Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes

PENG Shaolin; LU Xiaoyu; YANG Jingjin; ZHANG Ling; PENG Nianchun; YANG Shuibing

doi:10.16766/j.cnki.issn.1674-4152.004483

Volume 24 Issue 5

May 2026

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Article Navigation > Chinese Journal of General Practice > 2026 > 24(5): 750-754

PENG Shaolin, LU Xiaoyu, YANG Jingjin, ZHANG Ling, PENG Nianchun, YANG Shuibing. Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes[J]. Chinese Journal of General Practice, 2026, 24(5): 750-754. doi: 10.16766/j.cnki.issn.1674-4152.004483

Citation:

PENG Shaolin, LU Xiaoyu, YANG Jingjin, ZHANG Ling, PENG Nianchun, YANG Shuibing. Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes[J]. Chinese Journal of General Practice, 2026, 24(5): 750-754. doi: 10.16766/j.cnki.issn.1674-4152.004483

Citation:

PENG Shaolin, LU Xiaoyu, YANG Jingjin, ZHANG Ling, PENG Nianchun, YANG Shuibing. Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes[J]. Chinese Journal of General Practice, 2026, 24(5): 750-754. doi: 10.16766/j.cnki.issn.1674-4152.004483

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Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes

doi: 10.16766/j.cnki.issn.1674-4152.004483

1.
Department of Endocrinology, Metabolism and Clinical Nutrition, Hunan University of Medicine General Hospital; Huaihua Sub-center of National Clinical Research Center for Metabolic Diseases; Huaihua Sub-center of National Metabolic Management Center (MMC), Huaihua, Hunan 418000, China

Funds:

D202303068330

2021R3119

Received Date: 2025-06-25
Available Online: 2026-10-23

Abstract

Abstract

Objective To explore the diagnostic value of combined detection of lipoprotein-associated phospholipase A2 (Lp-PLA2), cystatin C (CysC), and homocysteine (Hcy) in cardiac autonomic neuropathy in type 2 diabetes mellitus (DCAN) to assess whether it is superior to each indicator alone. Methods A total of 204 inpatients diagnosed with type 2 diabetes mellitus admitted to the Department of Endocrinology and Metabolism at Hunan University of Medicine General Hospital between December 2021 and January 2023 were retrospectively. All patients were divided into the DCAN group (n=106) and the non-DCAN group (n=98). General patient information was recorded, and biochemical indices such as Lp-PLA2, CysC, and Hcy were measured in each group. Spearman correlation analysis was employed to assess the relationships among Lp-PLA2, CysC, Hcy, and DCAN. Multivariate logistic regression analysis was performed to investigate the potential risk factors associated with DCAN. The receiver operating characteristic (ROC) curve was utilized to analyze the predictive value of the combined indices in DCAN. Results The concentrations of Lp-PLA2, CysC, and Hcy were all elevated in the DCAN group compared to those in the non-DCAN group (P < 0.05). Spearman correlation analysis indicated that Lp-PLA2, CysC, and Hcy were positively correlated with DCAN (r_s=0.816, P=0.040; r_s= 0.713, P=0.020; r_s=0.676, P < 0.001). ROC analysis showed that the areas under the curves for Lp-PLA2, CysC, and Hcy were 0.607 (P=0.008), 0.540 (P=0.019), and 0.625 (P=0.002), respectively. The AUC for the combined detection of the three biomarkers was 0.745 (95% CI: 0.679-0.811, P < 0.001), exhibiting a sensitivity of 80.1% and a specificity of 70.5%. Conclusion Lp-PLA2, CysC, and Hcy were identified as independent risk factors for DCAN. Combined detection of these biomarkers demonstrates moderate diagnostic value and may improve the identification in the diagnosis of DCAN.
- Type 2 diabetes mellitus,
- Cardiac autonomic neuropathy,
- Lipoprotein-associated phospholipase A2,
- Cystatin C,
- Homocysteine

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References(27)

