Analysis Of Incidence And Severity Of Lower Extremity Arterial Disease In Patients With Type 2 Diabetes Mellitus

ObjectiveObjective to study the influencing factors of Lower extremity vascular disease（LEAD）in type 2 diabetes mellitus,and analyze the risk factors of LEAD with different severity.To provide a new reference for the diagnosis and treatment of LEAD in type 2 diabetes mellitus.Methoda retrospective analysis was conducted to select 1745 patients in two Endocrinology Department of 2018.9-2020.9 Affiliated Hospital of Shenyang Medical College.362 patients were selected strictly according to the inclusion and exclusion criteria.They were divided into simple type 2 diabetes group（simple T2DM group,n=89）and type 2 diabetes mellitus combined with LEAD group（Group T2DM+LEAD,n=273）.According to the color Doppler ultrasound of lower extremity arteries,T2DM+lead group was divided into lead intimal unsmooth group（group A,n=53）,lead intimal thickening group（group B,n=85）and lead plaque group（Group C,n=135）.The age,sex,course of disease,smoking history,waist hip ratio（WHR）,body mass index（BMI）,fasting C-peptide（FCP）,fasting blood glucose（FBG）,glycosylated hemoglobin（Hb A_lc）,glutamate aminotransferase（AST）and Aspartate aminotransferase（ALT）,uric acid（UA）,triglyceride（TG）,total cholesterol（TC）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）C-reactive protein（CRP）and calculate the neutrophil/lymphocyte ratio（NLR）.All data were analyzed by SPSS 23.0.Result1、Compared with simple T2DM group,age,course of disease,WHR,FBG,UA,LDL-C,CRP and NLR in T2DM+lead group were significantly higher（P<0.05）;C-peptide decreased significantly（P<0.05）.2、Compared with group A,WHR,UA,LDL-C,CRP and NLR in group B increased significantly（P<0.05）;Compared with group A,WHR,UA,LDL-C and NLR in group C increased significantly（P<0.05）;Compared with group A,C-peptide in group B decreased significantly（P<0.05）;Compared with group A,C-peptide in group C decreased significantly（P<0.05）.3、Taking the LEAD as the dependent variable,two yuan Logistic regression analysis was conducted.The results showed that age（OR=1.161）,WHR（OR=1.465）,FBG（OR=1.143）and NLR（OR=8.008）were independent risk factors for LEAD in type 2 diabetic patients.C peptide（OR=0.300）is an independent protective factor for LEAD in type 2 diabetic patients.4、Taking the severity of LEAD in T2DM as dependent variable,multiple ordinal Logistic regression analysis was conducted.The results showed that UA and NLR were independent risk factors of LEAD severity in patients with type 2 diabetes.FCP is an independent protective factor for LEAD severity in type 2 diabetic patients.5、ROC curve was used to analyze the indexes of simple T2DM group and T2DM+LEAD group.There was significant difference in NLR and FCP（P<0.05）,but there was no significant difference in age,WHR and FPG（P>0.05）.The AUC of NLR and FCP were 0.785（95%C.I 0.728～0.842）and 0.724（95%C.I 0.654～0.795）respectively.The best cut-off value of NLR was 2.275,and the sensitivity and specificity were89.4%and 55.1%respectively.The best cut-off value of FCP was 2.275,and the sensitivity and specificity were 99.6%and 1.1%respectively.6、ROC curve was used to analyze the indexes of subgroup A,B and C in T2DM+LEAD group.Compared with group A and B,the AUC of NLR was 0.670（95%C.I0.579～0.761）.The best cut-off value of NLR was 2.495,and the sensitivity and specificity were 75.3%and 50.9%respectively.There was no statistical significance in other groups（P>0.05）.Conclusion1.Age,WHR,FBG and NLR were independent risk factors for lead in T2DM patients;FCP is an independent protective factor.2、UA and NLR were independent risk factors for the severity of lead in T2DM patients;FCP is an independent protective factor.3、NLR and FCP have certain clinical value in the early diagnosis of lead in patients with T2DM.Among them,NLR has higher value in the early diagnosis of lead in patients with T2DM,which can predict the occurrence and development of lead earlier,so as to achieve early detection and early treatment.