2型糖尿病患者血清25-羟维生素D_3与颈动脉斑块及内膜中层厚度关系
|
摘要
目的探讨2型糖尿病(type 2diabetes mellitus,T2DM)患者血清25-羟维生素D_3[serum 25-hydroxyvitamin D_3,25(OH)D_3]水平与颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)及颈动脉斑块间的关系。方法 T2DM患者272例,检测血清25(OH)D_3水平,根据血清25(OH)D_3水平四分位数将患者分为Q1组(<10.1μg/L)75例、Q2组(10.1~12.7μg/L)67例、Q3组(>12.7~18.1μg/L)65例和Q4组(>18.1μg/L)65例;采用彩色多普勒超声测量CIMT和颈动脉斑块,分为斑块组166例和无斑块组106例。比较不同血清25(OH)D_3水平4组CIMT、颈动脉斑块发生率,比较斑块组和无斑块组血清25(OH)D_3水平,采用Pearson相关分析血清25(OH)D_3水平与CIMT的相关性,采用多元线性回归分析CIMT的危险因素,采用多因素logistic回归分析CIMT增加和颈动脉斑块形成的影响因素。结果 Q1组和Q2组CIMT[(1.08±0.13)、(1.05±0.11)mm]高于Q3组和Q4组[(0.91±0.15)、(0.82±0.13)mm](P<0.05),Q4组颈动脉斑块率(40.0%)低于Q1组(69.3%)、Q2组(68.7%)和Q3组(64.6%)(P<0.05);斑块组血清25(OH)D_3水平[(11.64±10.91)μg/L]低于无斑块组[(17.81±6.50)μg/L](P<0.05);Pearson相关分析显示血清25(OH)D_3水平与CIMT呈负相关(r=-0.384,P<0.001);多元线性逐步回归分析显示血清25(OH)D_3与CIMT独立相关(β=-0.285,P=0.001);多因素logistic回归分析显示血清25(OH)D_3水平增高是颈动脉斑块的保护因素(OR=0.86,95%CI:0.84~0.90,P=0.002)。结论 T2DM患者维生素D缺乏可能促进CIMT增加和颈动脉斑块的发生。
Objective To investigate the relationship of serum levels of 25-hydroxyvitamin D_3(25(OH)D_3)with carotid intima-media thickness(CIMT)and carotid plaque in patients with type 2diabetes mellitus(T2DM).Methods Totally272patients with T2DM were detected the serum 25(OH)D_3level and were divided into Q1group(25(OH)D_3<10.1μg/L,n=75),Q2group(25(OH)D_3:10.1-12.7μg/L,n=67),Q3group(25(OH)D_3>12.7-18.1μg/L,n=65)and Q4group(25(OH)D_3≥18.1μg/L,n=65).CIMT and carotid plaques were measured by color Doppler sonography and the patients were divided into plaque group(n=166)and no-plaque group(n=106).The CIMT and carotid plaque rate were compared among four groups and the levels of 25(OH)D_(3 )were compared between plaque group and no-plaque group.Pearson correlation analysis was adopted to study the correlation of 25(OH)D_(3 )with CIMT,and multivariate linear regression analysis and multivariate logistic regression analysis were adopted to study the influencing factors for the CIMT as well as the increased CIMT and carotid plaque.Results The CIMT was significantly thicker in Q1group((1.08±0.13)mm)and Q2group((1.05±0.11)mm)than that in Q3group((0.91±0.15)mm)and Q4group((0.82±0.13)mm)(P<0.05).The carotid plaque rate was significantly lower in Q4group(40.0%)than that in Q1group(69.3%),Q2group(68.7%)and Q3group(64.6%)(P<0.05).The level of serum 25(OH)D_(3 )was significantly lower in plaque group((11.64±10.91)μg/L)than that in no-plaque group((17.81±6.50)μg/L)(P<0.05).Pearson correlation analysis showed that serum 25(OH)D_3level was negatively correlated with CIMT(r=-0.384,P<0.001),multivariate linear regression analysis showed that serum 25(OH)D_(3 )level was independently correlated with CIMT(β=-0.285,P=0.001),and multivariate logistic regression analysis showed serum 25(OH)D_(3 )was the protective factor for carotid plaque(OR=0.86,95%CI:0.84-0.90,P=0.002).Conclusion Vitamin D deficiency in T2DM patients may promote the increase of CIMT and the formation of carotid plaque.