References

[1]	黄恺, 曾天舒, 刘刚, 等. 中国成人2型糖尿病及糖尿病前期患者动脉粥样硬化性心血管疾病预防与管理专家共识[J]. 中国糖尿病杂志, 2023, 31(9): 641-656. HUANG K, ZENG T S, LIU G, et al. Expert consensus on the prevention and management of atherosclerotic cardiovascular disease in Chinese homo sapiens with type 2 diabetes and prediabetes[J]. Chinese Journal of Diabetes, 2023, 31(9): 641-656.
[2]	李阳, 胡小磊, 朱月皓. 糖尿病患者降糖药临床应用相关问题的调查与分析[J]. 中华全科医学, 2025, 23(1): 81-84. doi: 10.16766/j.cnki.issn.1674-4152.003840 LI Y, HU X L, ZHU Y H. Investigation and analysis of problems related to clinical application of hypoglycemic drugs in diabetic patients[J]. Chinese Journal of General Practice, 2025, 23(1): 81-84. doi: 10.16766/j.cnki.issn.1674-4152.003840
[3]	KEMPLER P, KÖREI A. Diabetic cardiovascular autonomic neuropathy: clinical significance, diagnosis and therapy[J]. Orv Hetil, 2024, 165(16): 602-612. doi: 10.1556/650.2024.33027
[4]	KARTHIKEYAN A, MANJUNATH P R, LATHA A T, et al. Prevalence of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus[J]. J Family Med Prim Care, 2023, 12(9): 2070-2074. doi: 10.4103/jfmpc.jfmpc_609_23
[5]	DUQUE A, MEDIANO M F F, DE LORENZO A, et al. Cardiovascular autonomic neuropathy in diabetes: pathophysiology, clinical assessment and implications[J]. World J Diabetes, 2021, 12(6): 855-867. doi: 10.4239/wjd.v12.i6.855
[6]	OMRAN F, KYROU I, OSMAN F, et al. Cardiovascular biomarkers: lessons of the past and prospects for the future[J]. Int J Mol Sci, 2022, 23(10): 5680. DOI: 10.3390/ijms23105680.
[7]	余聪聪, 许炳, 尤巧英. 同型半胱氨酸与2型糖尿病心血管自主神经病变关系的研究进展[J]. 临床医学研究与实践, 2023, 8(34): 194-198. YU C C, XU B, YOU Q Y. Research progress on the relationship between homocysteine and cardiovascular autonomic neuropathy in type 2 diabetes mellitus[J]. Clinical Medicine Research and Practice, 2023, 8(34): 194-198.
[8]	BELL D S H. Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes[J]. Diabetes Obes Metab, 2022, 24(8): 1423-1428. doi: 10.1111/dom.14734
[9]	LEE D Y. Emerging circulating biomarkers for enhanced cardiovascular risk prediction[J]. J Lipid Atheroscler, 2024, 13(3): 262-279. doi: 10.12997/jla.2024.13.3.262
[10]	徐梦珠, 吴坚, 郝娟, 等. 2型糖尿病患者心脏自主神经病变相关危险因素[J]. 医学综述, 2022, 28(2): 372-379. XU M Z, WU J, HAO J, et al. Risk factors associated with cardiac autonomic neuropathy in patients with type 2 diabetes[J]. Medical Recapitulate, 2022, 28(2): 372-379.
[11]	彭少林, 李珏笛, 喻思宇, 等. 2型糖尿病心脏自主神经病变临床特征及诊疗研究进展[J]. 中国慢性病预防与控制, 2021, 29(10): 776-781. PENG S L, LI J D, YU S Y, et al. Clinical characteristics and research progress in diagnosis and treatment of cardiac autonomic neuropathy in type 2 diabetes[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2021, 29(10): 776-781.
[12]	HSIEH D Y, LAI Y R, HUANG C C, et al. Baroreflex sensitivity as a surrogate biomarker for concurrently assessing the severity of arterial stiffness and cardiovascular autonomic neuropathy in individuals with type 2 diabetes[J]. J Pers Med, 2024, 14(5): 491. DOI: 10.3390/jpm14050491.
[13]	MCCRORY C, MCLOUGHLIN S, LAYTE R, et al. Towards a consensus definition of allostatic load: a multi-cohort, multi-system, multi-biomarker individual participant data (IPD) meta-analysis[J]. Psychoneuroendocrinology, 2023, 153: 106117. DOI: 10.1016/j.psyneuen.2023.106117.
[14]	CARREIRA M, ARAÚJO J P, BETTENCOURT P, et al. Elevated cystatin C predicts higher mortality in chronic heart failure independently of renal function[J]. Crit Pathw Cardiol A J Evid Based Med, 2024, 23(3): 119-123.
