兰州大学机构库 >第一临床医学院
血清25羟维生素D与2型糖尿病合并下肢动脉病变的相关性及下肢动脉造影特点的分析
Alternative TitleAnalysis of the Relationship between 25(OH)D and LEAD in T2DM and the Characteristics of Lower Extremity Arteriography
谈娇娇
Subtype硕士
Thesis Advisor吕海宏
2021-05-20
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name医学硕士
Degree Discipline内科学
Keyword2型糖尿病 下肢动脉病变 下肢动脉血管造影 25羟维生素D
Abstract目的:本研究的目的是探讨血清25羟维生素D(25-hydroxyvitamin D, 25(OH)D)与2型糖尿病(Type 2 diabetes mellitus, T2DM)合并下肢动脉病变(Lower extremity arterial disease, LEAD)的相关性及25(OH)D与T2DM合并LEAD患者下肢动脉造影特点的关系,为T2DM合并LEAD的发病机制和防治提供一定的依据。 方法:采用回顾性研究方法,收集2019年1月-2020年6月于兰州大学第一医院就诊完善下肢动脉造影诊断为LEAD的T2DM患者74例(DM+LEAD组),同期纳入下肢动脉造影未发现LEAD的T2DM患者82例(DM组)及健康体检者88例(NC组)。收集受试者的一般资料,人体测量学资料,实验室检查指标,25(OH)D浓度,踝肱指数(ABI),肱踝脉搏波传导速度(baPWV)和下肢动脉血管造影的病历资料。比较各组的25(OH)D水平及不同浓度25(OH)D水平的例数分布。应用下肢动脉造影术,探究T2DM合并LEAD患者下肢动脉造影的特点,比较不同浓度25(OH)D与下肢动脉病变造影特点的关系。多因素二元Logistic回归分析用于探究T2DM患者发生LEAD的危险因素。采用受试者工作特征曲线(Receiver operating characteristic, ROC)分析25(OH)D筛查T2DM患者发生LEAD的最佳切点值。使用 SPSS 26.0 版本对所有数据进行统计分析。 结果: 1.研究对象基本信息、用药情况及生化指标比较:与NC组相比,DM组、DM+LEAD组BMI、WHR、FPG、FINS、HOMA-IR、HbA1C、TC、TG、LDL、CRP增高,吸烟人数更多,25(OH)D及HDL降低(P<0.05)。与DM组相比,DM+LEAD组男性占比更大,糖尿病病程更长,SBP、DBP、WHR、FPG、LDL、CRP升高而HDL、25(OH)D降低(P<0.05)。DM组、DM+LEAD组应用降血糖药物、胰岛素、抗聚药、调脂药、改善循环药物情况相似(P>0.05)。 2.三组之间不同浓度血清25(OH)D的例数比较:NC组25(OH)D充足者占20.5%,25(OH)D不足者占63.6%,25(OH)D缺乏者仅占15.9%。DM组25(OH)D充足者占9.8%,25(OH)D不足者占26.8%,25(OH)D缺乏者占63.4%。DM+LEAD组25(OH)D缺乏、不足和充足的比例分别为77.0%、14.9%和8.1%。与NC组相比,DM、DM+LEAD组中25(OH)D充足的占比低(P<0.05)。 3.T2DM合并LEAD患者下肢动脉造影特点:膝上动脉的狭窄率为51.1%,膝下动脉的狭窄率为48.9%(P>0.05)。膝上动脉的闭塞率为33.7%,膝下动脉的闭塞率为42.8%,膝上动脉的总累及率为84.8%,膝下动脉的总累及率为91.7%。膝下动脉的闭塞率及总累及率均高于膝上动脉(P<0.05)。 4.血清25(OH)D与T2DM合并LEAD患者下肢动脉造影特点的关系: (1)不同浓度25(OH)D下肢动脉狭窄节段分布:膝上动脉狭窄组25(OH)D缺乏占58.2%,不足占36.1%,充足占5.7%。膝下动脉狭窄组25(OH)D缺乏占77.8%,不足占9.6%,充足占12.6%,膝上动脉狭窄组及膝下动脉狭窄组25(OH)D缺乏占比最大,以膝下动脉狭窄组为著(P<0.05)。 (2)不同浓度25(OH)D下肢动脉闭塞节段分布:膝上动脉闭塞组25(OH)D缺乏占50.5%,不足占43.0%,充足占6.5%。膝下动脉闭塞组25(OH)D缺乏占50.0%,不足占40.7%,充足占9.3%。膝上动脉闭塞组和膝下动脉闭塞组25(OH)D缺乏占比较大,以膝上动脉闭塞组为著,但无统计学意义(P>0.05)。 (3)不同浓度25(OH)D下肢动脉狭窄与闭塞节段分布:下肢动脉狭窄组25(OH)D缺乏占67.8%,不足占23.2%,充足占9.0%。下肢动脉闭塞组25(OH)D缺乏占50.2%,不足占41.7%,充足占8.1%。下肢动脉狭窄组和闭塞组25(OH)D缺乏占比最大,以下肢动脉狭窄组为著(P<0.05)。 (4)不同浓度25(OH)D膝上动脉及膝下动脉总累及节段分布:膝上动脉总累及组25(OH)D缺乏占55.1%,不足占38.9%,充足占6.0%。膝下动脉总累及组25(OH)D缺乏占64.8%,不足占24.1%,充足占11.1%。膝上动脉总累及组和膝下动脉总累及组25(OH)D缺乏占比最大,以膝下动脉总累及组为著(P<0.05)。 5.T2DM合并LEAD影响因素的多因素二元Logistic回归分析:血清25(OH)D是T2DM患者发生LEAD的影响因素(OR=0.891,95%CI= 0.861-0.945)。 6.根据ROC曲线分析结果显示25(OH)D 筛查T2DM患者发生LEAD的AUC为0.911(95%CI:0.865-0.957, P<0.001),25(OH)D水平19.2ng/mL是筛查T2DM患者发生LEAD的最佳切点值。 结论:T2DM合并LEAD患者25(OH)D水平减低,血清维生素D缺乏占比较大。下肢动脉造影结果显示,T2DM合并LEAD患者下肢病变以膝下动脉为著,膝下动脉病变25(OH)D缺乏占比较大。低水平25(OH)D是T2DM患者发生LEAD的危险因素。高水平的25(OH)D可能是T2DM合并LEAD的保护性因素,提示临床医生及时补充维生素D,提高机体血清25(OH)D水平,可能对T2DM合并LEAD的发生发展有一定的积极作用。 关键词:2型糖尿病,下肢动脉病变,下肢动脉血管造影,25羟维生素D
Other AbstractObjective: The purpose of this study is to explore the correlation between serum 25(OH)D and LEAD in T2DM and the relationship between 25(OH)D and the characteristics of lower extremity arteriography in T2DM combined with LEAD, so as to provide a basis for the prevention and treatment of T2DM complicated with LEAD. Methods: A retrospective study was conducted to collect 74 patients with LEAD in T2DM (DM+LEAD group) diagnosed by lower extremity arteriography at the First Hospital of Lanzhou University from January 2019 to June 2020,82 patients without LEAD in T2DM (DM group) by arteriography of lower