血清Hcy、Lp(a)及25(OH)D_(3)水平与2型糖尿病合并高血压患者发生颈动脉粥样硬化的关系  

The Relationship Between Serum Hcy,Lp(a)and 25(OH)D_(3)Levels and Carotid Atherosclerosis in Patients with Type 2 Diabetes Mellitus and Hypertension

作　　者：王小庆 应喜红 黄丽[1] WANG Xiaoqing;YING Xihong;HUANG Li(General Practice Medical Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院全科(特需)病房,四川成都610041

出　　处：《标记免疫分析与临床》2024年第5期891-896,共6页Labeled Immunoassays and Clinical Medicine

摘　　要：目的研究血清同型半胱氨酸(Hcy)、脂蛋白(A)[Lp(a)]及25-羟基维生素D_(3)[25(OH)D_(3)]与2型糖尿病(T2DM)合并高血压患者发生颈动脉粥样硬化的关系。方法选取2020年2月至2023年2月期间收治的102例T2DM合并高血压患者作为观察组,另外选取同期单纯T2DM患者92例作为对照1组,体检中心健康体检人群92名作为对照2组,依据超声测定的颈动脉内膜-中层厚度(IMT)将观察组分为硬化组65例和非硬化组37例。比较各组一般资料[年龄、性别、病程、体质指数(BMI)、血压、合并其他基础疾病(高脂血症、冠心病)、吸烟史、饮酒史]和实验室检查指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、Hcy、Lp(a)、25(OH)D_(3)、IMT]。采用多元Logistic回归分析筛选T2DM合并高血压患者发生颈动脉粥样硬化的危险因素。应用Pearson相关性分析T2DM合并高血压患者血清Hcy、Lp(a)、25(OH)D_(3)与IMT的关系。采用受试者工作曲线(ROC)分析血清Hcy、Lp(a)、25(OH)D_(3)预测T2DM合并高血压患者发生颈动脉粥样硬化的价值。结果观察组Hcy、Lp(a)水平及IMT高于对照1、2组,25(OH)D_(3)水平低于对照1、2组(P<0.05);硬化组血清Hcy、Lp(a)水平、IMT高于非硬化组,25(OH)D_(3)水平低于非硬化组(P<0.05);多因素Logistic回归分析显示血清Hcy、Lp(a)、25(OH)D_(3)均为T2DM合并高血压患者发生颈动脉粥样硬化的危险因素(P<0.05);Pearson相关性分析显示Hcy、Lp(a)与IMT呈正相关(r=0.502、0.557,均P<0.05);25(OH)D_(3)与IMT呈负相关(r=-0.535,P<0.05);ROC分析显示血清Hcy、Lp(a)、25(OH)D_(3)水平预测颈动脉粥样硬化效能分别为0.704、0.738和0.714。结论T2DM合并高血压患者发生颈动脉粥样硬化风险更高,血清高Hcy、Lp(a)及低25(OH)D_(3)水平是T2DM合并高血压患者发生颈动脉粥样硬化的独立危险因素,且预测颈动脉粥样硬化发生的效能良好,临�Objective To study the relationship of serum homocysteine(Hcy),lipoprotein(A)[Lp(a)]and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]with carotid atherosclerosis in patients with type 2 diabetes mellitus(T2DM)complicated with hypertension.Methods 102 patients with T2DM and hypertension admitted from February,2020 to February,2023 were selected as the observation group,while 92 patients with T2DM alone during the same period were included in the control group 1,and 92 healthy people in the physical examination center were enrolled as the control group 2.According to carotid intima-media thickness(IMT)measured by ultrasound,patients in the observation group were divided into 65 cases in sclerosis group and 37 cases in non-sclerosis group.The general data[age,gender,disease duration,body mass index(BMI),blood pressure,presence of other underlying diseases(hyperlipidemia,coronary heart disease),smoking history,drinking history]and laboratory examination indicators[total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting plasma glucose(FPG),Hcy,Lp(a),25(OH)D_(3),IMT]were compared among groups.Multivariate logistic regression analysis was used to identify the risk factors of carotid atherosclerosis in T2DM patients with hypertension.Pearson correlation analysis was applied to evaluate the relationship between serum Hcy,Lp(a),25(OH)D_(3)and IMT in patients with T2DM and hypertension.Receiver operating characteristic(ROC)curve was drawn to analyze the value of serum Hcy,Lp(a)and 25(OH)D_(3)on predicting carotid atherosclerosis in T2DM patients with hypertension.Results Levels of Hcy and Lp(a)and IMT in the observation group were higher or thicker than those in the control groups 1 and 2,while the level of 25(OH)D_(3)was lower than that in control groups 1 and 2(P<0.05).Serum Hcy and Lp(a)levels and IMT in the sclerosis group were higher than those in the non-sclerosis group,while the level of 25(OH)D_(3)was lower than that in the non-sclerosis group(P<0.

关 键 词：血清同型半胱氨酸 脂蛋白(a) 25-羟基维生素D_(3) 2型糖尿病 高血压 颈动脉粥样硬化 

分 类 号：R5871.1[医药卫生—内分泌]