[15]	ZHU L, YU C Q, CHANG Y Y, et al. Serum cystatin C is associated with depression after intracerebral hemorrhage[J]. Neuropsychiatr Dis Treat, 2023, 19: 1117-1126. doi: 10.2147/NDT.S409421
[16]	WANG R R, ZHANG J, XU J G, et al. Association between initial serum cystatin C level and prognosis of aneurysmal subarachnoid hemorrhage[J]. BMC Neurol, 2025, 25(1): 151. DOI: 10.1186/s12883-025-04162-z.
[17]	MUZUROVIC E, KRALJEVIC I, SOLAK M, et al. Homocysteine and diabetes: role in macrovascular and microvascular complications[J]. J Diabetes Complications, 2021, 35(3): 107834. DOI: 10.1016/j.jdiacomp.2020.107834.
[18]	AN Y, XU B T, WAN S R, et al. The role of oxidative stress in diabetes mellitus-induced vascular endothelial dysfunction[J]. Cardiovasc Diabetol, 2023, 22(1): 237. DOI: 10.1186/s12933-023-01965-7.
[19]	JIANG Q, WANG L, SI X, et al. Current progress on the mechanisms of hyperhomocysteinemia-induced vascular injury and use of natural polyphenol compounds[J]. Eur J Pharmacol, 2021, 905: 174168. DOI: 10.1016/j.ejphar.2021.174168.
[20]	韦爱君, 贺杜鹃, 张梅奎. 同型半胱氨酸通过上调Rap1a诱导小鼠小胶质细胞炎性极化[J]. 中国病理生理杂志, 2023, 39(12): 2242-2250. WEI A J, HE D J, ZHANG M K. Homocysteine induces inflammatory polarization in mouse microglia by up-regulating Rap1a[J]. Chinese Journal of Pathophysiology, 2023, 39(12): 2242-2250.
[21]	TAWFIK A, ELSHERBINY N M, ZAIDI Y, et al. Homocysteine and age-related central nervous system diseases: role of inflammation[J]. Int J Mol Sci, 2021, 22(12): 6259. DOI: 10.3390/ijms22126259.
[22]	CHEN Y H, WANG S X, LI J, et al. The relationships between biological novel biomarkers Lp-PLA2 and CTRP-3 and CVD in patients with type 2 diabetes mellitus[J]. J Diabetes, 2024, 16(7): e13574. DOI: 10.1111/1753-0407.13574.
[23]	王钰滢, 崔德芝. Lp-PLA2在老年糖尿病血管并发症中的作用机制[J]. 中国老年学杂志, 2025, 45(16): 4073-4077. WANG Y Y, CUI D Z. Mechanism of Lp-PLA2 in Vascular Complications of Elderly Diabetes Mellitus[J]. Chinese Journal of Gerontology, 2025, 45(16): 4073-4077.
[24]	ZHANG Z, QIAN X, SUN Z W, et al. Association between lipoprotein-associated phospholipase A2 and 25-hydroxy-vitamin D on early stage diabetic kidney disease in patients with type-2 diabetes mellitus[J]. Heliyon, 2024, 10(16): e35635. DOI: 10.1016/j.heliyon.2024.e35635.
[25]	吕晓伟, 刘倩, 周欢欢, 等. 外周血β2微球蛋白、TFF3、Lp-PLA2对老年2型糖尿病患者早期肾功能损害及蛋白尿进展的评估价值[J]. 中国现代医学杂志, 2025, 35(15): 16-22. LYU X W, LIU Q, ZHOU H H, et al. Evaluation value of peripheral blood β2-microglobulin, TFF3, and Lp-PLA2 in assessing early renal impairment and proteinuria progression in elderly patients with type 2 diabetes mellitus[J]. China Journal of Modern Medicine, 2025, 35(15): 16-22.
[26]	廖国平, 范华青, 黄文彩, 等. Lp-PLA2、S-100B蛋白水平联合检测在糖尿病周围神经病变中的诊断价值[J]. 国际检验医学杂志, 2023, 44(20): 2490-2493. LIAO G P, FAN H Q, HUANG W C, et al. Diagnostic value of combined detection of Lp-PLA2 and S-100B protein levels in diabetic peripheral neuropathy[J]. International Journal of Laboratory Medicine, 2023, 44(20): 2490-2493.
[27]	吴强, 张虹, 贾文侠. 血清Lp-PLA2、NT-proBNP及hs-cTnI对冠心病合并左心衰短期预后的预测价值[J]. 临床医学研究与实践, 2024, 9(23): 98-101. WU Q, ZHANG H, JIA W X. Predictive value of serum Lp-PLA2, NT-proBNP and hs-cTnI on the short-term prognosis of coronary heart disease with left heart failure[J]. Clinical Research and Practice, 2024, 9(23): 98-101.

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Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes

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Diagnostic value of combined detection of three serum markers in cardiac autonomic neuropathy in type 2 diabetes

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