血清铁蛋白和心脏代谢指数与2型糖尿病患者外周动脉粥样硬化疾病的相关性研究

Correlation of serum ferritin and cardiometabolic index with peripheral atherosclerotic disease in patients with type 2 diabetes mellitus

目的探讨血清铁蛋白(SF)联合心脏代谢指数(CMI)与2型糖尿病(T2DM)患者外周动脉粥样硬化(AS)的关联,为T2DM患者血管病变的防治提供思路。方法选取2020年6月—2023年7月在兰州大学第一医院内分泌科住院的1246例T2DM患者为研究对象。根据双侧颈动脉及双下肢动脉超声结果将研究对象分为外周AS组和无外周AS组,比较两组间SF和CMI水平差异。根据SF水平将研究对象分为高铁蛋白(HF)组和非高铁蛋白(Non-HF)组,依据CMI四分位水平分为Q_(1)~Q_(4)组,比较各组间外周AS患病率及臂踝脉搏波速度(baPWV)水平的差异。采用SPSS 26.0软件进行独立样本t检验、单因素方差分析、Mann-Whitney U检验、Kruskal-Wallis H检验和χ^(2)检验;采用多因素logistic回归分析SF和CMI与发生外周AS的相关性;采用受试者工作特征(ROC)曲线分析SF联合CMI对T2DM患者发生外周AS的诊断价值。结果外周AS组SF水平为187.00μg/L(P_(25),P_(75):106.00,369.50μg/L)、CMI水平为0.93(P_(25),P_(75):0.61,1.56),分别高于无外周AS组SF水平[150.00μg/L(P_(25),P_(75):79.70,249.00μg/L)]和CMI水平[0.74(P_(25),P_(75):0.46,1.25)],差异均有统计学意义(P<0.05)。HF组外周AS患病率(74.0%)和颈部AS的患病率(67.9%)显著高于Non-HF组(分别为61.2%、56.4%),差异均有统计学意义(P<0.05)。随着CMI水平的升高,T2DM患者外周、颈部、下肢AS患病率均呈上升趋势(χ_(趋势)^(2)值分别为22.391、10.449和9.292,P_(趋势)<0.05),左、右侧baPWV水平均呈上升趋势(β值分别为0.080和0.064,P_(趋势)<0.05),其中Q4组左侧baPWV水平为18.28 m/s(P_(25),P_(75):15.71,21.07 m/s),高于Q_(1)组[17.14 m/s(P_(25),P_(75):15.04,19.77 m/s)],差异有统计学意义(P<0.05)。调整混杂因素后,多因素logistic回归分析显示,SF(OR=1.003,95%CI:1.002~1.004)、CMI(OR=1.389,95%CI:1.137~1.696)水平与T2DM患者外周AS患病高风险相关(P<0.05)。ROC曲线分析显示,SF联合CMI可提高对T2DM患者发生外周AS疾病的诊断价值,ROC曲线下面积(AUC)为0.758(95%CI:0.724~0.792,P<0.05)。结论SF和CMI水平升高与T2DM患者外周AS患病高风险相关,SF联合CMI可以提高对T2DM患者发生外周AS疾病的诊断价值。

Objective To explore the correlation of serum ferritin(SF)combined with cardiometabolic index(CMI)and peripheral atherosclerosis(AS)in patients with type 2 diabetes mellitus(T2DM),and provide the guidance for the clinical diagnosis and treatment of vascular diseases in T2DM patients.Methods Total of 1246 T2DM patients hospitalized in the department of endocrinology of the First Hospital of Lanzhou University from June 2020 to July 2023 were selected as the subjects.According to the ultrasound results of bilateral carotid and bilateral lower limb arteries,the subjects were divided into two groups(with peripheral AS group and without peripheral AS group),then the differences of SF and CMI levels between the two groups were compared.According to SF level,the subjects were divided into high ferritin(HF)group and Non-HF group,and according to CMI quartile level,they were divided into Q_(1)-Q_(4) groups,and the differences in the prevalence of peripheral AS and the levels of brachial and ankle pulse wave velocity(baPWV)were compared among the groups.Independent samples t test,one-way analysis of variance,Mann-Whitney U test,Kruskal-Wallis H test and χ^(2) test were used to analyze the data,the multifactor binary logistic regression was used to analyze the correlation between SF or CMI and the occurrence of peripheral AS;and the receiver operating characteristic(ROC)curves were used to analyze the effect of SF combined with CMI on the diagnostic value of the peripheral AS occurrence in T2DM patients.The used software was SPSS 26.0.Results The SF level in the peripheral AS group was 187.00μg/L(P_(25)-P_(75):106.00-369.50μg/L),and the CMI level was 0.93(P_(25)-P_(75):0.61-1.56),which were higher than those(150.00μg/L,P_(25)-P_(75):79.70-249.00μg/L and 0.74,P_(25)-P_(75):0.46-1.25)in the group without peripheral AS,P<0.05.The morbidity(74.0%)of peripheral AS and the morbidity(67.9%)of neck AS in the HF group were significantly higher than those(61.2% and 56.4%)in the Non-HF group,respectively,P<0.05.The AS morbidities of periphery,neck and lower limbs increased with CMI level in T2DM patients(χ_(trend)^(2) values were 22.391,10.449 and 9.292,P_(trend)<0.05);left and right baPWV levels showed upword trend(βvalues were 0.080 and 0.064,P_(trend)<0.05);left baPWV level in Q4 group was 18.28 m/s,P_(25)-P_(75):15.71-21.07 m/s,which was significantly higher than that(17.14 m/s,P_(25)-P_(75):15.04-19.77 m/s)in Q1 group,P<0.05.After adjusting for the confounding factors,multifactorial binary logistic regression analysis showed that the levels(OR=1.003,95%CI:1.002-1.004;OR=1.389,95%CI:1.137-1.696)of SF and CMI were correlated to high risk of peripheral AS in T2DM patients(P<0.05).ROC curves analysis showed that SF combined with CMI could improve the diagnostic value for the occurrence of peripheral AS disease in T2DM patients,the area under the ROC curve(AUC)was 0.758(95%CI:0.724-0.792,P<0.05).Conclusion The elevated levels of SF and CMI are associated with the high risk of peripheral AS in T2DM patients,and SF combined with CMI can improve the diagnostic value of the occurrence of peripheral AS disease in T2DM patients.