Correlation Research For Serum25-hydroxyvitamin D₃Levels, Type2Diabetes Mellitus, And Carotid Artery Atherosclerosis

Objective：Macroangiopathy is one of the chronic complications of type2diabetes mellitus, it impacts on the patients’ quality of life and threatens thelives of patients seriously. Atherosclerosis is one of the important mechanismsof diabetic macroangiopathy. Recent studies have shown that active vitamin Dnot only plays a role in the regulation of calcium phosphorus and bonemetabolism, but also related to the occurrence of type2diabetes andatherosclerosis closely, it may be a protective factor for diabetes and diabeticmacroangiopathy. The purpose of our study is to investigate a relationshipamong serum25-hydroxyvitamin D₃ï¼»25（OH）D₃ï¼½, high-sensitivity C-reactiveprotein （hs-CRP）, type2diabetes and carotid artery atherosclerosis bydetecting the level of serum25（OH）D₃, hs-CRP in type2diabetes patientswith or without concurrent carotid atherosclerosis, then to reveal risk factorsfor carotid atherosclerosis of type2diabetes patients, and provide basis fordiabetic macroangiopathy prevention and treatment.Methods：Select type2diabetes patients hospitalized from November2012to February2013in the Department of Endocrinology in SecondHospital of Hebei Medical University, they were all completed carotidultrasound in line with the diabetes diagnosis standards of the World HealthOrganization （WHO） in1999, and at the same time met the following criteria:1. Without serious liver and kidney dysfunction;2. Without taking vitamin Ddrugs as well as calcium and other drugs affecting bone metabolism;3.Without emphysema, cancer, systemic inflammation, recent surgery and otherstress;46cases were taken to type2diabetes mellitus （T2DM） group. Basedon the results of the carotid ultrasound, diabetes patients were further dividedinto simple type2diabetes （Simple T2DM） group of13patients and type2diabetic patients with carotid atherosclerosis （T2DM&CAS） group of33 patients; over the same period,39healthy people participating in theexamination and meeting the following conditions:1. normal glucosemetabolism （fasting glucose<5.6mmol/L）;2. normal blood pressure （systolicblood pressure<140mmHg, diastolic blood pressure<90mmHg）;3. normalblood lipids （TG<1.7mmol/L, HDL<2.0mmol/L, and LDL<4.0mmol/L）were taken to the control group.（1） Collect all the clinical data of the object inour study, including gender, age, smoking history, medical history, familyhistory, weight, height, systolic blood pressure, diastolic blood pressure, andcalculate the body mass index （BMI）.（2） Take subjects’ fasting blood tomeasure fasting plasma glucose （FPG）, triglycerides （TG）, total cholesterol（TC）, high density lipoprotein cholesterol （HDL-C）, low-density lipoproteincholesterol （LDL-C） calcium （Ca）, phosphorus （P）, alkaline phosphatase（ALP）, serum25-hydroxy vitamin D₃ï¼»25（OH）D₃ï¼½, high sensitive C-reactiveprotein （hs-CRP）. Patients in T2DM group also measured hemoglobin A1c（HbA1c）, fibrinogen （FIB）.（3） The same one in the department of ultrasoundused the same sets of color B-instrument carotid ultrasound to examine IMT.Statistics were processed by SPSS18.0software, measurement data arepresented as mean±standard deviation （x±S）, t test was used to compare thetwo normally distributed groups, abnormal distribution data used rank-sumtest. Count data were compared by chi-square test, and classification variableswere expressed as percentage （%）, Logistic regression analysis was chosen toscreen predictors of carotid atherosclerotic plaque formation, multipleregression stepwise analysis evaluated factors influencing serum25（OH）D₃levels. P <0.05determined that the difference was statistically significant.Results:1In the study of85cases,46cases were type2diabetes, including24males and22females;39cases were taken into control group, including17males and22females. The sex ratio was no significant difference （P>0.05）.People in T2DM group,19were smokers, mean age was52.24±9.41years old,the average SBP was135.85±15.80mmHg, The average DBP was83.74±12.78mmHg, their BMI was25.85±3.38kg/m²; people in control group,6were smokers, average age was44.10±9.59years old, the average ofSBP was122.36±12.39mmHg DBP average was76.23±9.84mmHg, BMIwas24.48±4.30kg/m². In T2DM group, the number of smokers, age, SBP,DBP, BMI was higher than that of the control group, and the difference wasstatistically significant （P <0.05）.2FBG, TG, hs-CRP, Ca, P of T2DM group were higher than that of thecontrol group, P<0.05, the difference was statistically significant; HDL-C,25（OH）D₃of T2DM group were less than the control group, P<0.05, thedifference was statistically significant; TC, LDL-C, ALP of T2DM group wasin a trend of increasing compared with the control group, but P>0.05, thedifference was not statistically significant.3T2DM group had33cases of carotid atherosclerosis, accounting for71.74%of the diabetic group; the control group, only4cases appear carotidplaque, accounting for10.26%of the control group.4The average age and FIB of T2DM&CAS group were higher thanSimple T2DM group （P<0.05）, the difference was statistically significant;FBG, TC, TG, HDL-C, ALP, HbA1C, hs-CRP,25（OH）D₃of T2DM&CASgroup were higher than that of Simple T2DM group, P>0.05, the differencewas not statistically significant; BMI, SBP, DBP, LDL-C, Ca, P weresignificant difference.5Logistic regression analysis showed that age （OR:4.955,95%CI:2.031¹2.093, P=0.000）, hyperglycemia （OR:18.295,95%CI:3.185¹05.105,P=0.001） were independent predictors of carotid artery plaque. Adjusted forsex and age, the results show that high blood sugar is the risk factor for AS.6Multiple regression analysis for25（OH）D₃levels showed that gender,BMI, FBG, HDL-C, hs-CRP were the main factors to effect25（OH）D₃levelgradually.Conclusions:25（OH）D₃level in T2DM patients was lower than thenormal control group, hs-CRP is higher than the control group. The mainfactors to effect25（OH）D₃level were gender, BMI, FBG and hs-CRP. But aclose relationship was not yet found between25（OH）D₃level and the formation of carotid artery atherosclerosis plaque in type2diabetes, whethervitamin D preparation was needed or not in clinical application to preventatherosclerosis in type2diabetes still needed to be further examined by alarger-scale trials.