2型糖尿病患者下肢血管病变与血清25羟维生素D及骨密度的相关性

Correlation between lower limb peripheral arterial disease and serum level of 25-hydroxyvitamin D,bone mineral density in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者下肢血管病变与血清25羟维生素D及骨密度的相关性。方法选取2型糖尿病患者235例,按踝肱指数(ankle brachial index,ABI)(采用多普勒血流探测仪测定)的数值将患者分为两组,分别为下肢血管病变组(PAD组,ABI<0.9)115例和非下肢血管病变组(NPAD组,ABI≥0.9)120例。采用双能X线骨密度仪进行腰椎(L1~4)、左侧股骨颈(Neck)、大转子(Troch)、华氏三角(Ward's)骨密度(bone mineral density,BMD)的测定。测定受试者血清25(OH)D的水平,并记录所有受试者的临床资料和生化指标。结果 PAD组血清25(OH)D的平均水平低于NPAD组[(12.89±1.48)ng/mL vs(15.82±2.35)ng/mL,P<0.05];PAD组的Neck、Troch、Ward's的BMD均分别低于NPAD组[(0.706±0.171)g/cm^2vs(0.823±0.133)g/cm^2,(0.501±0.111)g/cm^2vs(0.595±0.125)g/cm^2,(0.455±0.121)g/cm^2vs(0.524±0.210)g/cm^2,P<0.05]。Pearson相关分析发现,ABI与年龄、糖尿病病程、收缩压(systolic blood pressure,SBP)、胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein,LDL-C)、糖化血红蛋白(hemoglobin A1c,Hb A1c)呈负相关,与25(OH)D及Neck、Troch、Ward's的BMD呈正相关,差异有统计学意义(P<0.05)。Logistic分析显示:SBP、Hb A1c、TC、25(OH)D、Neck的BMD均为2型糖尿病患者发生下肢血管病变的危险因素。结论 2型糖尿病合并下肢血管病变患者往往同时伴有骨量减少或骨质疏松,低水平的25(OH)D及低下肢骨密度可能共同参与了2型糖尿病患者下肢动脉病变的发生发展。

Objective To investigate the correlation between lower limb peripheral arterial disease and serum level of 25-hydroxyvitamin D,bone mineral density in patients with type 2 diabetes mellitus（T2DM）.Methods A total of 235 T2DM patients were enrolled in this study.All the patients were divided into two groups according to the ankle brachial index（ABI,measured with Doppler blood flow detector） ：PAD group（ABI0.9 group,n=115） and NPAD group（ABI≥ 0.9,n=120）.Bone mineral density（BMD） of the lumbar spine（L1-4）,left femoral neck（Neck）,greater trochanter（troch）,and Wards triangle（Ward＇s） was measured using dual energy X-ray absorptiometry（DEXA）.Serum level of 25（OH）D was measured.Clinical data and biochemical indices were collected.Results Serum 25（OH）D level was lower in PAD group than that in NPAD group（10.89±1.48 ng/ml vs 15.82±2.35 ng/ml,P〈0.05）.BMD of Neck,troch,and Wards in PAD group was lower than that in NPAD group（0.706±0.171 g/cm^2 vs 0.823±0.133 g/cm^2,0.501±0.111 g/cm^2 vs 0.595±0.125 g/cm^2,and 0.455±0.121 g/cm^2 vs 0.524±0.210 g/cm^2,respectively,P〈0.05）.Pearson correlation analysis showed that ABI was negatively correlated with age,duration of diabetes,systolic blood pressure（SBP）,total cholesterol（TC）,low-density lipoprotein（LDLC）,and glycosylated hemoglobin（HbA1C）,but was positively correlated with 25（OH）D,BMD of troch,Neck,and Wards,and the differences were statistically significant（P〈0.05）.Logistic analysis showed that SBP,HbA1 c,TC,25（OH）D,Neck BMD were risk factors of lower limb peripheral arterial disease in patients with T2DM.Conclusion Patients with T2DM combined with lower limb peripheral arterial disease often have osteopenia or osteoporosis at the same time.Low levels of 25（OH）D and lower limb BMD may be involved in the development of lower limb peripheral arterial disease in T2DM patients.