Objective To investigate the relationship of serum levels of 25-hydroxyvitamin D_3(25(OH)D_3)with carotid intima-media thickness(CIMT)and carotid plaque in patients with type 2diabetes mellitus(T2DM).Methods Totally272patients with T2DM were detected the serum 25(OH)D_3level and were divided into Q1group(25(OH)D_3<10.1μg/L,n=75),Q2group(25(OH)D_3:10.1-12.7μg/L,n=67),Q3group(25(OH)D_3>12.7-18.1μg/L,n=65)and Q4group(25(OH)D_3≥18.1μg/L,n=65).CIMT and carotid plaques were measured by color Doppler sonography and the patients were divided into plaque group(n=166)and no-plaque group(n=106).The CIMT and carotid plaque rate were compared among four groups and the levels of 25(OH)D_(3 )were compared between plaque group and no-plaque group.Pearson correlation analysis was adopted to study the correlation of 25(OH)D_(3 )with CIMT,and multivariate linear regression analysis and multivariate logistic regression analysis were adopted to study the influencing factors for the CIMT as well as the increased CIMT and carotid plaque.Results The CIMT was significantly thicker in Q1group((1.08±0.13)mm)and Q2group((1.05±0.11)mm)than that in Q3group((0.91±0.15)mm)and Q4group((0.82±0.13)mm)(P<0.05).The carotid plaque rate was significantly lower in Q4group(40.0%)than that in Q1group(69.3%),Q2group(68.7%)and Q3group(64.6%)(P<0.05).The level of serum 25(OH)D_(3 )was significantly lower in plaque group((11.64±10.91)μg/L)than that in no-plaque group((17.81±6.50)μg/L)(P<0.05).Pearson correlation analysis showed that serum 25(OH)D_3level was negatively correlated with CIMT(r=-0.384,P<0.001),multivariate linear regression analysis showed that serum 25(OH)D_(3 )level was independently correlated with CIMT(β=-0.285,P=0.001),and multivariate logistic regression analysis showed serum 25(OH)D_(3 )was the protective factor for carotid plaque(OR=0.86,95%CI:0.84-0.90,P=0.002).Conclusion Vitamin D deficiency in T2DM patients may promote the increase of CIMT and the formation of carotid plaque.
引文
[1]ARABI A,El RASSI R,ELHAJJ F G.Hypovitaminosis D in developing countries-prevalence,risk factors and outcomes[J].Nat Rev Endocrinol,2010,6(10):550-561.
[2]ROSEN C J.Clinical practice:vitamin D insufficiency[J].N Engl J Med,2011,364(3):248-254.
[3]DEFRONZO R A.Insulin resistance,lipotoxicity,type 2diabetes and atherosclerosis:the missing links.The Claude Bernard Lecture 2009[J].Diabetologia,2010,53(7):1270-1287.
[4]VAN BELLE T L,GYSEMANS C,MATHIEU C.Vitamin D and diabetes:the odd couple[J].Trends Endocrinol Metab,2013,24(11):561-568.
[5]ZERWEKH J E.Blood biomarkers of vitamin D status[J].Am J Clin Nutr,2008,87(4):1087S-1091S.
[6]GIOVANNUCCI E,LIU Y,HOLLIS B W,et al.25-Hydroxyvitamin D and risk of myocardial infarction in men:a prospective study[J].Arch Intern Med,2008,168(11):1174-1180.
[7]王艳,陈燕,季黎明,等.不同血清25-羟维生素D水平的2型糖尿病患者颈动脉内膜中层厚度的变化[J].临床和实验医学杂志,2016,15(5):445-447.
[8]HERRMANN M,SULLIVAN D R,VEILLARD A S,et al.Serum 25-hydroxyvitamin D:apredictor of macrovascular and microvascular complications in patients with type 2diabetes[J].Diabetes Care,2015,38(3):521-528.
[9]MANCIA G,DE BACHLKER G,DOMINICZAK A,et al.2007Guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].J Hypertension,2007,25(6):1105-1187.
[10]夏瑾玮,张省亮,许婵婵,等.老年人血清维生素D与代谢综合征相关性的临床研究[J].中国糖尿病杂志,2013,21(10):903-906.
[11]KAWAMOTO R,KATOH T,KUSUNOKI T,et al.Carotid atherosclerosis as a surrogate maker of cardiovascular disease in diabetic patients[J].ISRN Endocrinology,2013:979481.
