The Relationship Between Serum MLCK1 And Type 2 Diabetes Mellitus With Left Ventricular Diastolic Dysfunction

ObjectiveDiabetes mellitus is one of the most common chronic diseases in China.65% of the Type 2 diabetes mellitus(T2DM)death patients are due to cardiovascular disease.So the typical abnormal function of the heart in T2 DM is left ventricular diastolic dysfunction,and the main mechanism may be related to the changes in the structure and function of microvascular endothelial.Myosin light chain kinase 1(MLCK1)is a serine/threonine protein kinase found mainly in smooth muscle cells and plays a leading role in the increase of endothelial permeability.The purpose of this study is to determine the level of serum MLCK1 in patients with T2 DM through case-control study,in order to the correlation between serum MLCK1 and type 2 diabetes mellitus with left ventricular diastolic dysfunction,as well as the influence of various factors on left ventricular diastolic dysfunction in type 2 diabetes mellitus,Moreover,this article is intended to provide more theoretical basis and clinical data about the pathogenesis and treatment for the left ventricular diastolic dysfunction in type 2 diabetes mellitus.MethodsThe subjects of this study were 198 patients admitted to the Department of Endocrinology of the First Affiliated Hospital of Xi ’an Medical University from June2020 to November 2020,including 148 cases in the case group and 50 cases in the control group.According to the ratio of early and late diastolic mitral flow E and A wave(E/A),patients in the case group were divided into T2 DM group with normal left ventricular diastolic function(n = 73)and T2 DM group with left ventricular diastolic dysfunction(n = 75).Enzyme linked immunosorbent assay(ELISA)was used to detect serum MLCK1 concentration in all subjects.The left ventricular ejection fraction(EF)was calculated by a modified simpson method.Cardiac diastolic function was measured by color doppler.Early diastolic transmitral velocities(E)and late diastolic transmitral velocities(A)and E/A were measured by spectral doppler.Inter ventricular septal thicknes(IVST)and left ventricular posterior wall end-diastolic thickness(LVPWT),Left ventricular diastolic diameter(LVEDD)et al.Body mass index(BMI),HOMA-insulin resistance index(HOMA-IR),HOMA beta cell function index(HOMA-β),Left ventricular mass index(LVMI)is calculated based on the above indicators.The input data were sorted out and SPSS22.0 software was used for statistical analysis of the data.and P< 0.05 indicated that the difference was statistically significant.Results1.The data showed the level of MLCK1 an increasing trend among the T2 DM patients with normal left ventricular diastolic function group(72.77±22.66μmol/L),the T2 DM patients with left ventricular diastolic dysfunction group(102.36±26.31μmol/L)and the type 2 diabetes mellitus complicated with diastolic dysfunction group(135.25±37.81μmol/L).Besides,there was a statistical difference between the three groups(P < 0.05),and MLCK1 was positively correlated withthe severity of type 2diabetes mellitus(r= 0.672,P < 0.05).2.In T2 DM patients with normal left ventricular diastolic function,the level of serum MLCK1 was correlated with negatively correlated with left ventricular systolic diameter(LEVSD)and fasting C-peptide(FCP)(r=-0.262,P<0.05;r=-0.547,P<0.05)and positively correlated with fasting plasma glucose(FPG)(r=0.297,P<0.05);In T2 DM patients with left ventricular diastolic dysfunction,the level of serum MLCK1 level was negatively correlated with E peak and FCP(r=-0.381,P<0.05;r=-0.758,P<0.05)and positively correlated with FPG and 2 hours postprandial plasma glucose(2h PG)(r=0.326,P<0.05;r=0.314,P<0.05).3.The experimental results showed that age(95%CI:1.067-1.176),MLCK1(95%CI:1.052-1.111)and FCP(95%CI:2.363-8.919)are independent risk factors affecting E/A ratio,with OR values of 1.12、1.081、4.591 respectively.4.The area under curve of MLCK1 level for diagnosis of T2 DM is 0.877,P<0.05.When MLCK1 level is greater than or equal to 94.27μmol/L,the corresponding specificity and sensitivity are 84% and 76.4%.The area under curve of serum MLCK level in diagnosis of type 2 diabetes mellitus with left ventricular diastolic dysfunction was0.780,P < 0.05.When MLCK1 level is greater than or equal to 115.52 μmol/L,the corresponding specificity and sensitivity are 78.1% and 74.7%.Conclusion1.The level of serum MLCK1 increased gradually in healthy people,T2 DM patients with normal left ventricular diastolic,T2 DM patients with left ventricular diastolic dysfunction,which indicated that MLCK1 may be related to the occurrence of type 2 diabetes mellitus and participate in the occurrence of left ventricular diastolic dysfunction caused by type 2 diabetes mellitus by affecting endothelial cell function.2.Serum MLCK1 level is correlated with FPG,2h PG,FCP,which indicates that there may be a certain relationship between MLCK1 and glucose metabolism,so MLCK1 has certain significance for clinical evaluation and intervention of type 2 diabetes.3.Higher serum MLCK1 is a new risk factor of left ventricular diastolic dysfunction caused by type 2 diabetes mellitus,which can be used as one of the screening indexes of early left ventricular diastolic dysfunction in type 2 diabetes mellitus patients,and provides early identification and early intervention of left ventricular diastolic dysfunction in type 2 diabetes mellitus patients.