| Objective:Type 2 diabetes mellitus(T2DM)is a global health disease with rapidly increasing incidence.It is a factor that increases the risk of myocardial disease independent of Coronary Artery Disease(CAD),hypertension and atherosclerosis,and increases a huge economic and health burden to society.Cardiac dysfunction in patients with type 2 diabetes mellitus usually manifests as left ventricular diastolic dysfunction in the early stage,and its pathological process is related to myocardial fibrosis and left ventricular hypertrophy.At present,early detection of diastolic dysfunction in T2 DM patients mainly relies on cardiac ultrasound,and there is a lack of serum biomarkers for early detection of cardiac dysfunction,so as to start corresponding treatment early.Current studies suggest that insulin resistance(IR)caused by impaired insulin signaling in cardiomyocytes is an important predictor of cardiac dysfunction in diabetes.Ty G index is considered to be an effective measure of insulin resistance,which is related to the severity of coronary heart disease,stroke and other diseases,and is related to the decline of left ventricular diastolic function in patients with hypertension.Fibronectin Type Ⅲ-omain Containing Protein 5(FNDC5),an upstream factor of Irisin,has been confirmed to be related to insulin resistance.There is no relevant study on Ty G index combined with FNDC5 in the diagnosis of early cardiac dysfunction in patients with type 2 diabetes.The aim of this study is to observe the difference of Triglyceride-Glucose index and FNDC5 level between patients with type 2 diabetes mellitus and non-diabetic patients,and the relationship between Ty G index and serum FNDC5 level and left ventricular diastolic function in patients with type 2 diabetes mellitus,to evaluate their diagnostic efficacy and explore their clinical value.Methods:A total of 158 patients with Type 2 diabetes mellitus(T2DM)admitted to the Department of Endocrinology and Health Care of Qingdao Municipal Hospital from November 2021 to June 2022 were selected,and 37 patients with non-T2 DM were selected as the control grou The patient’s age,gender,height,weight,body mass index(BMI= weight/height 2),heart rate,blood pressure,smoking and drinking history,hypertension and other medical history were collected.At the same time,the patient’s laboratory test results were collected.Ty G index was calculated,and serum FNDC5 level was detected by enzyme linked immunosorbent assay(ELISA).The results of echocardiography were collected.SPSS software was used for statistical analysis of the collected data.Continuous variables with normal distribution were expressed as X±s,and independent sample t test was used for comparison between groups.Non-normally distributed continuous variables were presented as M(P25,P75),and Mann-Whitney U test was used for comparison between groups.Categorical variables were presented as frequency(%),and chi-square test was used for comparison between groups.Correlation analysis was used to analyze the correlation between serum FNDC5 level,Ty G index and left ventricular diastolic function related indicators in patients with T2 DM.The relationship between continuous variables was analyzed by Pearman correlation coefficient in accordance with normal distribution,and Spearman correlation coefficient in non-normal distribution.The receiver operating characteristic curve(ROC curve)and the area under curve(AUC)were used to analyze the relationship between the receiver operating characteristic curve and the AUC.AUC was used to analyze the predictive ability of serum FNDC5 level,Ty G index and their combination for elevated left ventricular filling pressure.Spss software was used to compare the AUC between the two groups using Z test.All results of P < 0.05 were considered statistically significant.Results:1.There was no significant difference in age,gender,heart rate,systolic blood pressure,diastolic blood pressure,history of hypertension and coronary heart disease,liver and kidney function,LDL-c between patients with type 2 diabetes and non-type2 diabetes(P > 0.05).The levels of BMI,glycosylated hemoglobin and fasting blood glucose were significantly increased,while the levels of high-density lipoprotein cholesterol and serum FNDC5 were significantly decreased,and Ty G index was significantly increased(P < 0.05).2.Compared with non-T2 DM patients,the e ’wave velocity of mitral annulus septum,e’ wave velocity of mitral annulus lateral wall and E/A ratio were lower in T2 DM patients.The E/ mitral annulus septum e ’wave velocity ratio,E/ lateral wall e’wave velocity ratio,mean E/e ’ratio and interventricular septum thickness were higher(P < 0.05,statistically significant).3.Linear correlation analysis showed that FNDC5 was negatively correlated with triglyceride-glucose index(r=-0.159,P=0.045),and serum FNDC5 concentration was positively correlated with E/A(r=0.291,P=0.006)and negatively correlated with E/mitral annular septum e ’(r=-0.495,P=0.000).r=-0.595,P=0.000),E/ mean e’(r=-0.610,P=0.000),and left atrial anteroposterior diameter(r=-0.304,P=0.002).Ty G index was positively correlated with E/ mitral annular septum e ’(r=0.214,P=0.002),E/ mean e’(r=0.158,P=0.047)and left ventricular wall thickness(r=0.169,P=0.034)in patients with type 2 diabetes mellitus.4.Multiple linear regression analysis showed that age,Ty G index and FNDC5 concentration were independent influencing factors of the average E/e ’ratio of left ventricular diastolic function indexes.5.The results of ROC curve analysis showed that the area under the ROC curve(AUC)of Ty G index for diagnosing abnormal left ventricular filling pressure was0.727,the Youden index was 1.912,the sensitivity was 1.000,and the specificity was0.575.The area under the curve of FNDC5 concentration was 0.824,the Youden index was 416.92,the sensitivity was 0.917,and the specificity was 0.701.The area under the curve of the combined diagnostic model was 0.864,the sensitivity was0.917,and the specificity was 0.761.Further comparison between AUC showed that the diagnostic efficacy of FNDC5 concentration was better than that of Ty G index(P=0.042),and the diagnostic efficacy of the combined diagnostic model of Ty G index and FNDC5 concentration was better than that of FNDC5 concentration and Ty G index(P < 0.05).Conclusions:This experiment confirmed that serum FNDC5 level was significantly lower and Ty G index was significantly higher in patients with type 2 diabetes than in those without type 2 diabetes,and that serum FNDC5 level was negatively correlated with Ty G index in patients with type 2 diabetes.In addition,there are differences in left ventricular diastolic function parameters between patients with type 2 diabetes mellitus and those without type 2 diabetes mellitus,and left ventricular diastolic function parameters in patients with type 2 diabetes mellitus are related to serum FNDC5 level and Ty G index.Serum FNDC5 level and Ty G index are independent influencing factors for elevated left ventricular filling pressure in patients with type 2diabetes mellitus.In addition,serum FNDC5 level and Ty G index have certain diagnostic value for elevated left ventricular filling pressure in patients with type 2diabetes mellitus,and the diagnostic efficacy of serum FNDC5 level is better than Ty G index.Combined detection of serum FNDC5 level and Ty G index can further improve the accuracy of elevated left ventricular filling pressure in patients with type2 diabetes mellitus.Therefore,we speculate that serum FNDC5 level and Ty G index may be of great significance for early diagnosis of early cardiac dysfunction in patients with type 2 diabetes mellitus,and have certain value in judging the severity of the disease in clinical practice. |
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