基于三维斑点追踪成像参数联合血清3-NT、vaspin对2型糖尿病患者主要不良心脏事件预测模型的构建及应用

沈乐乐; 汪荣金; 钦婷婷; 沈元良; 茅晓敏; 李秀娟

doi:10.16766/j.cnki.issn.1674-4152.004488

基于三维斑点追踪成像参数联合血清3-NT、vaspin对2型糖尿病患者主要不良心脏事件预测模型的构建及应用

doi: 10.16766/j.cnki.issn.1674-4152.004488

1.
湖州市中医院超声科, 浙江湖州 313000
2.
湖州市中医院心内科
3.
中国科学院大学宁波华美医院超声科, 浙江湖州 315016

基金项目:

浙江省卫生健康科技计划项目 2022RC066

详细信息

通讯作者:
茅晓敏, E-mail：498043265@qq.com

中图分类号: R587.1 R445.1
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出版历程
- 收稿日期: 2025-05-08
- 网络出版日期: 2026-10-23

Construction and application of a prediction model for major adverse cardiac events in patients with type 2 diabetes based on three-dimensional speckle tracking imaging parameters combined with serum 3-NT and vaspin

1.
Department of Ultrasound, Huzhou Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的构建三维斑点追踪成像（3D-STI）参数联合血清3-硝基酪氨酸（3-NT）、腹腔脂肪型丝氨酸蛋白酶抑制剂（vaspin）的2型糖尿病患者主要不良心脏事件（MACE）风险预测模型，探讨该模型对患者MACE的预测价值。方法选取2020年12月—2021年12月于湖州市中医院治疗的118例2型糖尿病患者，根据随访结果分为无MACE组(96例)MACE组(22例)，对2组患者行超声心动图、3D-STI检查，检测血清3-NT、vaspin水平。采用Pearson相关性分析指标间关联，采用多因素logistic回归分析研究MACE发生的危险因素。结果与无MACE组比较，MACE组二尖瓣口舒张早期峰值血流速度/二尖瓣环舒张早期峰值运动速度（E/e′）、3-NT[（52.78±6.49）ng/mL vs.（40.36±5.33）ng/mL]水平升高，2D左心室整体长轴应变（2D-GLS）、3D-GLS、vaspin[（0.23±0.03）ng/mL vs.（0.41±0.05）ng/mL]水平降低（P < 0.05）。E/e′与3-NT呈正相关关系，与vaspin呈负相关关系；2D-GLS、3D-GLS与3-NT呈负相关关系，与vaspin呈正相关关系（P < 0.05）。多因素logistic回归分析结果显示, 2D-GLS水平偏低、3D-GLS水平偏低、3-NT水平偏高为影响MACE发生的独立危险因素(P < 0.05)，vaspin水平偏低为影响MACE发生的独立保护因素(P < 0.05)。3-NT、vaspin、3D-STI三者联合预测效能高于单一检测（P < 0.05）。结论构建3D-STI参数联合血清3-NT、vaspin预测模型，可用于评估2型糖尿病患者MACE的发生风险。
- 2型糖尿病 /
- 三维斑点追踪成像 /
- 3-硝基酪氨酸 /
- 腹腔脂肪型丝氨酸蛋白酶抑制剂
Abstract: Objective To construct a risk prediction model for major adverse cardiac events (MACE) in patients with type 2 diabetes mellitus using three-dimensional speckle tracking imaging (3D-STI) parameters combined with serum 3-nitrotyrosine (3-NT) and abdominal fatty serine protease inhibitor (vaspin), and to explore the predictive value of this model for MACE in patients. Methods A total of 118 patients with type 2 diabetes mellitus who were treated in Huzhou Hospital of Traditional Chinese Medicine from December 2020 to December 2021 were selected and divided into 96 cases in the non-MACE group and 22 cases in the MACE group according to the follow-up results. Echocardiography and 3D-STI examinations were performed in both groups to detect the levels of serum 3-NT and vaspin. Pearson correlation analysis was used to analyze the association between indicators, and multivariate logistic regression analysis was conducted to analyze the risk factors for MACE occurrence. Results Compared with the MACE group, the levels of early diastolic peak blood flow velocity at the mitral orifice/early diastolic peak movement velocity of the mitral annulus (E/e ') and 3-NT[(52.78±6.49) ng/mL vs. (40.36±5.33) ng/mL] in the MACE group increased. The levels of 2D left ventricular global long-axis strain (2D-GLS), 3D-GLS, and vaspin[(0.23±0.03) ng/mL vs. (0.41±0.05) ng/mL] decreased (P < 0.05). E/e 'was positively correlated with 3-NT and negatively correlated with vaspin. Multivariate logistic regression analysis showed that low 2D-GLS level, low 3D-GLS level, and high 3-NT level were independent risk factors for MACE (P < 0.05), while low vaspin level was an independent protective factor for MACE (P < 0.05). The combined predictive efficacy of 3-NT, vaspin, and 3D-STI was higher than that of a single detection (P < 0.05). Conclusion The construction of a prediction model combining 3D-STI parameters with serum 3-NT and vaspin can evaluate the risk of MACE in patients with type 2 diabetes.
- Type 2 diabetes /
- Three-dimensional spot tracking imaging /
- 3-nitrotyrosine /
- Abdominal fatty serine protease inhibitor

