Abstract:

Objective To investigate the relationship between macrophage migration inhibitory factor（MIF）and carotid vascular calcification in elderly patients with type 2 diabetes mellitus（T2DM）. Methods Totally，164 patients with T2DM from Jiangmen People's Hospital from April 2018 to August 2019 were enrolled. According to the vascular calcification of carotid artery，they were classified into non-calcification group，hypocalcification group and hypercalcification group. According to the expressions of MIF，they were classified into high MIF expression group and low MIF expression group. Enzyme-linked immunosorbent assay was used to determine the level of serum MIF. All the patients were followed up for 12 months to understand the incidence of major adverse cardiovascular events. Multivariate Logistic regression analysis was used to evaluate the risk factors of carotid vascular calcification in patients with T2DM. Pearson correlation analysis was used to evaluate the correlation among the indicators. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of serum MIF in judging carotid vascular calcification in patients with T2DM. Kaplan-Meier survival curve was used to analyze the incidence of major adverse cardiovascular events in elder T2DM patients. Cox proportional hazard regression analysis were used to evaluate the influencing factors of major adverse cardiovascular events in patients with T2DM. Results The course of T2DM，systolic blood pressure，total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），fasting blood glucose，high-sensitivity C-reactive protein（hs-CRP） and MIF levels in hypercalcification group and hypocalcification group were higher than those in non-calcification group（P<0.05）. The course of T2DM，TC，LDL-C，hs-CRP and MIF levels in hypercalcification group were higher than those in hypocalcification group（P<0.05）. There was no statistical significance in sex，age，body mass index（BMI），proportion of smoking history，diastolic blood pressure，creatinine，urea，aspartate aminotransferase（AST） and alanine aminotransferase（ALT） among the 3 groups（P>0.05）. The results of multivariate Logistic regression analysis showed that the course of T2DM，TC，LDL-C，hs-CRP and MIF were risk factors of carotid vascular calcification in elderly patients with T2DM [odds ratios（OR） were 3.473，2.077，2.230，2.581 and 3.171，95% confidence intervals（CI） were 1.940-6.216，1.179-3.660，1.074-4.632，1.419-4.692 and 1.425-7.055，respectively，P<0.05]. The results of Pearson correlation analysis showed that MIF in elderly patients with T2DM was positively correlated with the course of T2DM，TC，LDL-C and hs-CRP（r=0.389，0.271，0.282 and 0.486，P<0.05）. ROC curve analysis showed that the area under curve（AUC） of MIF in judging carotid vascular calcification in elderly patients with T2DM was 0.881. The incidence of major adverse cardiovascular events in high MIF expression group was higher than that in low MIF expression group（χ²=4.261，P=0.039）. The results of Cox proportional hazard regression analysis showed that hs-CRP，LDL-C and MIF were independent risk factors for major adverse cardiovascular events in elderly T2DM patients with carotid vascular calcification [hazard ratios（HR） were 3.091，3.597 and 3.311，95% CI were 1.628-3.862，3.174-4.928 and 2.497-3.653，respectively，P<0.001]. Conclusions The level of MIF is related to carotid vascular calcification in elderly patients with T2DM，and the high expression of MIF may affect the prognosis of patients by promoting carotid vascular calcification．

Key words: Macrophage migration inhibitory factor, Vascular calcification, Type 2 diabetes mellitus, Elder