彩色多普勒超声联合血清25-羟维生素D_3评价2型糖尿病下肢血管病变的价值

Value of combination of color Doppler ultrasound and serum 25-hydroxyvitamin D_3 on peripheral artery disease in type 2 diabetic patients

目的探讨2型糖尿病患者下肢血管病变(PAD)彩色多普勒超声血流成像(CDFI)的血流动力学指标参数与患者25-羟维生素D3[25(OH)D3]浓度的关系。方法筛选162例2型糖尿病患者,根据下肢血管超声结果将患者分为PAD组(71例)和无下肢血管病变(Non-PAD)组(91例),并选取同期来本院体检的60名健康者为对照组。记录测定各组患者的临床资料、血液生化指标,彩色多普勒超声检查下肢血管各参数指标,用酶联免疫吸附法(ELISA)测定血清25(OH)D3的浓度。结果应用高频超声能探测到2型糖尿病患者PAD主要表现为下肢动脉粥样硬化,其病理改变以动脉壁的增厚及斑块的出现为特征,2型糖尿病组患者血清25(OH)D3浓度明显低于对照组,且在2型糖尿病患者中PAD组25(OH)D3浓度明显低于Non-PAD组,差异均有统计学意义(P<0.01)。Pearson相关分析显示,PAD与年龄呈正相关(r=0.52,P<0.05),与25(OH)D3呈负相关(r=-0.35,P<0.05)。多元回归分析显示PAD与25(OH)D3浓度具有独立相关性(B=-0.32,P<0.05)。2型糖尿病患者中PAD组与Non-PAD组比较,足背动脉、腘动脉及股动脉均有不同程度的狭窄,彩色多普勒超声检查相关指标比较差异具有统计学意义(P<0.05)。结论 2型糖尿病患者血清25(OH)D3浓度是PAD的独立危险因素,彩色多普勒超声联合血清25(OH)D3浓度监测对2型糖尿病患者PAD病情判断有一定临床价值。

Objective To investigate the relationship between the hemodynamic indexes changes of color Doppler ultrasonography （CDFI） of lower‐extremity peripheral arterial disease （PAD） and 25‐hydmxyvitamin D3 [25（OH）D3 ] in type 2 diabetic （T2DM） patients .Methods A total of 162 T2DM selected cases were randomized divided into PAD group（ n =71） and non‐PAD group （ n=91） .At the same time ,60 non‐diabetic healthy con‐trols were enrolled in this study .Records were measured in patients of each group for clinical data and biochemical index of blood .Lower extremity vascular index was measured with Doppler ultrasound .Serum 25（OH）D3 concen‐tration was determined by ELISA .Results Lower limb atherosclerosis could be detected as the main performance in the T2DM patients with PAD by using high frequency ultrasound ,and their pathological changes were charac‐terized by the emergence of arterial wall thickening and plaques .Serum 25（OH）D3 concentration in patients with T2DM was lower than that of the control group .Serum 25（OH）D3 concentration of the T2DM patients with PAD was significantly lower than that of the patients with non‐PAD , and the difference was statistically significant （P〈0 .05） .The result of Pearson correlation analysis showed that PAD was positively correlated with age （ r =0.52 ,P〈0.05） ,but it was negatively correlated with serum 25（OH）D3 （ r= -0.35 ,P〈0.05） .Multiple regres‐sion analysis showed that low serum 25 （OH ） D3 concentration was an independent risk factor for PAD （ B = -0.32 ,P 〈0.05） .Compared with non‐PAD T2DM patients ,the patients＆#39;dorsalis pedis artery ,popliteal artery and femoral artery of PAD group had different degrees of stenosis ,and their correlation indexes of color Doppler ultrasonography were of significantly statistical difference （ P 〈 0.05）.Conclusion Serum 25（OH）D3 concentration is strongly and independently associated with PAD in patients with T 2DM .Color Doppler ultra‐sonography and serum 25（OH）D3 concentration monitoring have certain clinical value for the condition judgment in T2DM patients with PAD.