[1]周卫平,杨钱,林国建.2型糖尿病患者亚临床左心室收缩功能异常预测模型构建与验证：基于CD4+T细胞中趋化因子配体4样蛋白2/聚腺苷二磷酸核糖聚合酶8与临床数据的队列研究[J].陕西医学杂志,2026,(7):940-945.[doi:DOI:10.3969/j.issn.1000-7377.2026.07.012]
　ZHOU Weiping,YANG Qian,LIN Guojian.Construction and validation of a prediction model for subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus：A cohort study based on CCL4L2/PARP8 and clinical data[J].,2026,(7):940-945.[doi:DOI:10.3969/j.issn.1000-7377.2026.07.012]
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2型糖尿病患者亚临床左心室收缩功能异常预测模型构建与验证：基于CD4+T细胞中趋化因子配体4样蛋白2/聚腺苷二磷酸核糖聚合酶8与临床数据的队列研究

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2026年7期
页码:
940-945
栏目:
临床研究
出版日期:
2026-07-05

文章信息/Info

Title:
Construction and validation of a prediction model for subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus：A cohort study based on CCL4L2/PARP8 and clinical data
作者:
周卫平1; 杨钱2; 林国建3
(1.三峡大学附属第二人民医院 宜昌市第二人民医院内分泌科,湖北 宜昌 443000；2.三峡大学附属第二人民医院 宜昌市第二人民医院心血管内科,湖北 宜昌 443000；3.三峡大学附属第二人民医院 宜昌市第二人民医院放射科,湖北 宜昌 443000)
Author(s):
ZHOU Weiping1; YANG Qian2; LIN Guojian3
(1.Department of Endocrinology,The Second People’s Hospital of Yichang/The Second Affiliated Hospital of China Three Gorges University,Yichang 443000,China;2.Department of Cardiology,The Second People’s Hospital of Yichang/The Second Affiliated Hospital o
关键词:
CD4+T细胞中趋化因子配体4样蛋白2; 聚腺苷二磷酸核糖聚合酶8; 2型糖尿病; 糖尿病心肌病; 左心室收缩功能; 亚临床期
Keywords:
CCL4L2; PARP8; T2DM; DCM; Left ventricular systolic function; Subclinical stage
分类号:
R 587.1
DOI:
DOI:10.3969/j.issn.1000-7377.2026.07.012
文献标志码:
A
摘要:
目的：明确CD4+T细胞中趋化因子配体4样蛋白2（CCL4L2）和聚腺苷二磷酸核糖聚合酶8（PARP8）对 2型糖尿病（T2DM）患者亚临床期左心室收缩功能（LVSF）异常的影响，建立并验证列线图预测模型为临床早期LVSF异常诊断提供新方法。方法：采用巢式病例-对照研究，以收治的400例T2DM患者为基础队列，以GLS＜18%为判定标准，将随访期间127例并发LVSF异常者作为异常组，匹配127例未并发LVSF异常者为未异常组，最终纳入254例研究对象。按7∶3比例采用简单随机抽样拆分为训练集178例（异常组89例、未异常组89例）和验证集76例（异常组38例、未异常组38例）。比较两组临床资料及CCL4L2、PARP8表达差异，通过Logistic回归筛选独立危险因素，构建列线图模型并采用ROC曲线、校准曲线及Hosmer-Lemeshow检验验证模型效能。结果：无异常组糖化血红蛋白（HbA1c）、甘油三酯（TG）均低于异常组，高密度脂蛋白胆固醇（HDL-C）、左心室射血分数（LVEF）、左心室整体纵向应变（LV-GLS）、长轴纵向应变（LALS）、两腔心纵向应变（2CV-LS）、四腔心纵向应变（4CV-LS）均高于异常组，差异有统计学意义（均P<0.05）。无异常组CCL4L2，PARP8表达量低于异常组，差异有统计学意义（均P<0.05）。Logistic结果显示高表达CCL4L2，高表达PARP8，高比例HbA1c，低浓度HDL-C是影响T2DM患者并发LVSF异常的独立危险因素（均P＜0.05）。训练集联合模型AUC=0.965（95%CI：0.944~0.985），灵敏度95.5%，特异度91.3%；验证集AUC=0.971（95%CI：0.945~0.998），灵敏度96.1%，特异度93.8%。校准曲线显示预测概率与实际发生率拟合良好，Hosmer-Lemeshow检验P值分别为0.219（训练集）和0.304（验证集）。结论：CCL4L2、PARP8高表达及HbA1c升高、HDL-C降低是T2DM患者亚临床期LVSF异常的独立危险因素，基于上述因素构建的列线图预测模型具有优异的预测效能，可作为临床早期筛查工具。
Abstract:
