三项血清标志物联合检测在2型糖尿病心脏自主神经病变中的诊断价值

彭少林; 陆小玉; 杨井金; 张玲; 彭年春; 杨水冰

doi:10.16766/j.cnki.issn.1674-4152.004483

三项血清标志物联合检测在2型糖尿病心脏自主神经病变中的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.004483

彭少林^{1, 2},
陆小玉¹,
杨井金¹,
张玲¹,
彭年春²,
杨水冰^1, ,

1.
湖南医药学院总医院内分泌代谢与临床营养科，国家代谢性疾病临床医学研究中心怀化分中心，国家标准化代谢性疾病管理中心怀化分中心（MMC），湖南怀化 418000
2.
贵州医科大学附属医院内分泌科，贵州贵阳 550025

基金项目:

湖南省卫健委科研计划项目 D202303068330

怀化市科技创新计划项目 2021R3119

详细信息

通讯作者:
杨水冰，E-mail：13327254322@189.cn

中图分类号: R587.2
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- 文章访问数: 11
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- 被引次数: 0
出版历程
- 收稿日期: 2025-06-25
- 网络出版日期: 2026-10-23

Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes

1.
Department of Endocrinology, Metabolism and Clinical Nutrition, Hunan University of Medicine General Hospital; Huaihua Sub-center of National Clinical Research Center for Metabolic Diseases; Huaihua Sub-center of National Metabolic Management Center (MMC), Huaihua, Hunan 418000, China

摘要

摘要: 目的探讨脂蛋白相关磷脂酶A2（Lp-PLA2）、胱抑素C（CysC）、同型半胱氨酸(Hcy)联合检测在2型糖尿病心脏自主神经病变（DCAN）中的诊断价值，评估其是否优于单一指标。方法选取2021年12月—2023年1月湖南医药学院总医院内分泌代谢科诊疗的204例T2DM患者，根据有无DCAN分为DCAN组（106例）和无DCAN组（98例），检测Lp-PLA2、CysC、Hcy等生化指标。采用Spearman相关分析研究Lp-PLA2、CysC、Hcy与DCAN的关系，采用logistic回归分析探讨DCAN的危险因素，ROC曲线分析三者联合检测在DCAN中的预测价值。结果 DCAN组中Lp-PLA2、CysC、Hcy均高于无DCAN组（P < 0.05）。Spearman相关分析显示三者与DCAN呈正相关关系（r_s=0.816，P=0.040；r_s=0.713，P=0.020；r_s=0.676，P＜0.001）。Lp-PLA2、CysC、Hcy预测DCAN的AUC分别为0.607（P=0.008）、0.540（P=0.019）、0.625（P=0.002），三者联合检测诊断DCAN的AUC为0.745（95% CI：0.679~0.811，P＜0.001），灵敏度为80.1%，特异度为70.5%。结论 Lp-PLA2、CysC、Hcy均为DCAN的独立影响因素，三者联合检测对DCAN有一定的预测价值。
- 2型糖尿病 /
- 心脏自主神经病变 /
- 脂蛋白相关磷脂酶A2 /
- 胱抑素C /
- 同型半胱氨酸
Abstract: Objective To explore the diagnostic value of combined detection of lipoprotein-associated phospholipase A2 (Lp-PLA2), cystatin C (CysC), and homocysteine (Hcy) in cardiac autonomic neuropathy in type 2 diabetes mellitus (DCAN) to assess whether it is superior to each indicator alone. Methods A total of 204 inpatients diagnosed with type 2 diabetes mellitus admitted to the Department of Endocrinology and Metabolism at Hunan University of Medicine General Hospital between December 2021 and January 2023 were retrospectively. All patients were divided into the DCAN group (n=106) and the non-DCAN group (n=98). General patient information was recorded, and biochemical indices such as Lp-PLA2, CysC, and Hcy were measured in each group. Spearman correlation analysis was employed to assess the relationships among Lp-PLA2, CysC, Hcy, and DCAN. Multivariate logistic regression analysis was performed to investigate the potential risk factors associated with DCAN. The receiver operating characteristic (ROC) curve was utilized to analyze the predictive value of the combined indices in DCAN. Results The concentrations of Lp-PLA2, CysC, and Hcy were all elevated in the DCAN group compared to those in the non-DCAN group (P < 0.05). Spearman correlation analysis indicated that Lp-PLA2, CysC, and Hcy were positively correlated with DCAN (r_s=0.816, P=0.040; r_s= 0.713, P=0.020; r_s=0.676, P < 0.001). ROC analysis showed that the areas under the curves for Lp-PLA2, CysC, and Hcy were 0.607 (P=0.008), 0.540 (P=0.019), and 0.625 (P=0.002), respectively. The AUC for the combined detection of the three biomarkers was 0.745 (95% CI: 0.679-0.811, P < 0.001), exhibiting a sensitivity of 80.1% and a specificity of 70.5%. Conclusion Lp-PLA2, CysC, and Hcy were identified as independent risk factors for DCAN. Combined detection of these biomarkers demonstrates moderate diagnostic value and may improve the identification in the diagnosis of DCAN.
- Type 2 diabetes mellitus /
- Cardiac autonomic neuropathy /
- Lipoprotein-associated phospholipase A2 /
- Cystatin C /
- Homocysteine

