Evaluation And Diagnostic Value Of HbA1c And Cys-C In Type 2 Diabetes Mellitus With Ischemic Heart Failure

objective: the purpose of this study was to evaluate the changes of glycosylated hemoglobin(HbA1c)and serum cystatin C(Cys-c)levels in patients with type 2 diabetes mellitus complicated with ischemic heart failure(NYHA),and to compare the value of HbA1c,Cys-C,BNP and LVEF in the early diagnosis of type 2 diabetes mellitus complicated with ischemic heart failure.Methods: from March 2018 to December 2020,90 patients with type 2 diabetes mellitus complicated with ischemic heart failure(Type 2 diabetes mellitus with Ischemic heart failure))were selected as the observation group,and 90 patients with type 2diabetes mellitus complicated with coronary heart disease(Type 2 diabetes mellitus with Coronary heart disease))without symptoms and signs of heart failure were selected as the control group.The effects of the changes of BNP,HbA1c,Cys-C,LVEF,hs-c Tn I,HDL-C,LDL-C,HB,ALB,AST and ALT on the severity of cardiac function in the observation group and the control group were compared,and the value of HbA1c,Cys-C,BNP and LVEF in the early diagnosis of ischemic heart failure in patients with type 2diabetes mellitus were compared.The basic data and biochemical indexes of all patients were collected,and the cardiac color ultrasound was improved and LVEF was recorded.According to the(NYHA)cardiac function classification of the New York College of Cardiology,the observation group was divided into cardiac function class Ⅱ group,cardiac function group Ⅲ and cardiac function group Ⅳ.T-test was used to compare the mean of the two samples,ANOVA was used to compare the mean of multiple samples,Pearson analysis was used to study the correlation of normal distribution data,binary Logistic regression analysis was used to analyze independent risk factors and predictive probability,and the area under ROC curve was used for early diagnosis of ischemic heart failure in patients with type 2 diabetes.Results:1.The level of HbA1c in type 2 diabetes with ischemic heart failure(7.89% ±1.02%)was significantly higher than that in type 2 diabetes with coronary heart disease(6.76%±0.5%).The levels of HbA1c in cardiac function class Ⅱ group(7.13% ±0.42%),cardiac function class Ⅲ group(7.72% ±0.72%),cardiac function class Ⅳ group(8.72% ±1.03%)and control group were significantly higher than those in control group(P < 0.05).And the level of HbA1c in cardiac function class IV group > cardiac function class Ⅲ group >cardiac function class Ⅱ group > control group.2.The serum Cys-C level in type 2 diabetes mellitus with ischemic heart failure group(1.65mg/ L ±0.35 mg/L)was significantly higher than that in type 2 diabetes mellitus with coronary heart disease group(0.93mg/ L ±0.12 mg/L).There were significant differences in serum Cys-C levels between the cardiac function class Ⅱ group,the cardiac function class Ⅲ group,the cardiac function class Ⅳ group and the type 2diabetes with coronary heart disease group(0.93mg/ L ±0.12 mg/L),and the cardiac function class Ⅳ group > the cardiac function class Ⅲ group > the cardiac function classⅡ group > the type 2 diabetes with coronary heart disease group.3.There was no significant difference in sex,age,TG,TC,LDL-C,AST,ALT,BUN,Scr,UA and NEU between the observation group and the control group.The BNP(828.80pg/ L ±896.57 pg / L)and hs-c Tn I(0.018 μ g / L ±0.017μ g / L)in the observation group were higher than those in the control group(BNP(45.28pg/ L ±16.54 pg / L)and hs-c Tn I(0.004 μ g / L ±0.003 μ g / L),and the differences were statistically significant.HDL-C(0.91mmol/ L ±0.22 mmol/L),ALB(34.58g/ L ±3.32 g / L),LVEF(38.88%±7.12%)and HB(117.80g/ L ±17.32 g / L)in the observation group were lower than those in the control group HDL-C(1.05mmol/ L ±0.21 g / L),ALB(37.07g/ L ±1.82 g / L),LVEF(57.14%±4.86%),HB(142.66g/ L ±8.64 g / L).And the differences were statistically significant(P < 0.05).4.Pearson correlation analysis showed that HbA1c and Cys-C were positively correlated with BNP,the correlation coefficients were r(HbA1c)= 0.422,r(Cys-C)=0.584,HbA1c,Cys-C were negatively correlated with LVEF,r(HbA1c =-0.420,r(Cys-C)=-0.597,and HbA1c was positively correlated with Cys-C.5.The sensitivity(98.9%)and specificity(98.9%)of BNP,HbA1c and Cys-C in type2 diabetes mellitus complicated with ischemic heart failure were higher than those of BNP(sensitivity 78.9%,specificity 98.3%),HbA1c(sensitivity 71.1%,specificity83.3%),Cys-C(sensitivity 97.8%,specificity 91.3%),LVEF(sensitivity 67.8%,specificity 98.4%)were detected separately;and the areas under the ROC curve of BNP,HbA1c,Cys-C and LVEF for early prediction of ischemic heart failure in patients with type 2 diabetes were 0.938,0.865,0.987 and 0.726,respectively.Conclusion:1.There is a high positive correlation between glycosylated hemoglobin and serum cystatin C.the increase of HbA1c and serum cystatin C levels can evaluate the severity of NYHA cardiac function in patients with type 2 diabetes mellitus complicated with ischemic heart failure,and HbA1c and Cys-C increase with the deterioration of cardiac function.Control of blood glucose level and proper improvement of renal function may have a certain value for the improvement of patients’ condition,which provides a new way of treatment.2.HbA1c and serum Cys-C levels were positively correlated with BNP,glycosylated hemoglobin and serum cystatin C also increased in patients with high BNP levels,while HbA1c and Cys-C were negatively correlated with LVEF and increased with the decrease of LVEF.3.The combined detection of BNP,HbA1c and Cys-C improves the sensitivity and specificity of early diagnosis of type 2 diabetes mellitus complicated with ischemic heart failure,and is of great significance to the clinical efficacy and long-term prognosis of the disease.