不同BMI水平T2DM患者25(OH)D3与糖尿病血管并发症的关联分析

Association between 25 (OH) D3 and vascular complications in type 2 diabetes mellitus at different BMI levels

目的分析2型糖尿病(type 2 diabetes mellitus,T2DM)患者不同体质指数(body mass index,BMI)水平下25羟维生素D3(25-hydroxyvitamin D3,25(OH)D3)与糖尿病血管并发症的相关性。方法选取2021年10月至2023年10月池州市人民医院收治的113例T2DM患者为研究对象。根据BMI水平将入组的患者分为正常组、超重组、肥胖组,收集患者一般资料(性别、年龄、病程、吸烟史、饮酒史、合并高血压、糖尿病家族史)、实验室指标[甘油三酯(triglyceride,TG)、肌酐(creatinine,Cr)、高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,HDL-C)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、糖化血红蛋白(glycated hemoglobin,HbA1c)、空腹血糖(fasting plasma glucose,FPG)、尿微量白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)、白蛋白(albumin,Alb)、血钙、血磷、25-(OH)D3]水平等。采用Spearman相关性分析法分析糖尿病血管并发症与25(OH)D3相关性,采用Logistic回归分析不同BMI组间糖尿病血管并发症的危险因素。结果超重组和肥胖组病程分别为(8.51±2.39)年、(10.82±3.02)年,TG分别为(2.58±0.45)mmol/L、(3.24±0.64)mmol/L,TC分别为(6.23±1.45)mmol/L、(9.32±2.01)mmol/L,BMI分别为(26.48±1.53)kg/m2、(30.12±1.62)kg/m2,水平均高于正常组相应指标(P<0.05)。与超重组相比,肥胖组高血压占比为45.00%,LDL-C(3.58±1.02)mmol/L、HbA1c(10.78±1.68)水平更高(P<0.05)。与超重组相比,肥胖组高血压占比,病程、TG、TC、LDL-C、HbA1c、BMI水平更高(P<0.05)。超重组和肥胖组血清25-(OH)D3分别为(40.25±3.35)mmol/L、(33.18±2.78)mmol/L,水平均低于正常组(P<0.05)。糖尿病血管并发症发生率分别为65.22%、87.50%,均高于正常组(P<0.05)。与超重组相比,肥胖组血清25(OH)D3水平更低(P<0.05),糖尿病血管并发症发生率更高(P<0.05)。Spearman相关性分析显示,病程、TG、TC、HbA1c与糖尿病血管并发症呈正相关(P<0.05),25(OH)D3与糖尿病血管并发症呈负相关(P<0.05)。Logistic回归分析显示病程、HbA1c水平是影响三组患者发生糖尿病血管并发症的危险因素(P<0.05),TG、TC、低25(OH)D3是影响超重组、肥胖组患者发生糖尿病血管并发症的危险因素(P<0.05)。结论超重/肥胖的T2DM患者中25(OH)D3水平与糖尿病血管并发症呈负相关,对于超重/肥胖的T2DM患者应注意补充维生素D,以期降低糖尿病血管并发症的发生风险。

Objective To analyze the relativity between 25-hydroxyvitamin D3(25(OH)D3)and vascular complications in type 2 diabetes mellitus(T2DM)patients at different body mass index(BMI)levels.Methods A total of 113 T2DM patients admitted to Chizhou People’s Hospital from Oct.2021 to Oct.2023 were selected as the study objects.The enrolled patients were divided into normal group,overweight group and obese group according to BMI level.General data(gender,age,course of disease,smoking history,drinking history,family history of hypertension and diabetes)and laboratory indicators were collected,including triglyceride(TG),creatinine(Cr),high-density lipoprotein-cholesterol(HDL-C),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),glycated hemoglobin(HbA1c),fasting plasma glucose(FPG),urinary albumin/creatinine ratio(UACR),albumin(Alb),blood calcium,blood phosphorus,25(OH)D3,etc.Spearman correlation analysis was used to analyze the correlation between diabetic vascular complications and 25(OH)D3,and Logistic regression was used to analyze the risk factors of diabetic vascular complications among different BMI groups.Results The disease course of overweight and obesity group was(8.51±2.39)years,(10.82±3.02)years,TG was(2.58±0.45)mmol/L,(3.24±0.64)mmol/L,TC was(6.23±1.45)mmol/L,(9.32±2.01)mmol/L,and BMI was(26.48±1.53)kg/m2,(30.12±1.62)kg/m2,higher than those of the control group(P<0.05).The level of LDL-C(3.58±1.02)mmol/L and HbA1c(10.78±1.68)were higher in obese group(45.00%)(P<0.05).Compared with those of the overweight group,the levels of hypertension,disease duration,TG,TC,LDL-C,HbA1c and BMI in the obese group were higher(P<0.05).The levels of serum 25(OH)D3[(40.25±3.35)mmol/L,(33.18±2.78)mmol/L]in overweight and obese group were lower than those in the normal group(P<0.05),and the incidence of diabetic vascular complications was 65.22%and 87.50%,respectively,higher than those in the normal group(P<0.05).Compared with that in the overweight group,serum 25(OH)D3 level was lower in the obese group(P<0.05),and the incidence of diabetic vascular complications was higher(P<0.05).Spearman correlation analysis showed that disease duration,TG,TC,HbA1c were positively correlated with diabetic vascular complications(P<0.05),and 25(OH)D3 was negatively correlated with diabetic vascular complications(P<0.05).Logistic regression analysis showed that disease duration and HbA1c level were risk factors for diabetic vascular complications in the three groups(P<0.05),while TG,TC and low 25(OH)D3 were risk factors for diabetic vascular complications in the hyperrecombination and obesity groups(P<0.05).Conclusion The level of 25(OH)D3 in overweight/obese T2DM patients is negatively correlated with vascular complications of diabetes,and vitamin D supplementation should be paid attention to overweight/obese T2DM patients to reduce the risk of vascular complications of diabetes.