extremities and 88 healthy persons (NC group) during the same period. Collect general data of subjects in each group, anthropometric data, laboratory test indicators, 25(OH)D, ABI, baPWV and medical records of lower extremity arterial angiography data. Compare the serum 25(OH)D and the distribution of the number of cases of different vitamin D levels in each group. Lower limb arteriography was used to explore the characteristics of lower limb arteriography in patients with T2DM complicated with LEAD, and to compare the relationship between different 25(OH)D and the characteristics of LEAD. Multivariate Logistic regression analysis was used to explore the risk factors of LEAD in patients with T2DM. Receiver operating characteristic was used to analyze the best cut-off value of 25(OH)D for LEAD screening. All data were statistically analyzed using SPSS26.0 version. Results: 1.Comparison of basic information, drug use and biochemical indexes: Compared with NC group, BMI, WHR, FPG, FIns, HOMA-IR, HbA1C, TC, TG, LDL and CRP increased, smokers increased and HDL, 25(OH)D decreased in DM and DM+LEAD group. Compared with DM group, the proportion of males in DM+LEAD group was larger, the course of diabetes was longer, SBP, DBP, WHR, FPG, LDL, CRP were higher, HDL and 25(OH)D was lower in DM+LEAD group. There was no significant difference in the use of hypoglycemic drugs, insulin, anti-aggregation drugs, lipid-regulating drugs and circulatory drugs between DM and DM+LEAD group (P>0.05). 2. Comparison of the number of patients with different 25(OH)D among the three groups: In NC group, 20.5% of the patients had 25(OH)D sufficiency, 63.6% had 25(OH)D insufficiency and only 15.9% had 25(OH)D deficiency. In DM group, sufficient 25(OH)D accounted for 9.8%,25(OH)D insufficient accounted for 26.8%, and 25(OH)D deficiency accounted for 63.4%. The proportion of 25(OH)D deficiency, insufficiency and sufficiency in DM+LEAD group was 77.0%, 14.9% and 8.1%, respectively. The percentage of 25(OH)D sufficient in DM and DM+LEAD groups was significantly lower than that in NC group(P<0.05). 3.The characteristics of lower limb arteriography in patients with T2DM and LEAD: The stenosis rate of superior genicular artery was 51.1%, and that of inferior genicular artery was 48.9% (P>0.05). The occlusion rate of the superior genicular artery was 33.7%, the occlusion rate of the inferior genicular artery was 42.8%, the total involvement rate of the superior genicular artery was 84.8%, and the total involvement rate of the inferior genicular artery was 91.7%. The occlusion rate and total involvement rate of inferior knee artery were higher than those of superior knee artery (P<0.05). 4.Relationship between 25(OH)D and arteriographic characteristics in patients with LEAD in T2DM: (1) The segmental distribution of arterial stenosis in lower extremities with different 25(OH)D: In the superior knee artery stenosis group, the vitamin D deficiency accounted for 58.2%, the insufficient accounted for 36.1%, and the sufficient accounted for 5.7%. Vitamin D deficiency, insufficiency and sufficiency in inferior genicular artery stenosis group accounted for 77.8%, 9.6% and 12.6%, respectively. The proportion of vitamin D deficiency in superior knee artery stenosis group and inferior knee artery stenosis group was the highest, especially the inferior knee artery (P<0.05). (2) The