HbA1c、LDL-C与2型糖尿病下肢动脉血管病变的相关性

Correlation between HbA1c,LDL-C and lower extremity arterial disease in type 2 diabetes mellitus

目的:探讨糖化血红蛋白(glycosylated hemoglobin,HbA1c)、低密度脂蛋白胆固醇(lowdensity lipoprotein cholesterol,LDL-C)与2型糖尿病(type 2 diabetes mellitus,T2DM)患者下肢动脉血管病变(lower extremity arterial disease,LEAD)的相关性。方法:选取2018年5月至2021年5月华东师范大学附属芜湖医院收治的T2DM患者96例,根据双下肢彩超是否有斑块将患者分为单纯T2DM组(n=47)与T2DM合并LEAD组(n=49)。比较两组血清HbA1c、LDL-C等指标差异,对HbA1c、LDL-C水平与双下肢血管病变的相关性进行多元逐步回归分析,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价HbA1c、LDL-C对LEAD的诊断能力。结果:两组空腹血糖、HbA1c、总胆固醇、三酰甘油、LDL-C水平差异均有统计学意义(t=-3.345、5.022、-2.721、-2.494、2.462,均P<0.05)。多元逐步回归分析显示:血清HbA1c、LDL-C水平与T2DM患者发生LEAD相关(t=-3.823、-2.493,P<0.05)。ROC曲线分析显示:HbA1c的ROC曲线下面积为0.680,诊断LEAD的敏感度为60.0%,特异度为70.6%;LDL-C的ROC曲线下面积为0.727,敏感度为61.2%,特异度为76.5%。结论:T2DM合并LEAD患者血清HbA1c、LDL-C水平显著增高,HbA1c、LDL-C有望作为LEAD的诊断指标。

Objective: To investigate the correlation between glycosylated hemoglobin(HbA1c), low-density lipoprotein cholesterol(LDL-C) and lower extremity arterial disease(LEAD) in patients with type 2 diabetes mellitus(T2DM). Methods: A total of 96 patients with T2DM admitted to our hospital from May 2018 to May 2021 were selected. The patients were divided into a T2DM alone group(n=47) and a T2DM combined with LEAD group(n=49) according to whether there were plaques in the lower limbs. The differences in serum HbA1c and LDL-C and other indicators were compared between the two groups. The correlation between HbA1c and LDL-C levels and vascular lesions of both lower extremities was analyzed by multiple stepwise regression analysis. The diagnostic ability of HbA1c and LDL-C for LEAD was evaluated by receiver operating characteristic(ROC) curve. Results: The differences of fasting plasma glucose, HbA1c, total cholesterol, triglyceride, LDL-C levels and the proportion of hypertension between the 2 groups were statistically significant(t=-3.345, 5.022,-2.721,-2.494, 2.462, all P<0.05). Multiple stepwise regression analysis showed that serum HbA1c and LDL-C levels were correlated with LEAD in T2DM patients(t=-3.823,-2.493, P<0.05). The area under ROC curve of HbA1c was 0.680, and the sensitivity and specificity of LEAD were 60.0% and 70.6%, respectively. The area under ROC curve of LDL-C was 0.727, the sensitivity was 61.2%, and the specificity was 76.5%. Conclusion: The serum levels of HbA1c and LDL-C in T2DM patients with LEAD are significantly increased, and HbA1c and LDL-C are expected to be used as diagnostic indicators of LEAD.