heart-related Damage

Chapter 1 The expression level and significance of zinc finger protein A20 mRNA in peripheral blood mononuclear cells in patients with diabetic cardiomyopathyObjective:Inflammation plays a key role in the development of Diabetic cardiomyopathy(DCM),and zinc finger protein A20,a negative feedback regulator of inflammation,is closely related to a variety of immune metabolism-related diseases including diabetes.In this chapter,a cross-sectional study will be used to verify and evaluate the relationship between Peripheral blood mononuclear cells(PBMC)A20 mRNA expression level and the onset of diabetic cardiomyopathy from a clinical perspective.Methods:In this study,44 patients with diabetic cardiomyopathy,30 patients with simple diabetes and 35 healthy subjects were selected from the hospitalized patients in the Department of Cardiology and Endocrinology of the Affiliated Hospital of Yangzhou University from June 2020 to December 2020.Real-time fluorescence quantitative PCR was used.The mRNA expression level of zinc finger protein A20 in peripheral blood PBMC was detected.The general conditions,serological indexes and the expression level of A20 mRNA in peripheral blood PBMC of the three groups were compared.Multivariate Logistic regression was used to analyze the related influencing factors of diabetic cardiomyopathy.The correlation between A20 mRNA expression in peripheral blood PBMC and urinary albumin-creatinine ratio(UACR)and C-reactive protein(CRP)in patients with diabetic cardiomyopathy was analyzed by Pearson bivariate correlation analysis.Results:1.There were no significant differences in gender,age,smoking history and low-density lipoprotein(LDL)among normal control group,diabetic group and diabetic cardiomyopathy group(P>0.05).However,there were significant differences in body mass index(BMI),fasting blood glucose(FPG),total cholesterol(CHO),triglyceride(TG),high density lipoprotein(HDL),urea nitrogen(UN),creatinine(CR)and uric acid(UA)among the three groups(P<0.05).There were statistically significant differences in disease course,CRP,urinary microalbumin(MALB-U)and UACR between diabetic group and diabetic cardiomyopathy group(P<0.05).2.The mRNA expression level of A20 in peripheral blood PBMC was significantly different among normal control group,diabetic group and diabetic cardiomyopathy group(1.09±0.20 vs 0.62±0.23 vs 0.32±0.24,F=111.070,P<0.001).3.Logistic regression analysis showed that triglyceride(TG),total cholesterol(CHO),urea nitrogen(UN)and uric acid(UA)were risk factors for diabetic cardiomyopathy(P<0.05),while HDL and A20 mRNA levels were protective factors(P<0.05).Multivariate Logistic regression analysis showed that CHO was a risk factor for the onset of diabetic cardiomyopathy,A20 was a protective factor for the onset of diabetic cardiomyopathy,and both the increase of CHO and the low expression of A20 mRNA were independent predictors of the onset of diabetic cardiomyopathy(P<0.05).4.The area under the ROC curve(AUC)of total cholesterol(CHO)and A20 mRNA expression levels in predicting the onset of diabetic cardiomyopathy were 0.874 and 0.921,respectively,and the optimal cut-off values were 2.71 and 0.509,respectively.The sensitivity of the expression levels in predicting diabetic cardiomyopathy was 81.5%and 95%,respectively.The specificity was 87.7%and 90.9%,respectively.5.According to the New York Heart Association(NYHA)classification,the patients with diabetic cardiomyopathy were divided into the heart function(Ⅰ～Ⅱ)group and the heart function(Ⅲ～Ⅳ)group.The levels of CRP,MALB-U and UACR in the heart function(Ⅲ～Ⅳ)group were higher than those in the heart function(Ⅰ～Ⅱ)group(P<0.05).The mRNA expression of A20 in PBMC in peripheral blood was lower than that in the heart function(Ⅰ～Ⅱ)group(P=0.027).6.CRP,UACR and A20 mRNA expression in peripheral blood PBMC of diabetic cardiomyopathy patients were negatively correlated(r=-0.401,P=0.007;R=-0.499,P=0.001).Conclusion:1.The expression level of A20 mRNA in peripheral blood PBMC of diabetic cardiomyopathy patients was significantly lower than that of healthy people and diabetic patients,which was an independent predictor of diabetic cardiomyopathy.2.The expression level of PBMC zinc finger protein A20 mRNA in peripheral blood of patients with diabetic cardiomyopathy decreased with the deterioration of function,and the low expression of PBMC zinc finger protein A20 mRNA in peripheral blood of