| Objective:Analysis of Type 2 Diabete Mellitus(T2DM)with Carotid Atherosclerosis,The difference of neutrophil to lymphocyte ratio(NLR)and lymphocyte to monocyte ratio(LMR)between patients with T2 DM and those without CAS and healthy controls was investigated to explore the changes in NLR and LMR levels in patients with T2 DM and CAS.Methods:A total of 350 patients with T2 DM admitted to a hospital from August 2021 to October2022 were selected as the experimental group,they were divided into two groups: carotid atherosclerosis group(T2DM + CAS group,243 cases)and no carotid atherosclerosis group(T2DM-CAS,107 cases),There were 96 healthy subjects in the control group during the same period.The experimental groups were further divided into four groups according to the number of plaques: Group A with normal intima(n=107),group B with unilateral or bilateral thickening(n=77),group C with unilateral plaque(n=71),and group D with bilateral plaque or stenosis(n=95).General clinical data(including age,sex,height,weight,systolic blood pressure,diastolic blood pressure,disease course,smoking,drinking,hypertension,hyperlipidemia history),blood routine,blood lipid,fasting blood glucose(FBG),glycohemoglobin(Hb A1c)and other indicators of all subjects were collected,and the ratio of NLR to LMR was calculated.The correlation between T2 DM with CAS and NLR and LMR was analyzed.At the same time,the experimental group was divided into high and low groups according to the median NLR and LMR.The general data and laboratory test results between the two groups were compared,and the incidence of CAS in different NLR and LMR levels was compared.SPSS 26.0 statistical software was used for statistical analysis.Normal distribution measurement data were presented in the form of ±s.Independent sample t test was used for comparison between two groups,one-way ANOVA was used for comparison between multiple groups,and LSD was used for multiple comparisons between groups.Data with non-normal distribution were presented as M(P25,P75),Mann-Whitney U was used for comparison between two groups,Kruskal-Wallis H was used for comparison between multiple groups,and Bonfeeroni test was used for multiple comparisons.Count data were expressed as frequency(percentage),and chi-square(2)test was used between groups.Pearson correlation analysis was used to analyze the correlation between NLR,LMR and clinical indicators in T2 DM patients,and binary logistic regression analysis was used to analyze the independent influencing factors of T2 DM patients with CAS.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR and LMR for T2 DM with CAS.P < 0.05 was considered statistically significant.Results:1.There were statistically significant differences in gender,age,body mass index(BMI),disease duration,systolic blood pressure,neutrophil count(NEUT),lymphocyte count(LYM),monocyte count(MONO),NLR,LMR,FBG,Hb A1 c,total cholesterol(TC)and low-density lipoprotein(LDL-C)among the three groups(χ2= 5.572~33.651,F=4.714~10.152,H= 12.809~112.809,P < 0.05).There were no significant differences in smoking,drinking,history of hypertension,history of hyperlipidemia,diastolic blood pressure,triglyceride(TG)and other indicators among the three groups(P >0.05).2.NLR,LMR and other indicators were compared between the experimental group and the control group according to the severity.There were significant differences in age,course of disease,systolic blood pressure,diastolic blood pressure,NLR and LMR levels among the four groups(P < 0.05).There was no significant difference in BMI,NUET,LYM,MONO,HDL-C,LDL-C,TG,TC,FBG and Hb A1 c levels between the two groups(P > 0.05).3.The plaque detection rate of the high NLR group was higher than that of the low NLR group,and the number of cervical vascular ultrasound normal or endometrial thickening cases of the low NLR group was higher than that of the high NLR group,and the difference between the two groups was statistically significant(P < 0.05).The incidence of T2 DM with CAS increased gradually with the increase of NLR level.4.The plaque detection rate of the low LMR level group was higher than that of the high LMR level group,and the number of cervical vascular ultrasound normal or intimal thickening cases of the high LMR level group was higher than that of the low LMR group,the difference between the two groups was statistically significant(P < 0.05).The incidence of T2 DM with CAS increased gradually with the decrease of LMR level.5.Pearson correlation analysis showed that NLR was positively correlated with FBG and Hb Ac1(r = 0.232,0.273,P < 0.05).LMR was positively correlated with HDL-C(r = 0.155,P < 0.05),and negatively correlated with course of disease,systolic blood pressure,TC,FBG and Hb Ac1(r =-0.353~0.131,P < 0.05).6.Taking CAS as the dependent variable and NLR,LMR,age,course of disease,BMI,SBP,FBG,Hb A1 c,TC,HDL-C and LDL-C levels in T2 DM patients as independent variables,after adjusting for confounding factors,NLR(OR = 2.706,95%CI =1.458~5.022;P < 0.05)and LMR(OR = 0.764,95%CI = 0.598~0.977,P < 0.05)were still independent risk factors for CAS in T2 DM patients.7.Drawing the receiver operating characteristic(ROC)curve,the AUC of peripheral blood NLR and LMR in evaluating the risk of CAS in T2 DM patients were 0.760 and0.706,respectively,which were more than 0.70,the sensitivity was 80.10% and79.4%,and the specificity was 61.5% and 54.1%,respectively.The optimal cut-off values were 1.580 and 4.580,and the Youden index were 0.416 and 0.335,respectively.8.With the gradual increase of NLR level,the probability of T2 DM complicated with CAS increases.With the decrease of LMR level,the probability of T2 DM complicated with CAS increases.Conclusion:1.The incidence of CAS in T2 DM is high,and the independent risk factors include NLR,LMR,age and Hb A1 c.2.The level of NLR is significantly increased and the level of LMR is significantly decreased in T2 DM patients with CAS.3.NLR and LMR can predict the occurrence of T2 DM with CAS to a certain extent. |
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