标题：冠心病合并糖尿病患者血清CX43、ZO-1表达及其与冠状动脉病变的关系

      作者：李倩，周锦豹    延安市中医医院心血管内科，陕西 延安 716000

      卷次： 2022年33卷24期

      【摘要】 目的 探讨连接蛋白43 (CX43)、闭锁小带蛋白-1 (ZO-1)在冠心病(CHD)合并糖尿病(DM)患者血清中的表达情况，并分析其与冠状动脉病变的关系。方法 选取2020年7月至2022年1月在延安市中医医院接受过冠状动脉造影并确诊为CHD的145例患者为研究对象。根据是否合并DM分为CHD组(未合并DM，n=59)、CHD合并DM组(n=86)，同时选取60例健康体检者为对照组。收集研究对象的一般资料，采用Gensini评分评估冠状动脉病变程度，采用实时荧光定量PCR法检测血清中CX43 mRNA表达水平，采用酶联免疫吸附法(ELISA)检测血清中ZO-1水平，采用Pearson相关性分析CX43、ZO-1表达与临床指标的相关性，采用受试者工作特征曲线(ROC)评价血清CX43、ZO-1对CHD合并DM发生的诊断价值；采用多因素Logistic回归分析影响CHD合并DM发生的危险因素。结果 CHD合并DM组患者血清中ZO-1的表达水平为(3.85±0.61) ng/mL，明显高于CHD组的(2.48±0.55) ng/mL和对照组的(1.16±0.39) ng/mL，而血清中CX43的表达水平为 2.75±0.63，明显低于CHD组的 4.89±0.85和对照组的10.68±1.83，差异均具有统计学意义(P<0.05)；同时CHD合并DM组患者的舒张压、FPG、HbA1c较对照组和CHD组均升高，LVEF较对照组和CHD组降低，差异均具有统计学意义(P<0.05)；CHD合并DM组患者病变支数和Gensini评分明显多(高)于CHD组，差异均具有统计学意义(P<0.05)；经Pearson相关性分析结果显示，CHD合并DM患者血清中ZO-1表达与舒张压、病变支数、FPG、HbA1c、Gensini评分均呈正相关(P<0.05)，与LVEF呈负相关(P<0.05)，CX43与舒张压、病变支数、FPG、HbA1c、Gensini评分均呈负相关(P<0.05)，与LVEF呈正相关(P<0.05)；经ROC分析结果显示，CX43、ZO-1预测 CHD合并 DM患者的曲线下面积(AUC)分别为 0.953 (95%CI：0.904~0.981)、0.955(95%CI：0.908~0.983)，对应的敏感度分别为83.72%、94.19%，特异度分别为96.61%、88.14%，两者联合预测的AUC为 0.994 (95%CI：0.963~0.999)，敏感度为 98.84%，特异度为 93.22%；经多因素Logistic回归分析结果显示，CX43、ZO-1、病变支数、FPG、HbA1c、LVEF、Gensini评分均是CHD合并DM发生的危险因素(P<0.05)。结论 CHD合并DM患者血清中ZO-1表达升高，CX43表达下降，两者表达与冠状动脉病变程度密切相关。
      【关键词】 冠心病；糖尿病；连接蛋白43；闭锁小带蛋白-1；冠状动脉病变；相关性
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2022）24—3151—05

Expression of serum connexin 43 and zona occluden-1 in patients with coronary heart disease complicated withdiabetes mellitus and its relationship with coronary artery lesions.
LI Qian, ZHOU Jin-bao. Department ofCardiovascular Medicine, Yan'an Hospital of Traditional Chinese Medicine, Yan'an 716000, Shaanxi, CHINA
【Abstract】 Objective To investigate the expression of connexin 43 (CX43) and zonula occluden-1 (ZO-1) inserum of patients with coronary heart disease (CHD) and diabetes mellitus (DM), and to analyze their relationship withcoronary artery lesions. Methods A total of 145 patients with CHD who underwent coronary angiography and diag-nosed in Yan'an Hospital of Traditional Chinese Medicine from July 2020 to January 2022 were selected as the researchobjects. The patients were grouped into CHD group (without DM, n=59) and CHD with DM group (n=86) according towhether they had DM, and 60 healthy subjects were regarded as the control group at the same time. The general data ofthe research subjects were collected, and the degree of coronary artery lesions was assessed by Gensini score. The expres-sion level of CX43 mRNA in serum was measured by real-time fluorescence quantitative PCR method. The level ofZO-1 in serum was measured by enzyme-linked immunosorbent assay (ELISA), and the correlation of CX43, ZO-1 ex-pression with clinical indicators was analyzed by Pearson method. The diagnostic value of serum CX43 and ZO-1 forCHD complicated with DM was evaluated by receiver operating characteristic (ROC) curve. Multivariate Logistic regres-sion analysis was used to analyze the risk factors of CHD complicated with DM. Results The expression level of ZO-1in CHD with DM group was (3.85±0.61) ng/mL, which was significantly higher than (2.48±0.55) ng/mL in CHD groupand (1.16±0.39) ng/mL in the control group, and the expression level of CX43 in serum was 2.75±0.63, significantly low-er than 4.89±0.85 in the CHD group and 10.68±1.83 in the control group (P<0.05). At the same time, the diastolic bloodpressure, FPG, and HbA1c of CHD with DM group were higher than those of control group and CHD group, and LVEFwas lower than those of control group and CHD group, with statistically significant differences (P<0.05). The number of