糖尿病患者糖化血红蛋白及25-羟维生素D水平与外周血管病变的相关性研究  

Correlation of glycated hemoglobin and 25-hydroxyvitamin D levels with peripheral vascular disease in patients with diabetes mellitus

作　　者：李月 孙艺娟 Li Yue;Sun Yijuan(Department of Laboratory Medicine,Shangluo Central Hospital,Shangluo 726000,Shaanxi Province,China)

机构地区：[1]商洛市中心医院医学检验科,商洛726000

出　　处：《中国基层医药》2025年第1期21-26,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨糖化血红蛋白(HbA1c)及25-羟维生素D[25(OH)D]水平与糖尿病(T2DM)患者外周血管病变的关系。方法选取2021年4月至2023年4月在商洛市中心医院治疗的T2DM患者165例为研究对象,采用回顾性研究,依据T2DM患者有无外周血管病变将其分为阳性组(T2DM伴外周血管病变)115例,阴性组(单纯T2DM)50例。搜集两组患者的年龄、性别、病程、疾病家族史、是否合并高血压等一般临床资料以及25(OH)D、血钙、血磷、载脂蛋白B(apoB)、脂蛋白a[Lp(a)]、尿酸、载脂蛋白AⅠ(apoAⅠ)等实验室资料。使用logistic回归分析外周血管病变的高危影响因素,采用Pearson或Spearman相关分析方法来评价HbA1c、25(OH)D及外周血管病变的相关性,采用ROC分析高危影响因素对外周血管病变的诊断效能。结果长病程(t=2.74,P=0.007)、高血压史(χ^(2)=6.60,P=0.010)、HbA1c控制不佳(χ^(2)=12.14,P<0.001)、维生素D缺乏(χ^(2)=10.20,P<0.001)、低密度脂蛋白胆固醇高水平(t=2.58,P=0.024)、高密度脂蛋白胆固醇低水平(t=3.65,P=0.008)、高HbA1c水平(t=6.68,P<0.001)、低25(OH)D水平(t=6.60,P<0.001)均是T2DM伴外周血管病变患者的独立危险因素。logistic回归分析显示,长病程(OR=2.327、P=0.008)、维生素D缺乏(OR=1.255、P=0.034)、高HbA1c水平(OR=3.124、P<0.001)、低25(OH)D水平(OR=4.256、P=0.002)均是外周血管病变的高危影响因素。Pearson相关分析显示,HbA1c水平与25(OH)D水平呈负相关(r=-0.810,P<0.001);Spearman相关分析显示HbA1c水平与外周血管病变呈正相关(r=0.472、P<0.001),25(OH)D水平与外周血管病变呈负相关(r=-0.443、P<0.001)。ROC曲线分析显示,HbA1c预测外周血管病变的曲线下面积(AUC)=0.797,95%CI(0.719,0.874),敏感度0.817,特异度0.760,截断值8.27%;25(OH)D预测外周血管病变的AUC=0.778,95%CI(0.695,0.861),敏感度0.748,特异度0.780,截断值63.49 nmol/L;HbA1c及25(OH)D联合预测外周血管病变的AUC=0.805,95%CI(0.730,0.876),敏感度0Objective To investigate the correlation between glycated hemoglobin(HbA1c)and 25-hydroxyvitamin D[25(OH)D]levels with peripheral vascular disease in patients with type 2 diabetes mellitus(T2DM).Methods A total of 165 patients with T2DM who were treated at Shangluo Central Hospital from April 2021 to April 2023 were included in this retrospective study.Based on the presence or absence of peripheral vascular disease,the patients were divided into two groups:the positive group(115 patients with T2DM and peripheral vascular disease)and the negative group(50 patients with T2DM only).Data on general clinical characteristics including age,gender,duration of diabetes,family history of the disease,and the presence of hypertension were collected from both groups.Laboratory data,including 25(OH)D,serum calcium,phosphorus,apolipoprotein B,lipoprotein(a),uric acid,and apolipoprotein AⅠ,were also gathered.Logistic regression analysis was performed to identify high-risk factors for peripheral vascular disease,while Pearson or Spearman correlation analyses were used to evaluate the correlation between HbA1c,25(OH)D,and peripheral vascular disease.The diagnostic efficiency of the high-risk factors for peripheral vascular disease was assessed using receiver operating characteristic analysis.Results Long disease duration(t=2.74,P=0.007),a history of hypertension(χ^(2)=6.60,P=0.010),poor control of HbA1c(χ^(2)=12.14,P<0.001),vitamin D deficiency(χ^(2)=10.20,P<0.001),high levels of low-density lipoprotein cholesterol(t=2.58,P=0.024),low levels of high-density lipoprotein cholesterol(t=3.65,P=0.008),high HbA1c levels(t=6.68,P<0.001),and low levels of 25(OH)D(t=6.60,P<0.001)are the independent risk factors for peripheral vascular disease in patients with T2DM.Logistic regression analysis revealed that long disease duration(OR=2.327,P=0.008),vitamin D deficiency(OR=1.255,P=0.034),high HbA1c levels(OR=3.124,P<0.001),and low 25(OH)D levels(OR=4.256,P=0.002)are significant risk factors for peripheral vascular disease.Pearson correlat

关 键 词：糖尿病 2型 糖尿病血管病变 25-羟维生素D2 血红蛋白A 糖基化 因素分析 统计学 

分 类 号：R58[医药卫生—内分泌]