Objective:To clarify the impact of Chemokine Ligand 4 Like 2 (CCL4L2) and Poly ADP-ribose Polymerase 8 (PARP8) in peripheral blood CD4+T cells on subclinical Left Ventricular Systolic Function (LVSF) dysfunction in patients with type 2 diabetes mellitus (T2DM),establish and validate a nomogram prediction model,and optimize clinical early intervention strategies.Methods：A nested case-control study was adopted.A baseline cohort of 400 T2DM patients admitted to our hospital from May 2022 to May 2024 was established.During follow-up,127 patients with concurrent LVSF dysfunction were selected as the abnormal group,and 127 patients without LVSF dysfunction were matched as the non-abnormal group by 1∶1 individual matching based on age (±3 years) and the same year and month of initial examination,resulting in a total of 254 subjects.They were divided into a training set (178 cases：89 in the abnormal group and 89 in the non-abnormal group) and a validation set (76 cases：38 in the abnormal group and 38 in the non-abnormal group) by simple random sampling in a 7∶3 ratio.Differences in clinical data and the expression of CCL4L2 and PARP8 between the two groups were compared.Logistic regression was used to screen for independent risk factors,and a nomogram model was constructed.The model performance was verified by ROC curve,calibration curve,and Hosmer-Lemeshow test.Results:The levels of glycated hemoglobin (HbA1c) and triglyceride (TG) in the non-abnormal group were significantly lower than those in the abnormal group,while the levels of high-density lipoprotein cholesterol (HDL-C),left ventricular ejection fraction (LVEF),left ventricular global longitudinal strain (LV-GLS),long-axis longitudinal strain (LALS),two-chamber view longitudinal strain (2CV-LS) and four-chamber view longitudinal strain (4CV-LS) were significantly higher (all P<0.05).The expression levels of CCL4L2 and PARP8 in the non-abnormal group were significantly lower than those in the abnormal group (all P<0.05).Logistic regression analysis showed that high expression of CCL4L2,high expression of PARP8 and elevated HbA1c and low HDL-C were independent risk factors for concurrent LVSF dysfunction in T2DM patients,whereas elevated HDL-C was an independent protective factor (all P<0.05).For the combined model,the training set had an AUC of 0.965 (95%CI：0.944~0.985),a sensitivity of 95.5% and a specificity of 91.3%;the validation set had an AUC of 0.971 (95%CI：0.945~0.998),a sensitivity of 96.1% and a specificity of 93.8%.The calibration curve showed a good fit between the predicted probability and the actual incidence of the model,with Hosmer-Lemeshow test P-values of 0.219 (training set) and 0.304 (validation set),respectively.Conclusion:High expressions of CCL4L2 and PARP8,elevated HbA1c,and decreased HDL-C are independent risk factors for subclinical LVSF dysfunction in T2DM patients.The constructed nomogram prediction model based on the above factors has excellent predictive performance and can serve as a clinical early screening tool.

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备注/Memo

备注/Memo:
湖北省卫生健康委员会科研项目（WJ2023M155）；湖北省卫生健康委员会面上项目(WJ2019M065)； 湖北省宜昌市科学技术局医疗卫生研究项目(A20-2-034)
更新日期/Last Update: 2026-07-10