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图 1 2型糖尿病患者MACE发生风险预测模型的ROC曲线

Figure 1. ROC curve of the prediction model for the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes

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图 2 血清3-NT、vaspin联合三维斑点追踪成像预测2型糖尿病患者发生MACE的ROC曲线

Figure 2. ROC curve of serum 3-NT and vaspin combined with three-dimensional speckle tracking imaging for predicting major adverse cardiovascular events (MACE) in patients with type 2 diabetes

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表 1 2组2型糖尿病患者一般资料比较

Table 1. Comparison of general information of two groups of type 2 diabetes patients

项目	无MACE组(n=96)	MACE组(n=22)	统计量	P值
年龄(x±s，岁)	61.19±8.57	60.11±8.54	0.534^a	0.595
性别[例(%)]			0.507^b	0.477
男性	56(58.33)	11(50.00)
女性	40(41.67)	11(50.00)
BMI(x±s)	23.51±3.06	25.63±3.96	2.767^a	0.007
心率(x±s，次/min)	73.05±8.11	73.09±8.16	0.021^a	0.983
SBP(x±s，mmHg)	124.25±12.05	123.04±11.97	0.425^a	0.671
DBP(x±s，mmHg)	75.33±6.24	75.29±6.20	0.027^a	0.978
FPG(x±s，mmol/L)	7.38±0.53	7.41±0.55	0.238^a	0.812
HbA1c(x±s，%)	8.28±0.33	8.31±0.36	0.378^a	0.706
cTnI(x±s，ng/mL)	10.36±2.36	17.25±2.33	12.380^a	＜0.001
CK-MB(x±s，U/L)	138.36±20.77	185.96±26.45	9.192^a	＜0.001
注：^a为t值，^b为χ²值；1 mmHg=0.133 kPa。

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表 2 2组2型糖尿病患者超声、3D-STI参数比较(x±s)

Table 2. Comparison of ultrasound and 3D-STI parameters between two groups of type 2 diabetic patients(x±s)

组别	例数	LVEDd (mm)	LVEF (%)	LAVImax (mL/m²)	E/e′	2D-GLS (%)	3D-GLS (%)	3D-GCS (%)	3D-GRS (%)	3D-GAS (%)
无MACE组	96	42.36±5.17	66.12±7.01	24.05±3.51	6.12±0.73	23.25±1.33	21.36±2.46	23.36±2.17	28.56±3.53	24.36±3.11
MACE组	22	43.02±5.20	66.23±7.09	24.37±5.48	7.44±0.85	16.25±1.08	17.05±2.15	23.41±2.19	28.61±3.60	25.03±3.18
t值		0.540	0.066	0.344	7.415	22.987	7.576	0.097	0.060	0.907
P值		0.591	0.947	0.732	＜0.001	＜0.001	＜0.001	0.923	0.953	0.366

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表 3 2组2型糖尿病患者血清3-NT、vaspin水平比较(x±s，ng/mL)

Table 3. Comparison of serum 3-NT and vaspin levels in two groups of patients with type 2 diabetes(x±s, ng/mL)

组别	例数	3-NT	vaspin
无MACE组	96	40.36±5.33	0.41±0.05
MACE组	22	52.78±6.49	0.23±0.03
t值		9.454	16.198
P值		＜0.001	＜0.001

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表 4 超声、3D-STI参数与血清3-NT、vaspin水平的相关性

Table 4. Correlation between ultrasound and 3D-STI parameters and serum 3-NT and vaspin levels

项目	3-NT		vaspin
项目	r值	P值	r值	P值
E/e′	0.563	0.008	-0.602	0.001
2D-GLS	-0.485	0.023	0.508	0.015
3D-GLS	-0.499	0.020	0.536	0.010

