| Death caused by macrovascular complications in type 2 diabetes mellitus(T2DM)patients accounts for 59%.The main cause of macrovascular disease is atherosclerosis and thrombosis.The major pathological basis of macrovascular disease is atherosclerosis(AS).AS is characterized by thickening the arterial wall,loss of elasticity,and narrowing the lumen.In recent years,people’s living standard continues improving,with the average of life expectancy increasing,unhealthy lifestyle growing,leading to the relative and absolute incidence rate of AS increasing.AS has now become one of the major causes of death.The prevalence of AS in diabetic patients is higher,the age of onset is younger,and the disease progresses more rapidly.More and more studies have shown that vitamin D not only plays an important role in calcium and phosphorus metabolism and bone metabolism,but also participates in the development of diabetes and AS.Vitamin D deficiency may be a risk factor for diabetes and macrovascular complications in diabetes.ObjectiveIn recent years,the prevalence of T2 DM is high in China.T2 DM macrovascular disease is a major complication of T2 DM,more than half of T2 DM patients died because of macrovascular disease,which is a serious threat to the lives of patients.It is reported that vitamin D can regulate calcium and phosphorus metabolism and bone metabolism,also involves in diabetes and its macrovascular disease,may be a protective factor.However,there are few reports about the relationship between different serum vitamin D levels and AS in patients with T2 DM.In this study,carotid atherosclerosis was as a window for the study of diabetic macrovascular,and intends to investigate the relationship between different levels of serum vitamin D andT2 DM of carotid atherosclerosis,and further study the protective factors of diabetic macrovascular disease,treatment method,to provide new ideas for its pathogenesis.MethodsRandomly selected 155 patients with T2 DM,from January 2016 to May2016 in the endocrine department of Baoding First Central Hospital of inpatient treatment,all patients were in line with the WHO T2 DM diagnosis and typing standard recommended in 1999.According to the serum 25 hydroxyvitamin D[25(OH)D3] level,T2 DM group was further divided into three groups,namely the lack of vitamin D group: 25(OH)D3<20ng/mL;vitamin D deficiency group: 20ng/mL≤25(OH)D3 < 30ng/mL;plenty of vitamin D group: 25(OH)D3≥30ng/mL.Another 30 healthy persons were selected as normal control group(NC group).Asked and recorded the general situation,including gender,age,duration of diabetes,medication,smoking and other lifestyle,measured their height,weight,systolic blood pressure,diastolic blood pressure,body mass index(BMI).Fasting venous blood 6mL,detected their serum total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,glycosylated hemoglobin,fasting blood glucose,serum calcium,serum phosphorus,25(OH)D3.The determination of various biochemical indexes was detected by automatic blood biochemical analyzer type 7600 produced by Japanese Hitachi company,the Japanese ARKRAY HA8180 type instrument and the original reagents was used for the determination of HbA1 c content.The determination of vitamin D content was used by Shenzhen New Industry 4000.All subjects were examined by carotid artery ultrasound with the same color Doppler apparatus.The data were analyzed by SPSS19.0 statistical software,and the measurement data were expressed as mean ± standard deviation(sx?).T test was used to compare the two groups,and single factor analysis of variance was used to compare the differences between multiple groups.Enumeration data or rate comparison was used χ2 test.Screening risk factors of carotid atherosclerosis used two Logistic regression analysis.The difference was statisticallysignificant when P<0.05.Result1 There was no significant difference in age and sex between the control group and the case group(P>0.05),but there was significant difference in body mass index,systolic blood pressure and diastolic blood pressure(P < 0.05).Compared with the control group,the levels of TC,TG,LDL-C,FBG and HbA1 c were significantly increased in the lack group,deficiency group and sufficient group,and the difference was statistically significant(P<0.05),LDL-C decreased,FBG,HbA1 c and HDL-C were increased,and the difference of serum calcium and phosphorus was not statistically significant(P>0.05).2 Carotid intima-media thickness in the control group was significantly lower than that in the lack group,the control group was significantly lower than that in the insufficient group,the lack group was significantly higher than the adequate group,the insufficient group was significantly higher than the adequate group,the difference was statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).3 Pearson correlation analysis of 25(OH)D3 There was no significant correlation in analysis of 25(OH)D3 with age,sex,systolic blood pressure,diastolic blood pressure,blood glucose(P>0.05),and there was a negative correlation between BMI,HbA1 c and CIMT(r =-0.28,-0.42,-0.79,P <0.05).And HDL-C was positively correlated with 25(OH)D3(r = 0.37,P <0.05).4 Logistic regression analysis of carotid atherosclerosis The level of carotid atherosclerosis was dependent variable,and age,smoking,systolic blood pressure,diastolic blood pressure,BMI,TC,LDL-C,HbA1 c,serum calcium,blood phosphorus,FBG,TG,HDL-C and 25(OH)D3 were independent variable,the Logistic regression analysis showed that TG and LDL-C(OR:1.093 and4.116,95%CI:1.007~1.193 and 1.003~19.208,P<0.05)were the risk factors of carotid atherosclerosis,and the protective factor of carotid atherosclerosis was 25(OH)D3(OR:0.938,95%CI:0.904~0.987,P<0.05).ConclusionCIMT significantly increased in T2 DM patients with vitamin Ddeficiency and vitamin D insufficiency,vitamin D can slow the occurrence and development of CAS.25(OH)D3 was negatively correlated with BMI,HbA1 c and CIMT,and positively correlated with HDL-C.And 25(OH)D3 is the protective factor of CAS,TG and LDL-C are the risk factors of CAS.In clinical work,T2 DM patients in addition to strengthening the general management of blood biochemical indicators,early by adding 25(OH)D3may play a protective role in the CAS,reduce the incidence of T2 DM vascular complications,slowing its progress. |
