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糖尿病患者特征、治疗方式、肾功能损害及炎症标志物的聚类分析

Cluster analysis of patient characteristics, treatment modalities, renal impairments, and inflammatory markers in diabetes mellitus.

作者信息

Cojic Milena, Klisic Aleksandra, Sahmanovic Amina, Petrovic Nemanja, Kocic Gordana

机构信息

University of Montenegro-Faculty of Medicine, Podgorica, Montenegro.

Primary Health Care Center, Podgorica, Montenegro.

出版信息

Sci Rep. 2024 Mar 12;14(1):5994. doi: 10.1038/s41598-024-56451-1.

Abstract

Type 2 diabetes mellitus (T2DM) is caused by an interplay of various factors where chronic hyperglycemia and inflammation have central role in its onset and progression. Identifying patient groups with increased inflammation in order to provide more personalized approach has become crucial. We hypothesized that grouping patients into clusters according to their clinical characteristics could identify distinct unique profiles that were previously invisible to the clinical eye. A cross-sectional record-based study was performed at the Primary Health Care Center Podgorica, Montenegro, on 424 T2DM patients aged between 30 and 85. Using hierarchical clustering patients were grouped into four distinct clusters based on 12 clinical variables, including glycemic and other relevant metabolic indicators. Inflammation was assessed through neutrophil-to-lymphocyte (NLR) and platelet to lymphocyte ratio (PLR). Cluster 3 which featured the oldest patients with the longest T2DM duration, highest hypertension rate, poor glycemic control and significant GFR impairment had the highest levels of inflammatory markers. Cluster 4 which featured the youngest patients, with the best glycemic control, the highest GFR had the lowest prevalence of coronary disease, but not the lowest levels of inflammatory markers. Identifying these clusters offers physicians opportunity for more personalized T2DM management, potentially mitigating its associated complications.

摘要

2型糖尿病(T2DM)是由多种因素相互作用引起的,其中慢性高血糖和炎症在其发病和进展中起核心作用。识别炎症增加的患者群体以便提供更个性化的治疗方法已变得至关重要。我们假设根据患者的临床特征将其分组可以识别出以前临床无法察觉的独特特征。在黑山波德戈里察的初级卫生保健中心对424名年龄在30至85岁之间的T2DM患者进行了一项基于记录的横断面研究。使用层次聚类法,根据12个临床变量(包括血糖和其他相关代谢指标)将患者分为四个不同的组。通过中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)评估炎症。第3组患者年龄最大,T2DM病程最长,高血压发生率最高,血糖控制不佳且肾小球滤过率(GFR)显著受损,其炎症标志物水平最高。第4组患者最年轻,血糖控制最佳,GFR最高,冠心病患病率最低,但炎症标志物水平并非最低。识别这些组为医生提供了更个性化管理T2DM的机会,有可能减轻其相关并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ae0/10933260/d4b4f1031037/41598_2024_56451_Fig1_HTML.jpg

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