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表 5 2型糖尿病患者MACE发生的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of the incidence of major adverse cardiac events (MACE) in patients with type 2 diabetes

变量	B	SE	Waldχ²	P值	OR值	95% CI
BMI	1.563	0.805	3.770	0.121	4.773	3.163~6.383
cTnI(U/L)	1.105	0.508	4.731	0.105	3.019	2.003~4.035
CK-MB(U/L)	1.177	0.696	2.860	0.138	3.245	1.853~4.637
E/e'	1.058	0.448	5.577	0.085	2.881	1.985~3.777
2D-GLS(%)	0.485	0.133	13.298	＜0.001	1.624	1.358~1.890
2D-GLS(%)	0.524	0.125	17.573	＜0.001	1.689	1.439~1.939
3-NT(ng/mL)	1.285	0.418	9.450	0.008	3.615	2.779~4.451
vaspin(ng/mL)	0.636	0.199	10.214	0.002	1.889	1.491~2.287

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表 6 血清3-NT、vaspin联合三维斑点追踪成像对2型糖尿病患者MACE的预测价值

Table 6. Predictive value of serum 3-NT and vaspin combined with three-dimensional speckle tracking imaging for major adverse cardiovascular events in patients with type 2 diabetes

项目	AUC(95% CI)	P值	灵敏度(%)	特异度(%)	准确度(%)
3-NT	0.714(0.636~0.792)^a	0.001	77.27(17/22)	67.71(65/96)	69.49(82/118)
vaspin	0.680(0.593~0.767)^a	0.001	68.18(15/22)	70.83(68/96)	70.34(83/118)
三维斑点追踪成像	0.746(0.672~0.819)^a	0.001	77.27(17/22)	68.75(66/96)	70.34(83/118)
联合检测	0.850(0.793~0.907)	0.001	95.45(21/22)	66.67(64/96)	72.03(85/118)
注：与联合预测比较，^aP＜0.05。

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参考文献(25)