segmental distribution of arterial occlusion in lower extremities with different 25(OH)D: In superior knee artery occlusion group, vitamin D deficiency accounted for 50.5%, insufficient accounted for 43.0%, and sufficient accounted for 6.5%. In the inferior knee artery occlusion group, vitamin D deficiency accounted for 50.0%, insufficiency accounted for 40.7%, and sufficiency accounted for 9.3%. The proportion of vitamin D deficiency in superior knee artery occlusion group and inferior knee artery occlusion group was higher, especially in superior knee artery occlusion group, but there was no statistical significance (P>0.05). (3) The segmental distribution of total arterial stenosis and total occlusion of lower extremity arteries at different 25(OH)D: In the lower limb artery stenosis group, vitamin D deficiency accounted for 67.8%, insufficiency accounted for 23.2%, and sufficiency accounted for 9.0%. In the lower limb artery occlusion group, vitamin D deficiency accounted for 50.2%, insufficiency accounted for 41.7%, and sufficiency accounted for 8.1%. The proportion of vitamin D deficiency in lower limb artery stenosis group and occlusion group was the highest, especially in stenosis group. (P<0.05). (4) The total segmental distribution of superior and inferior genicular arteries at different 25(OH)D: In the group with total involvement of superior knee artery, vitamin D deficiency accounted for 55.1%, insufficiency accounted for 38.9%, and sufficiency accounted for 6.0%. In the total involvement of inferior genicular artery group, vitamin D deficiency accounted for 64.8%, insufficiency accounted for 24.1%, and sufficiency accounted for 11.1%. The degree of vitamin D deficiency was highest in superior and inferior knee artery, particularly in the inferior knee artery. (P<0.05). 5. Multivariate logistic regression analysis of influencing factors in T2DM combination with LEAD: Serum 25(OH)D is the influencing factor in T2DM with LEAD (OR = 0.891, 95% CI = 0.861-0.945). 6. According to the ROC curve analysis results, the AUC of LEAD in 25(OH)D screening T2DM patients is 0.911 (95%CI: 0.865-0.957, P<0.001), the 25(OH)D level of 19.2ng/mL is the best cut-off point for screening patients with T2DM for LEAD. Conclusion: The level of 25(OH)D in patients with T2DM combination with LEAD was significantly decreased, and the deficiency of 25(OH)D was higher. The results of lower limb arteriography showed that the lesions of lower extremities in T2DM with LEAD were mainly inferior genicular artery, and 25(OH)D deficiency of inferior genicular artery was more common. Lower 25(OH)D is a risk factor for LEAD in patients with T2DM. A high level of 25(OH)D may be a protective factor for T2DM combined with LEAD. It is suggested that the timely supplement of vitamin D by clinicians and the increase of serum vitamin D level may have a certain preventive effect on the occurrence and development of T2DM complicated with LEAD. Key words: type 2 diabetes mellitus, lower extremities arterial disease, arteriography of lower extremities, 25 hydroxyvitamin D
Pages62
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/462717
Collection第一临床医学院
Affiliation第一临床医学院
First Author AffilicationFirst Clinical School
Recommended Citation
GB/T 7714
谈娇娇. 血清25羟维生素D与2型糖尿病合并下肢动脉病变的相关性及下肢动脉造影特点的分析[D]. 兰州. 兰州大学,2021.
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