绝经后女性2型糖尿病患者25-羟维生素D与下肢动脉粥样硬化疾病的关系

Association of 25-hydroxyvitamin D with lower extremity atherosclerosis in postmenopausal women with type 2 diabetes mellitus

目的探讨血清25-羟维生素D[25(OH)D]与绝经后女性2型糖尿病(T2DM)患者下肢动脉斑块及踝肱指数(ABI)<0.9的关系。方法收集2018年9月至2019年12月在河北省唐山市工人医院内分泌二科就诊的298例绝经后女性T2DM患者。采用彩色多普勒超声诊断下肢动脉斑块,并测量ABI。将患者分为3组,分别为下肢动脉无斑块组(无斑块组,133例)、下肢动脉有斑块并ABI≥0.9组(斑块并ABI≥0.9组,108例)和下肢动脉有斑块并ABI<0.9组(斑块并ABI<0.9组,57例)。记录及收集所有患者的一般情况及实验室指标,应用化学发光法测定血清25(OH)D的水平。比较各组患者的血清25(OH)D水平,采用多因素logistic回归分析评价下肢动脉斑块及ABI<0.9的危险因素。结果无斑块组血清25(OH)D水平为(15.29±6.46)ng/ml,斑块并ABI≥0.9组及斑块并ABI<0.9组的血清25(OH)D水平分别为(13.40±5.04)、(12.02±4.02)ng/ml,均低于无斑块组,差异均有统计学意义(P均<0.05)。下肢动脉有斑块组和无斑块组间在不同四分位25(OH)D水平的分布差异有统计学意义(P<0.05);而ABI≥0.9组和ABI<0.9组2组间,以及无斑块组、斑块并ABI≥0.9组和斑块并ABI<0.9组3组间在不同25(OH)D水平的分布差异均无统计学意义(P>0.05)。年龄、收缩压(SBP)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白、糖尿病病程、超敏C反应蛋白、25(OH)D及大血管病变与绝经后女性T2DM患者下肢动脉斑块的发生密切相关(P<0.05);年龄、SBP、甘油三酯、糖尿病病程、25(OH)D及大血管病变与绝经后女性T2DM患者出现ABI<0.9的风险密切相关(P均<0.05)。结论在绝经后女性T2DM中,低水平的25(OH)D是下肢动脉斑块发生及下肢ABI<0.9的独立危险因素之一。

Objective To examine the associationof serum 25-hydroxyvitamin D[(25(OH)D]with lower limb arterial plaques and ankle brachial index(ABI)<0.9 in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods In the observational study,the 298 postmenopausal women with T2DM were selected.The lower limb arterial plaque was assessed by color Doppler ultrasound and ABI was measared.The patients were divided into three groups including the lower limb artery without plaque group(non-plaque group,133 cases),the lower limb arterial plaque with ABI≥0.9 group(plaque with ABI≥0.9 group,108 cases)and the lower limb arterial plaque with ABI<0.9 group(plaque with ABI<0.9 group,57 cases).Serum 25(OH)D levels were detected by chemilumine scence assay and compared among the three groups.The risk factors for arterial plaques of lower limb and ABI<0.9 was analyzed by multivariate logistic regression analysis.Results Compared with the non-plaque group[(15.29±6.46)ng/ml],the serum level of 25(OH)D was significantly decreased in the plaque with ABI≥0.9 group[(13.40±5.04)ng/ml]and the plaque with ABI<0.9 group[(12.02±4.02)ng/ml](P<0.05).At different levels of 25(OH)D quartile,there was a difference between the lower limb artery with plaque and without(P<0.05),while no difference was found between ABI≥0.9 and ABI<0.9,and no difference was found among no plaque,plaque with ABI≥0.9 and plaque with ABI<0.9(P>0.05).Age,systolic blood pressure(SBP),high-density lipoprotein-cholesterol(HDL-C),glycated hemoglobin A1c(HbA1c),diabetic duration,hypersensitive C-reactive protein(hs-CRP),25(OH)D and macroangiopathy were significantly associated with the risk of lower limb arterial plaques in postmenopausal women with T2DM(all P<0.05).Age,SBP,triglyceride,diabetic duration.25(OH)D and macroangiopathy were closely related to the risk of ABI<0.9 in postmenopausal women with T2DM(all P<0.05).Conclusion In postmenopausal women with T2DM the decreased level of 25(OH)D increased the risk of arterial plaque of lower limb and ABI<0.9.