Relationship Between Serum MiR-27a,25（OH）D₃ And Lower Extremity Arterial Disease In Type 2 Diabetes Mellitus

Objective:To study the relationship between serum miR-27a,serum 25hydroxyvitamin D₃[25hydroxyvitamin D₃,25（OH）D₃]level and lower extremity arterial disease（LEAD）in patients with type 2 diabetes mellitus（T2DM）.Methods:From September 2018 to February 2020,279 patients with type 2diabetes mellitus diagnosed by the department of endocrinology of Cangzhou People’s Hospital.Patients with type 2 diabetes mellitus were divided into groups according to Ankle Brachial Index（ABI）and the result of lower limb blood vessel detection by doppler ultrasound.The T2DM patients were divided into non-lower extremity arterial disease（Non-LEAD）sub group（126cases）and lower extremity arterial disease（LEAD）sub group（153cases）.The expression of miR-27and the level of 25（OH）D₃,TC,TG,Hb A1c,FINS,FPG,HOMA-IR and age,course of disease,history of smoking were measured and compared.Color doppler ultrasound examination of lower extremity and Limb doppler examination of ankle index were performed by specialists.All data were statistically analyzed using SPSS19.0 software.Results:1 Comparison of general and related indicators between groups.Through statistical analysis,there was no significant difference in age,course of disease,BMI,smoking rate between groups（P>0.05）.there were significant differences in miR-27a,25（OH）D₃,TC,TG,Hb A1c,FPG,HOMA-IR between groups（P<0.05）.2 Logistic regression analysis of risk factors for T2DM complicated with lower extremity arterial disease.Logistic regression analysis was performed to determine whether T2DM was associated with lower extremity arterial disease as a dependent variable,and the miR-27,25（OH）D₃,TC,TG,Hb A1c,FPG,HOMA-IR as independent variables.The results showed that miR-27a（OR=33.690,95%CI9.515-119.285,P<0.001）,TC（OR=11.501,95%CI3.683-35.919,P<0.001）,HO MA-IR（OR=4.830,95%CI 1.688-13.816,P<0.05）as risk factors of LEAD while 25（OH）D₃（OR=0.037,95%CI 0.011-0.119,P<0.001）as protective factor.3 TC,HOMA-IR,miR-27a and 25（OH）D₃ROC curve analysis.The areas under the ROC curves for TC was 0.837,and the best interception threshold is 5.665nmol/L.The sensitivity and specificity of TC in the diagnosis of T2DM complicated with lower extremity arterial disease were respectively 0.604 and 0.699.The areas under the ROC curves for HOMA-IR was 0.801,and the best interception threshold is 1.471nmol/L.The sensitivity and specificity of HOMA-IR in the diagnosis of T2DM complicated with lower extremity arterial disease were respectively 0.680and 0.794.The areas under the ROC curves for miR-27a was 0.937,and the best interception threshold is 2.445nmol/L.The sensitivity and specificity of miR-27a in the diagnosis of T2DM complicated with lower extremity arterial disease were respectively 0.974 and 0.738.The areas under the ROC curves for 25（OH）D₃was 0.936,and the best interception threshold is33.065nmol/L.The sensitivity and specificity of 25（OH）D₃in the diagnosis of T2DM complicated with lower extremity arterial disease were respectively 0.935 and 0.802.Conclusion:1 Elevated serum miR-27a、TC、HOMA-IR levels and decreased serum25（OH）D₃levels are independent risk factors for lower extremity arterial lesions in type 2 diabetes.2 TC、HOMA-IR、miR-27a、25（OH）D₃level can predict the degree of lower extremity arterial lesions in type 2 diabetes mellitus,and miR-27a、25（OH）D₃has high sensitivity and specificity.