patients with diabetic cardiomyopathy may promote the progression of diabetic cardiomyopathy by aggravating the inflammatory response.3.Monitoring the changes of PBMC zinc finger protein A20 mRNA expression level in peripheral blood of patients with diabetic cardiomyopathy may be helpful for early identification of patients with diabetic cardiomyopathy and dynamic assessment of heart failure.Chapter 2 The relationship between NLR,PLR and the degree of atherosclerosis in patients with coronary heart disease and type 2 diabetesObjective:Activation of inflammation plays a key role in the progression of type 2 diabetes and coronary atherosclerosis,and recent studies have shown that Peripheral-blood Neutrophil/lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR),a novel inflammatory marker,are good predictors of vascular endothelial dysfunction.In this chapter,retrospective study was conducted to explore the relationship between NLR and PLR levels and the severity of coronary artery disease in patients with coronary heart disease complicated with type 2 diabetes.Methods:In this study,144 patients with coronary heart disease complicated with type 2 diabetes who were hospitalized in Department of Cardiology,Affiliated Hospital of Yangzhou University from June 2015 to July 2016 were selected as the observation group,and 60 healthy subjects who underwent physical examination in the physical examination center during the same period were selected as the healthy control group.The degree of coronary artery disease in patients with CHD complicated with type 2 diabetes undergoing selective coronary angiography was scored according to Gensini scoring method,and the patients were divided into high risk group(Gensini score ≥64 points,75 cases)and medium and low risk group(Gensini score<64 points,69 cases)according to their scores.By comparing the general data and laboratory examination indexes of the three groups,multivariate Logistic regression analysis was used to analyze the relationship between NLR,PLR and the complexity of coronary artery lesions.In addition,Pearson correlation analysis was used to analyze the correlation between NLR,PLR and Gensini scores in patients with CHD complicated with type 2 diabetes.Finally,the predictive value of NLR and PLR for high-risk complex coronary artery lesions in patients with CHD complicated with type 2 diabetes was evaluated by drawing ROC curve.Results:1.There were no statistically significant differences in gender,age,MCV,HDL-C,TBil,Cr and UA among healthy group,medium and low risk group and high risk group(P>0.05).However,the BMI,systolic blood pressure,lipoprotein A,glycated hemoglobin,NLR and PLR in high-risk group were higher than those in healthy group and medium and low risk Gensini score group,and the difference was statistically significant(P<0.05).TG,LDL,CR and FPG in high-risk group were higher than those in healthy group,and the difference was statistically significant(P<0.05).BMI,TG,CR and FPG in the middle and low risk group were higher than those in the healthy group,and the difference was statistically significant(P<0.05).2.Multivariate logistic regression analysis showed that lipoprotein A,NLR and PLR were independent risk factors reflecting the degree of coronary artery disease(P<0.05).3.The degree of coronary artery disease in CHD patients with type 2 diabetes mellitus was positively correlated with NLR and PLR(r=0.386,P<0.001;R=0.487,P<0.001).4.NLR and PLR predicted high-risk coronary artery disease in patients with CHD complicated with type 2 diabetes mellitus:the area under the ROC curve of NLR was 0.843,95%CI(0.78-0.907),the best cutoff value was 2.566,the sensitivity was 82.6%,and the specificity was 73.3%.The area under the ROC curve of PLR was 0.72,95%CI(0.778～0.909),the optimal cut-off value was 107.054,the sensitivity was 84.1%,and the specificity was 78.7%.Conclusion:1.NLR and PLR were independent risk factors for high risk coronary artery disease in patients with CHD complicated with type 2 diabetes mellitus.The sensitivity of NLR and PLR in predicting high risk coronary artery disease was 82.6%and 84.1%,respectively.The specificity was 73.3%and 78.7%,respectively.2.In patients with CHD complicated with type 2 diabetes mellitus,inflammatory indexes NLR and PLR were positively correlated with Gensini score.NLR and PLR can be used as simple and easily measurable laboratory indexes to predict the severity of coronary artery.