不同证型糖尿病性心脏病患者血清AMPKα1水平相关性研究

Study on the correlation of serum AMPKα1 levels in patients with diabetic heart disease of different evidence types

关键词:  糖尿病性心脏病  血清腺苷单磷酸活化蛋白α1水平  中医证型

Key words:  diabetic heart disease  serum AMPKα1 level  Chinese medicine evidence type

摘要:

[目的] 探究糖尿病性心脏病（DHD）患者血清AMP依赖的蛋白激酶（AMPK）水平与疾病损伤状态相关性及在不同中医证型中的分布规律。[方法] 纳入2022年10月—2023年1月于天津市第四中心医院心内科住院的DHD患者、内分泌科2型糖尿病（T2DM）患者和健康志愿人群（HC）各30例，比较3组血清中腺苷单磷酸活化蛋白α1（AMPKα1）水平差异，并将DHD组根据中医辨证分型为气阴两虚兼瘀组、心肾阴虚兼瘀组、阴阳两虚兼瘀组。以Spearman相关性分析研究AMPKα1与DHD组糖脂代谢[空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）]、心肌损伤[B型钠尿肽（BNP）、乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK-MB）]和超声心功能指标如右房内径（RAD）、左心室舒张内径（LVIDd）、室间隔厚度（IVS）、左心室后壁厚度（LVPW）等之间的关系。[结果] 疾病组血清AMPKα1低于HC组（P<0.01）。DHD组血清AMPKα1水平与HbA1c呈高度负相关（r=-0.811，P<0.001），与三酰甘油葡萄糖指数（TyG）呈中度负相关（r=-0.743，P<0.001），与血液脂质代谢物呈负相关（0.3<r<0.5，P<0.05），与心功能腔室运动LVIDd、LVPW、IVS呈低度负相关（r=-0.421，P=0.018；r=-0.433，P=0.015；r=-0.434，P=0.015），与RAD呈中度负相关（r=-0.694，P<0.001），与心肌损伤指标暂无相关性。在DHD证型中，气阴两虚兼瘀证AMPKα1水平低于其他证型（P<0.05）。[结论] DHD患者AMPKα1水平低于健康人群，与患者糖脂代谢及心肌腔室运动程度呈负相关。AMPKα1水平在不同中医证型患者中存在统计学差异，可为临床辨证分型提供客观依据。

Abstract:

[Objective] To investigate the correlation between serum adenosine mono phosphate(AMP)-activated protein kinase(AMPK) levels and disease injury status in patients with diabetic heart disease(DHD) and the distribution pattern in different Chinese medicine certificates. [Methods] Thirty cases each of DHD patients,type 2 diabetes mellitus patients(DM) in the Department of Endocrinology and healthy volunteer population(HC) hospitalized in the Department of Cardiology of our hospital from October 2022 to January 2023 were included to compare the differences in serum AMPKα1 levels among the three groups,and the DHD group was divided into the group of qi and yin deficiency with blood stasis,the group of cardiac and renal yin deficiency with blood stasis,and the group of yin and yang deficiency with blood stasis according to the identification of traditional Chinese medicine(TCM) evidence. Spearman's correlation analysis was used to study the differences between adenosine activated protein kinase alpha 1(AMPKα1) and glucose and lipid metabolism including fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),myocardial injury including B-type natriuretic peptide(BNP),lactate Dehydrogenase(LDH),Creatine Kinase-Myocardial Band(CK-MB),and echocardiographic indices of cardiac function,such as right atrial diameter(RAD),left ventricular internal diastolic diameter(LVIDd),interventricular septal thickness(IVS),left ventricular posterior wall thickness(LVPW),etc. In addition,the DHD group was classified according to the Chinese medicine diagnosis,and the DHD group was divided into the heart and kidney yin and yang deficiency group and the stasis group. thickness(LVPW),and so on. [Results] Serum AMPKα1 was significantly lower in the disease group than in the HC group(P<0.01). serum AMPKα1 levels in the DHD group showed a high negative correlation with HbA1c(r=-0.811,P<0.001),a moderate negative correlation with TyG(r=-0.743,P<0.001),a low negative correlation with blood lipid metabolites(0.3<r<0.5,P<0.05),low negative correlation with cardiac function chamber movement LVIDd,LVPW,IVS(r=-0.421 P=0.018,r=-0.433 P=0.015),r=-0.434 P=0.015),moderate negative correlation with RAD(r=-0.694 P<0.001),and no correlation with the indicators of myocardial damage. Among the DHD patterns,the AMPKα1 level in the pattern of qi and yin deficiency with stasis pattern was lower than that in other patterns(P<0.05). [Conclusion] AMPKα1 levels in DHD patients were lower than those in healthy people and were negatively correlated with glucose and lipid metabolism and the degree of myocardial chamber movement. There were statistically significant differences in AMPKα1 levels in patients with different TCM patterns,which may provide an objective basis for the clinical diagnosis of diabetic heart disease.