Correlation Analysis Between Serum 25(OH)D3 And Type 2 Diabetes Combined With Hyperuricemia And TCM Syndrome Types

Objective:The purpose of this study was to research the correlation between serum 25 hydroxy vitamin D3 levels and Type 2 Diabetes Mellitus combined with hyperuricemia,which provided new ideas and insights for the early prevention and diagnosis of T2DM combined with HUA.At the same time,the distribution rules of TCM syndrome type of T2DM combined with HUA and the relationship between vitamin D and TCM syndrome types were analyzed,which provided a certain reference for the study of T2DM combined with HUAMethods:We collected a total of 357 patients with type 2 diabetes in the Endocrinology Ward of Jiangsu Provincial Hospital of Traditional Chinese Medicine.After a total of 48 cases of severe liver and kidney dysfunction,acute complications of diabetes,tumors,gout,and already taking vitamin D analogs were excluded according to the exclusion criteria,and 309 cases were finally included.According to the diagnostic criteria of hyperuricemia,all cases were divided into two groups,including 250 cases in T2DM group and 59 cases in T2DM combined with HUA group.Collect basic information and clinical data of patients,fasting serum for fasting more than 8 hours,collect serum creatinine(SCr)?Serum uric acid(SUA)?Fasting blood glucose(FBG)?Fasting insulin(FINS)?Fasting C peptide(FC-P)?Urine Uric acid(UUA)?Urine creatinine(UCr)?albumin-creatinine ratio(ACR)?urine total protein(UTP)?25 hydroxy vitamin D(25(OH)D3).Then calculation of body mass index(BMI)was based on elevation,weight,and calculated homeostatic model assessment for insulin resistance(HOMA-IR)based on fasting blood glucose and fasting insulin,and fractional excretion of uric Acid(FEUA)based on blood uric acid,blood creatinine,uric acid,urinary creatinine,and the estimated glomerular filtration rate(eGFR)based on serum creatinine,age,gender,etc.We compared the differences between 25(OH)D3 and other indicators in the two groupsand analyzed the relationships between 25(OH)D3 and age,disease course,waist circumference,BMI,C peptide,HOMA-IR,FC-P,ACR,UTP,SUA,FEU A,EGFR.And binary logistic regression was used to study the relationship between 25(OH)D3 and T2DM combined HUA.The T2DM group and the T2DM combined HUA group were separately counted for the TCM syndrome types,and the distribution of the TCM syndrome types in the two groups was studied.The correlation between vitamin D and syndrome types was analyzed and the influencing factors of each syndrome type were studied.Results:(1)T2DM combined HUA group had significantly lower 25(OH)D3,age,and uric acid excretion scores than the T2DM group(P<0.05).The course of T2DM,WC,BMI,SUA,uric acid variability,FCP,ACR,and 24HUUA in the T2DM combined HUA group were higher than those in the T2DM group(P<0.05).(2)Correlation analysis results:Serum uric acid was positively correlated with waist circumference,BMI,FCP,ACR,UTP,24hUUA(P<0.05),and negatively correlated with age and gender(P<0.05);partial correlation analysis showed that uric acid was independently negatively correlated with gender,age and eGFR,Independently correlated with waist circumference,BMI,FCP,ACR,UTP;(3)The binary logistic regression analysis was performed with and without HUA as the dependent variable and 25(OH)D3 and other indicators as independent variables.The results showed that female,duration,waist circumference,and BMI were risk factors for T2DM combined with HUA(all P<0.05),but age,25(OH)D3,eGFR,and FEUA are protective factors for type 2 diabetes with hyperuricemia(all P<0.05),and the results of brinary regression analysis of 25(OH)D3 quartile analysis show that after controlling for confounding factors,The risk of T2DM combined with HUA is increasing with the decrease of 25(OH)D3.(4)The analysis of subgroup showed that in female patients,25(OH)D3 was negatively correlated with SUA and 24HUUA(P<0.05)and positively correlated with FEUA(P<0.05);in patients of male,course of diseases were higher than 10 years,whose age was lower than 60 years,waist In patients with T2DM was higher than 90cm,BMI was higher than 28kg/m2,ACR was higher than 30,25(OH)D3 was protective factor for T2DM combined with HUA(P<0.05).(5)In the T2MD group,the TCM syndromes is mainlv based on syndrome of dryness-heat due to yin deficiency and blood stasis.The T2DM combined with HUA group is based on Qi-Yin deficiency syndrome,and the standard is phlegm syndrome In the group of T2DM and T2MD combined HUA,25(OH)D3 showed a downward trend with the change of syndromes from syndrome of dryness-heat due to yin deficiency to yin and yang deficiency syndrome,and phlegm turbidity syndrome 25(OH)D3 level was significantly lower than blood stasis syndrome,the difference between groups was statistically significant.(6)With the change of syndrome type from syndrome of dryness-heat due to yin deficiency to Yin Deficiency Syndrome,the risk of T2DM combined with HUA is generally increasing,and the risk of T2DM combined with HUA is decreasing with Changes from dampness syndrome to blood stasis syndrome.(7)25(OH)D3 was positively correlated with syndrome of dryness-heat due to yin deficiency,SUA was positively correlated with both Qi-Yin deficiency syndrome;25(OH)D3 was negatively correlated with Yin and yang deficiency syndrome;25(OH)D3 was negatively correlated with phlegm syndrome,SUA,BMI were positively correlated with phlegm and turbidity syndrome;25(OH)D3 was positively correlated with blood stasis syndrome,SUA,BMI was negatively correlated with blood stasis syndrome.Conclusion:1.25(OH)D3 was positivly correlated with T2DM combined with HUA.This correlation was mainly manifested in women,young people,obesity,or type 2 diabetes with proteinuria.2.The TCM syndrome in T2DM combined with HUA was mainly based on deficiency of Qi and Yin,and phlegm and dampness syndrome.The syndrome of T2DM TCM is mainly based on syndrome of dryness-heat due to yin deficiency,and the syndrome is mainly based on blood stasis syndrome.3.With the progression of the disease and the appearance of phlegm and dampness syndrome,25(OH)D3 gradually decreased;25(OH)D3 was the positively correlated with syndrome of dryness-heat due to yin deficiency,and was negatively correlated with deficiency of spleen and kidney,deficiency of yin and yang and dampness syndrome,which suggested that 25(OH)D3 level can be one of the basis of T2DM combined HUA TCM syndrome differentiation.