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图 1 Lp-PLA2、CysC、Hcy联合检测诊断DCAN的ROC曲线

Figure 1. The receiver operating characteristic curve for the combined detection of Lp-PLA2, CysC and Hcy in the diagnosis of DCAN

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表 1 2组2型糖尿病患者基线资料及生化指标比较

Table 1. Comparison of basic data and biochemical indexes between the two groups of patients with type 2 diabetes

组别	例数	性别(男/ 女, 例)	年龄(x±s, 岁)	糖尿病病程(x±s, 年)	BMI (x±s)	吸烟(例)	饮酒(例)	高血压(例)	冠心病(例)
无DCAN组	98	52/46	58.18±9.50	9.76±2.43	25.71±2.83	28	40	10	5
DCAN组	106	64/42	62.02±6.09	10.74±1.57	25.08±3.10	44	50	12	7
统计量		1.112^a	3.463^b	3.447^b	1.512^b	3.732^a	0.834^a	0.006^a	0.207^a
P值		0.292	＜0.001	＜0.001	0.132	0.053	0.361	0.797	0.649

组别		例数	FPG (x±s, mmol/L)	2hPG (x±s, mmol/L)	HbA1c (x±s, %)	TC (x±s, mmol/L)	TG (x±s, mmol/L)	HDL-C (x±s, mmol/L)	LDL-C (x±s, mmol/L)
无DCAN组		98	8.22±2.87	16.99±4.79	8.61±2.03	4.85±1.15	1.96±0.89	1.18±0.63	2.35±0.70
DCAN组		106	8.13±2.17	17.45±4.02	8.59±1.90	4.94±1.09	2.04±1.01	1.07±0.47	2.62±1.02
统计量			0.254^b	0.745^b	0.073^b	0.573^b	0.598^b	1.420^b	2.187^b
P值			0.799	0.457	0.942	0.567	0.551	0.157	0.030

组别		例数		UA (x±s, μmol/L)	Scr (x±s, μmol/L)	BUN (x±s, mmol/L)	Lp-PLA2 (x±s, ng/mL)	CysC (x±s, mg/L)	Hcy (x±s, μmol/L)
无DCAN组		98		341.71±36.56	77.59±9.92	5.91±1.16	169.13±11.61	1.67±0.48	8.50±3.03
DCAN组		106		334.35±38.80	85.09±8.95	5.83±1.07	176.02±20.80	1.81±0.42	9.93±3.52
统计量				1.392^b	5.677^b	0.512^b	2.881^b	2.221^b	3.098^b
P值				0.166	＜0.001	0.609	0.004	0.028	0.002
注：^a为χ²值，^b为t值。

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表 2 2型糖尿病患者DCAN发生影响因素的logistic回归分析

Table 2. Logistic regression analysis of the influencing factors of DCAN occurrence in patients with type 2 diabetes

变量	B	SE	Z值	P值	OR(95%CI)
年龄	0.075	0.029	6.688	0.010	1.078(1.018~1.142)
糖尿病病程	0.445	0.120	13.750	＜0.001	1.260(1.232~1.975)
吸烟	0.105	0.146	0.517	0.053	1.073(1.002~1.394)
LDL-C	0.177	0.254	0.486	0.485	1.194(0.726~1.964)
Scr	1.571	1.597	0.967	0.591	3.267(1.734~11.255)
Lp-PLA2	0.033	0.014	5.556	0.017	1.033(1.006~1.061)
CysC	0.084	0.024	12.250	＜0.001	1.087(1.037~1.139)
Hcy	0.147	0.075	3.842	0.049	1.158(1.000~1.341)

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