[12]HOSSEINPANAH F,YARJANLI M,SHEIKHOLESLAMI F,et al.Associations between vitamin D and cardiovascular outcomes:Tehran Lipid and Glucose Study[J].Atherosclerosis,2011,218(1):238-242.
[13]GOUNI-BERTHOLD I,KRONE W,BERTHOLD H K.Vitamin D and cardiovascular disease[J].Curr Vasc Pharmacol,2009,7(3):414-422.
[14]LEE J H,O'KEEFE J H,BELL D,et al.Vitamin D deficiency an important,common,and easily treatable cardiovascular risk factor[J].J Am Coll Cardiol,2008,52(24):1949-1956.
[15]PLUDOWSKI P,HOLICK M F,PILZ S,et al.Vitamin D effects on musculoskeletal health,immunity,autoimmunity,cardiovascular disease,cancer,fertility,pregnancy,dementia and mortality:a review of recent evidence[J].Autoimmun Rev,2013,12(10):976-989.
[16]CHEN R H,JIANG X Z,JIANG Q,et al.Correlations between serum levels of 25-hydroxyvitamin D and carotid atherosclerosisin patients with type 2diabetes in Shanghai[J].Ann Endocrinol(Paris),2014,75(4):206-212.
[2]ROSEN C J.Clinical practice:vitamin D insufficiency[J].N Engl J Med,2011,364(3):248-254.
[3]DEFRONZO R A.Insulin resistance,lipotoxicity,type 2diabetes and atherosclerosis:the missing links.The Claude Bernard Lecture 2009[J].Diabetologia,2010,53(7):1270-1287.
[4]VAN BELLE T L,GYSEMANS C,MATHIEU C.Vitamin D and diabetes:the odd couple[J].Trends Endocrinol Metab,2013,24(11):561-568.
[5]ZERWEKH J E.Blood biomarkers of vitamin D status[J].Am J Clin Nutr,2008,87(4):1087S-1091S.
[6]GIOVANNUCCI E,LIU Y,HOLLIS B W,et al.25-Hydroxyvitamin D and risk of myocardial infarction in men:a prospective study[J].Arch Intern Med,2008,168(11):1174-1180.
[7]王艳,陈燕,季黎明,等.不同血清25-羟维生素D水平的2型糖尿病患者颈动脉内膜中层厚度的变化[J].临床和实验医学杂志,2016,15(5):445-447.
[8]HERRMANN M,SULLIVAN D R,VEILLARD A S,et al.Serum 25-hydroxyvitamin D:apredictor of macrovascular and microvascular complications in patients with type 2diabetes[J].Diabetes Care,2015,38(3):521-528.
[9]MANCIA G,DE BACHLKER G,DOMINICZAK A,et al.2007Guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].J Hypertension,2007,25(6):1105-1187.
[10]夏瑾玮,张省亮,许婵婵,等.老年人血清维生素D与代谢综合征相关性的临床研究[J].中国糖尿病杂志,2013,21(10):903-906.
[11]KAWAMOTO R,KATOH T,KUSUNOKI T,et al.Carotid atherosclerosis as a surrogate maker of cardiovascular disease in diabetic patients[J].ISRN Endocrinology,2013:979481.
[12]HOSSEINPANAH F,YARJANLI M,SHEIKHOLESLAMI F,et al.Associations between vitamin D and cardiovascular outcomes:Tehran Lipid and Glucose Study[J].Atherosclerosis,2011,218(1):238-242.
[13]GOUNI-BERTHOLD I,KRONE W,BERTHOLD H K.Vitamin D and cardiovascular disease[J].Curr Vasc Pharmacol,2009,7(3):414-422.
[14]LEE J H,O'KEEFE J H,BELL D,et al.Vitamin D deficiency an important,common,and easily treatable cardiovascular risk factor[J].J Am Coll Cardiol,2008,52(24):1949-1956.
[15]PLUDOWSKI P,HOLICK M F,PILZ S,et al.Vitamin D effects on musculoskeletal health,immunity,autoimmunity,cardiovascular disease,cancer,fertility,pregnancy,dementia and mortality:a review of recent evidence[J].Autoimmun Rev,2013,12(10):976-989.
[16]CHEN R H,JIANG X Z,JIANG Q,et al.Correlations between serum levels of 25-hydroxyvitamin D and carotid atherosclerosisin patients with type 2diabetes in Shanghai[J].Ann Endocrinol(Paris),2014,75(4):206-212.