基于血清miR-351、miR-638水平构建2型糖尿病患者颈动脉粥样硬化的影响因素列线图预测模型与评价OACSTPCD

Objective To construct and evaluate a nomogram prediction model of influencing factors of carotid atherosclerosis(CAS)in patients with type 2 diabetes mellitus(T2DM)base on serum microribonucleic acid(miR)-351 and miR-638 levels.Methods One hundred and eighty-two T2DM patients admitted to the Department of Endocrinology of The First Affiliated Hospital of Xinjiang Medical University from March 2021 to December 2022 were selected as observation group,and 91 healthy cases who underwent physical examination in the hospital during the same period were selected as healthy control group.The expression levels of serum miR-351 and miR-638,as well as differences in blood glucose and blood lipid were compared between two groups.T2DM patients were divided into CAS subgroup and non-CAS subgroup according to whether they were combined with CAS,and the differences in clinical characteristics in two subgroups were compared.The risk factors of T2DM combined with CAS were analyzed by multivariate Logistic regression.The risk nomo-gram prediction model of T2DM combined with CAS was constructed according to the risk factors.The predictive efficacy was analyzed by receiver operating characteristic(ROC)curve,and the calibration and decision-making ability of the model were analyzed by Bootstrap method and decision curve.Results The serum miR-638 level in observation group was lower than that in control group,and the serum miR-351 level was higher than that in control group(t/P=9.999/<0.001,12.051/<0.001).The level of high-density lipoprotein cholesterol(HDL-C)in observation group was lower than that in control group(t/P=11.060/<0.001),and the levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)were higher than those in control group(t=18.034,20.355,21.744,7.991,20.682,13.256,P<0.001);Multivariate Logistic regression analy-sis showed that,elevated HbA1c,TC,TG,LDL-Cand miR-351 were independent risk factors for T2DM combined with CAS[OR(95%CI)=8.129(3.377-19.567),1.444(1.093-1.908),7.868(2.254-27.459),2.728(1.241-5.997),1.337(1.039-1.721)],and elevated miR-638 was protective factor[OR(95%CI)=0.046(0.006-0.337)].ROC analysis showed that the ar-ea under the curve(AUC)of the levels of HbA1c,TC,TG,LDL-C,miR-351,miR-638 and the prediction model were 0.863,0.670,0.693,0.726,0.776,0.655 and 0.936 respectively,the AUC of the prediction model was the largest(Z=3.468,6.602,5.832,5.599,5.064,6.674,P<0.001);The nomogram model internally was verified by Bootstrap method,the repeated sampling of 1000 times(B=1000)showed that the C-index was 0.871,suggesting that the nomogram model had better predictive abil-ity.The decision analysis shows that the threshold probability of the model was 0.01-0.97,and the net return rate was>0,which was higher than two invalid lines.Conclusion The levels of serum miR-351 and miR-638 in T2DM patients are ab-normally express,which are involve in the occurrence and progression of patients with CAS combine with T2DM.Elevated HbA1c,TC,TG,LDL-C,miR-351,and decreased miR-638 are independent risk factors for T2DM combine with CAS,nomo-gram prediction model base on miR-351,miR-638 and other independent risk factors has good predictive value for T2DM combine with CAS,which could be used to evaluate the risk of patients with CAS combine with T2DM.