[1]	杨蓉, 陆媛, 于德华. 胰高血糖素样肽-1对2型糖尿病合并轻度认知功能障碍患者认知功能改善的研究进展[J]. 中华全科医学, 2023, 21(10): 1749-1752. doi: 10.16766/j.cnki.issn.1674-4152.003216 YANG R, LU Y, YU D H. Research progress of glucagon-like peptide-1 in improving cognitive function in patients with type 2 diabetes mellitus complicated with mild cognitive dysfunction[J]. Chinese Journal of General Practice, 2023, 21(10): 1749-1752. doi: 10.16766/j.cnki.issn.1674-4152.003216
[2]	徐爱花, 黄建胜, 何银辉, 等. 达格列净片治疗2型糖尿病血糖控制不佳患者的疗效与低血糖风险观察[J]. 中华全科医学, 2020, 18(9): 1500-1503, 1526. doi: 10.16766/j.cnki.issn.1674-4152.001544 XU A H, HUANG J S, HE Y H, et al. Therapeutic effect of dapagliflozin on patients with type 2 diabetes with poor glycemic control and the risk of hypoglycemia[J]. Chinese Journal of General Practice, 2020, 18(9): 1500-1503, 1526. doi: 10.16766/j.cnki.issn.1674-4152.001544
[3]	段奕全, 梁青青, 徐艳萍, 等. 基于二维经胸超声心动图与三维斑点追踪成像相关参数特征构建家族肥厚型心肌病突变基因携带者的列线图预测模型[J]. 中华超声影像学杂志, 2023, 32(9): 773-781. DUAN Y Q, LIANG Q Q, XU Y P, et al. Early identification of familial hypertrophic cardiomyopathy mutation gene carriers by constructing Nomogram prediction model based on parametric characteristics of two-dimensional transthoracic echocardiography and three-dimensional speckle tracking imaging[J]. Chinese Journal of Ultrasonography, 2023, 32(9): 773-781.
[4]	安彩霞, 房辉, 杨岳. 新诊断2型糖尿病患者血清3-硝基酪氨酸水平与颈动脉粥样硬化的相关性[J]. 中华内分泌代谢杂志, 2019, 35(6): 491-493. AN C X, FANG H, YANG Y. Association of serum 3-nitrotyrosine with carotid atherosclerosis in newly diagnosed type 2 diabetic patients[J]. Chinese Journal of Endocrinology and Metabolism, 2019, 35(6): 491-493.
[5]	石爱萍, 任寿安, 魏红霞, 等. 阻塞性睡眠呼吸暂停低通气综合征患者血清Nesfatin-1和Vaspin与病情严重程度及炎性反应的关系[J]. 中华实用诊断与治疗杂志, 2024, 38(5): 493-497. SHI A P, REN S A, WEI H X, et al. Relationships of serum Nesfatin-1 and Vaspin with severity and inflammatory response in patients with obstructive sleep apnoea hypopnoea syndrome[J]. Journal of Chinese Practical Diagnosis and Therapy, 2024, 38(5): 493-497.
[6]	中国研究型医院学会糖尿病学专业委员会分级诊疗与基层管理糖尿病学组. 2型糖尿病分级诊疗与质量管理专家共识[J]. 中国医学前沿杂志(电子版), 2020, 12(5): 38-53. Diabetes Study Group on the Hierarchical Medical Care and Community Management, Professional Committee on Diabetes, Chinese Research Hospital Association. Experts consensus on the grading medical care and quality management of type 2 diabetes mellitus[J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2020, 12(5): 38-53.
[7]	KANALEY J A, COLBERG S R, CORCORAN M H, et al. Exercise/physical activity in individuals with type 2 diabetes: a consensus statement from the American college of sports medicine[J]. Med Sci Sports Exerc, 2022, 54(2): 353-368. doi: 10.1249/MSS.0000000000002800
[8]	POLLAKOVA D, ANDREADI A, PACIFICI F, et al. The impact of vegan diet in the prevention and treatment of type 2 diabetes: a systematic review[J]. Nutrients, 2021, 13(6): 2123. doi: 10.3390/nu13062123
[9]	YAN Y, WU T, ZHANG M, et al. Prevalence, awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population[J]. BMC Public Health, 2022, 22(1): 1382. doi: 10.1186/s12889-022-13759-9
[10]	ZHANG Y, YANG Y, HUANG Q, et al. The effectiveness of lifestyle interventions for diabetes remission on patients with type 2 diabetes mellitus: a systematic review and meta-analysis[J]. Worldviews Evid Based Nurs, 2023, 20(1): 64-78. doi: 10.1111/wvn.12608
[11]	KHOSLA S, SAMAKKARNTHAI P, MONROE D G, et al. Update on the pathogenesis and treatment of skeletal fragility in type 2 diabetes mellitus[J]. Nat Rev Endocrinol, 2021, 17(11): 685-697. doi: 10.1038/s41574-021-00555-5
[12]	HUANG G, CHEN X, CHEN Y, et al. Causal relationship between type 2 diabetes mellitus and bone mineral density: a Mendelian randomization study in an East Asian population[J]. Osteoporos Int, 2023, 34(10): 1719-1727. doi: 10.1007/s00198-023-06807-6
[11]	YU J J, HAN J G, TAN Y, et al. Right ventricular dysfunctions in type 1 diabetic mice: a longitudinal study[J]. World J Diabetes, 2025, 16(10): 109526. DOI: 10.4239/wjd.v16.i10.109526.
