2型糖尿病患者血清25(OH)D3、Lp-PLA2水平与周围血管病变及临床疗效的关系探究

Relationship between Serum 25(OH)D3,Lp-PLA2 Levels and Peripheral Vascular Disease and Clinical Efficacy in Type 2 Diabetes Patients

目的探讨2型糖尿病(T2DM)患者血清25羟基维生素D3(25(OH)D3)、脂蛋白磷脂酶A2(Lp-PLA2)水平与糖尿病周围血管病变(DPVD)及临床疗效的关系。方法选取2020年1月—2022年10月平顶山市第一人民医院收治的168例T2DM患者为研究对象,根据是否并发DPVD将患者分为并发组(n=95)和未并发组(n=73)。比较2组一般临床资料[糖化血红蛋白(HbA1c)、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血钙、血磷、肌酐(Cr)、尿素氮(BUN)],比较2组治疗前血清25(OH)D3、Lp-PLA2水平,分析其与并发DPVD及临床有差异指标的相关性,比较并发组不同预后患者(治疗前、治疗1个月、治疗2个月)血清各指标水平,分析血清各指标水平联合检测对T2DM并发DPVD患者治疗效果的预测价值。结果并发组糖尿病病程、HbA1c、FBG、TC、TG、LDL-C水平明显高于未并发组,且血清25(OH)D3水平与糖尿病病程、HbA1c、FBG、TC、TG、LDL-C水平及并发DPVD呈负相关,血清Lp-PLA2水平与之呈正相关,差异有统计学意义(P<0.05);未并发组血清25(OH)D3水平高于并发组,Lp-PLA2水平低于并发组,差异有统计学意义(P<0.05);治疗后,有效患者血清25(OH)D3水平高于无效患者,Lp-PLA2水平低于无效患者,差异有统计学意义(P<0.05);治疗1个月、2个月后,血清25(OH)D3、Lp-PLA2水平联合预测T2DM并发DPVD患者治疗无效的AUC为0.739、0.827。结论T2DM患者血清25(OH)D3、Lp-PLA2水平与DPVD及临床疗效密切相关,可作为诊断是否并发DPVD、评估临床疗效的有效指标。

Objective To investigate the relationship between serum levels of 25 hydroxyvitamin D3(25(OH)D3),lipoprotein phospholipase A2(Lp-PLA2)and diabetic peripheral vascular disease(DPVD)and clinical efficacy in patients with type 2 diabetes mellitus(T2DM).Methods 168 T2DM patients admitted to Pingdingshan First People's Hospital from January 2020 to October 2022 were selected as the research subjects.The patients were divided into concurrent group(n=95)and non-concurrent group(n=73)based on whether they were complicated with DPVD.The general clinical data[glycated hemoglobin(HbA1c),fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),calcium,phosphorus,creatinine(Cr)and blood urea nitrogen(BUN)]of the two groups were compared,and the levels of serum 25(OH)D3 and Lp-PLA2 of the two groups(before treatment)were compared.The correlation between the levels of serum 25(OH)D3 and Lp-PLA2 and the complications of DPVD and clinically differentiated indicators was analyzed,to compare the serum levels of various indicators in patients with different prognosis(before treatment,1 month of treatment,2 months of treatment)in the concurrent group,and analyze the predictive value of combined detection of serum levels of various indicators for the treatment effect of T2DM complicated with DPVD patients.Results The course of diabetes,the levels of HbA1c,FBG,TC,TG,LDL-C in the concurrent group were significantly higher than those in the non-concurrent group,and the level of serum 25(OH)D3 was negatively correlated with the course of diabetes,the levels of HbA1c,FBG,TC,TG,LDL-C,and the level of concurrent DPVD,while the level of serum Lp-PLA2 was positively correlated with them,with a statistically significant difference(P<0.05).Serum 25(OH)D3 level in the non-concurrent group was higher than that in the concurrent group,while Lp-PLA2 level was lower than that in the concurrent group,with a statistically significant difference(P<0.05).After treatment,serum 25(OH)D3 levels in effective patients were higher than those in ineffective patients,and Lp-PLA2 levels were lower than those in ineffective patients,with a statistically significant difference(P<0.05).After 1 and 2 months of treatment,the combined prediction of serum 25(OH)D3 and Lp-PLA2 levels for ineffective AUC in T2DM patients with DPVD was 0.739 and 0.827,respectively.Conclusion Serum levels of 25(OH)D3 and Lp-PLA2 in T2DM patients are closely related to DPVD and clinical efficacy,and can be used as effective indicators for diagnosing DPVD and evaluating clinical efficacy.