[12]	LIU X, GAO Y, GUO Y K, et al. Cardiac magnetic resonance T1 mapping for evaluating myocardial fibrosis in patients with type 2 diabetes mellitus: correlation with left ventricular longitudinal diastolic dysfunction[J]. Eur Radiol, 2022, 32(11): 7647-7656. doi: 10.1007/s00330-022-08800-9
[13]	李晨菲, 葛英辉. 心脏磁共振在心脏淀粉样变诊断中应用研究进展[J]. 中华实用诊断与治疗杂志, 2021, 35(10): 985-987. LI C F, GE Y H. Application of cardiac MRI in the diagnosis of cardiac amyloidosis[J]. Journal of Chinese Practical Diagnosis and Therapy, 2021, 35(10): 985-987.
[14]	纳丽莎, 刘蕾, 朱力, 等. 超声三维斑点追踪成像联合心脏磁共振成像－钆延迟增强序列对成人肥厚型心肌病左室整体收缩功能与心肌纤维化的关联性研究[J]. 中华超声影像学杂志, 2020, 29(1): 6-12. NA L S, LIU L, ZHU L, et al. Correlation between three-dimensional speckle tracking echocardiography combined with cardiac magnetic resonance imaging-late gadolinium enchancemet on left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy[J]. Chinese Journal of Ultrasonography, 2020, 29(1): 6-12.
[15]	陈梅香, 刘芃, 黄建玉, 等. 二维斑点追踪成像联合实时三维超声心动图对非ST段抬高型急性冠状动脉综合征疑诊患者冠状动脉显著狭窄的预测价值[J]. 中华超声影像学杂志, 2022, 31(2): 93-100. CHEN M X, LIU P, HUANG J Y, et al. Predictive value of significant coronary stenosis in patients suspected of non-ST-segment elevation acute coronary syndrome by two-dimensional speckle tracking imaging combined with real-time three-dimensional echocardiography[J]. Chinese Journal of Ultrasonography, 2022, 31(2): 93-100.
[16]	高秋妹, 苏茂龙, 王斌, 等. 应用二维斑点追踪显像和压力-应变环评价左室射血分数保留的重度主动脉瓣狭窄患者经导管主动脉瓣置换术后的左室心肌功能[J]. 中华超声影像学杂志, 2021, 30(11): 975-981. GAO Q M, SU M L, WANG B, et al. Evaluation of left ventricular myocardial function after transcatheter aortic valve implantation in severe aortic stenosis patients with preserved left ventricular ejection fraction by two-dimensional speckle tracking imaging technology and pressure-strain loop[J]. Chinese Journal of Ultrasonography, 2021, 30(11): 975-981.
[17]	张娟, 张根生, 黄雪, 等. 贝前列素钠片联合当归黄芪汤对糖尿病足溃疡患者创面愈合、血管新生及氧化应激的影响[J]. 中华中医药学刊, 2024, 42(7): 202-205. ZHANG J, ZHANG G S, HUANG X, et al. E Effects of Beraprost Sodium Tablets Combined with Danggui Huangqi Decoction on Wound Healing, Angiogenesis and Oxidative Stress in Diabetic Foot Ulcer Patients[J]. Chinese Archives of Traditional Chinese Medicine, 2024, 42(7): 202-205.
[18]	孙晓婷, 郭丹, 范瑞龙, 等. 颈动脉超声参数结合血浆小而密低密度脂蛋白评估糖尿病患者动脉粥样硬化性心血管疾病的临床价值[J]. 河北医学, 2023, 29(8): 1340-1344. SUN X T, GUO D, FAN R L, et al. Clinical Value of Carotid Artery Ultrasound Parameters Combined with Plasma Small and Dense Low-Density Lipoprotein in Evaluating Atherosclerotic Cardiovascular Disease in Diabetic Patients[J]. Hebei Medicine, 2023, 29(8): 1340-1344.
[19]	TONYAN S, POSPELOVA M, KRASNIKOVA V, et al. Neurotrophin-3 (NT-3) as a potential biomarker of the peripheral nervous system damage following breast cancer treatment[J]. Pathophysiology, 2023, 30(2): 110-122. doi: 10.3390/pathophysiology30020010
[20]	CHEN T, HE X, WANG J, et al. NT-3 combined with TGF-β signaling pathway enhance the repair of spinal cord injury by inhibiting glial scar formation and promoting axonal regeneration[J]. Mol Biotechnol, 2024, 66(6): 1484-1495. doi: 10.1007/s12033-023-00781-4
[21]	赵晶, 许娟, 刘靖. 高压氧联合利拉鲁肽及健脾化痰方治疗早期2型糖尿病视网膜病变的临床疗效分析[J]. 中华航海医学与高气压医学杂志, 2021, 28(3): 330-335. ZHAO J, XU J, LIU J. Clinical efficacy analysis of hyperbaric oxygen combined with Liraglutide and Jianpi Huatan Formula in treating early type 2 diabetic retinopathy[J]. Chinese Journal of Nautical Medicine and Hyperbaric Medicine, 2021, 28(3): 330-335.
[22]	于文慧, 张彤, 徐恒. 参芪活血汤对2型糖尿病下肢血管病变患者症状及血清Vaspin、ANGPTL4水平的影响[J]. 中国临床研究, 2022, 35(7): 927-931. YU W H, ZHANG T, XU H. Effects of Shenqi Huoxue Decoction on symptoms and serum Vaspin and ANGPTL4 levels in T2DM patients with lower extremity vascular disease[J]. Chinese Journal of Clinical Research, 2022, 35(7): 927-931.
[23]	董小康, 陈文静. 血清不规则趋化因子和内脏脂肪特异性丝氨酸蛋白酶抑制剂水平与高血压合并心力衰竭的相关性[J]. 中华高血压杂志, 2021, 29(10): 991-994. DONG X K, CHEN W J. Correlation between serum irregular chemokines and visceral fat-specific serine protease inhibitor levels and hypertension complicated with heart failure[J]. Chinese Journal of Hypertension, 2021, 29(10): 991-994.