2023 年第 6 期 第 18 卷

2型糖尿病患者发生下肢动脉硬化闭塞症的危险因素分析

Risk factors of lower extremity arteriosclerotic occlusive disease in patients with type 2 diabetes mellitus

作者：王冠赵亚男程志新

英文作者：Wang Guan Zhao Yanan Cheng Zhixin

单位：山东中医药大学附属医院周围血管科，济南250014

英文单位：Department of Peripheral Vasculopathy Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan 250014 China

关键词：2型糖尿病；下肢动脉硬化闭塞症；脂联素；胱抑素C；载脂蛋白

英文关键词：Type2diabetesmellitus;Lowerextremityarterioscleroticocclusivedisease;Adiponectin; CystatinC;Apolipoprotein

• 摘要：

• 目的  探讨2型糖尿病患者发生下肢动脉硬化闭塞症（LEAOD）的危险因素及与脂联素、胱抑素C、载脂蛋白A1（ApoA1）/ApoB比值的关系。方法  选取山东中医药大学附属医院2018年1月至2021年1月收治的2型糖尿病患者120例，根据是否合并LEAOD将患者分为LEAOD组和非LEAOD组。比较2组临床资料，采用逐步Logistic回归分析方法分析2型糖尿病患者发生LEAOD的危险因素，采用Spearman相关性分析方法分析LEAOD发生风险与2型糖尿病患者血清脂联素、胱抑素C、ApoA1/ApoB比值的相关性。 结果  120例患者中，48例合并LEAOD（LEAOD组）、72例未合并LEAOD（非LEAOD组）。2组吸烟史、糖尿病周围神经病变（DPN）、脑梗死、高血压病、冠心病（冠状动脉粥样硬化性心脏病）比例及空腹血糖、糖化血红蛋白（HbA1c）、空腹C肽、三酰甘油、总胆固醇、低密度脂蛋白胆固醇（LDL-C）、脂蛋白a、血尿酸、血肌酐、脂联素、胱抑素C水平、ApoA1/ApoB比值比较差异均有统计学意义（均P＜0.05）。逐步Logistic回归分析结果显示DPN（比值比=2.988，95%置信区间：1.335~6.688）、冠心病（比值比=2.513，95%置信区间：1.366~4.623）、HbA1c（比值比=2.617，95%置信区间：1.163~5.889）、LDL-C（比值比=2.478，95%置信区间：1.292~4.753）、脂联素（比值比=2.192，95%置信区间：1.014~4.739）、胱抑素C（比值比=2.431，95%置信区间：1.071~5.718）、ApoA1/ApoB比值（比值比=3.091，95%置信区间：1.376~6.944）是2型糖尿病患者发生LEAOD的独立危险因素（均P＜0.05）。Spearman相关性分析结果显示2型糖尿病患者LEAOD的发生风险与血清脂联素、ApoA1/ApoB比值呈负相关，与胱抑素C呈正相关（均P＜0.001）。结论  DPN、冠心病、HbA1c、LDL-C、脂联素、胱抑素C、ApoA1/ApoB比值是2型糖尿病患者发生LEAOD的独立危险因素，LEAOD的发生风险与血清脂联素、ApoA1/ApoB比值呈负相关性，与胱抑素C呈正相关性。

• Objective    To explore the risk factors of lower extremity arteriosclerotic occlusive disease (LEAOD) in patients with type 2 diabetes mellitus (T2DM) and the relationship with adiponectin (APN), cystatin C (CysC), and apolipoprotein A1 (ApoA1)/ApoB ratio. Methods  From January 2018 to January 2021, 120 patients with T2DM admitted to Affiliated Hospital of Shandong University of Traditional Chinese Medicine were enrolled. According to whether patients combined with LEAOD, they were divided into LEAOD group and non-LEAOD group. The clinical data were compared between the two groups. Stepwise Logistic regression analysis method was used to analyze the risk factors of LEAOD in patients with T2DM. Spearman correlation analysis method was used to analyze the correlation of LEAOD risk with APN, CysC and ApoA1/ApoB ratio in patients with T2DM. Results  Among 120 patients, 48 of them had LEAOD (LEAOD group) and 72 of them had no LEAOD (non-LEAOD group). There were significant differences between the two groups in rates of smoking history, diabetic peripheral neuropathy (DPN), cerebral infarction, hypertension, coronary atherosclerotic heart disease, and levels of fasting plasma glucose, glycosylated hemoglobin (HbA1c), fasting C-peptide, triacylglycerol, total cholesterol, low-density lipoprotein cholesterol (LDL-C), lipoprotein (a)［Lp(a)］, serum uric acid, serum creatinine, APN, CysC and ApoA1/ApoB ratio (all P<0.05). The stepwise Logistic regression analysis results showed that DPN ［odds ration (OR)=2.988, 95% confidence interval (CI): 1.335-6.688］, coronary atherosclerotic heart disease (OR=2.513, 95% CI: 1.366-4.623), HbA1c (OR=2.617, 95% CI: 1.163-5.889), LDL-C (OR=2.478, 95% CI: 1.292-4.753), APN (OR=2.192, 95% CI: 1.014-4.739), CysC (OR=2.431, 95% CI: 1.071-5.718) and ApoA1/ApoB ratio (OR=3.091, 95% CI: 1.376-6.944) were independent risk factors of LEAOD in patients with T2DM (all P<0.05). Spearman correlation analysis results showed that LEAOD risk in patients with T2DM was negatively correlated with APN and ApoA1/ApoB ratio, and positively correlated with CysC (all P＜0.001). Conclusions  DPN, coronary atherosclerotic heart disease, HbA1c, LDL-C, APN, CysC and ApoA1/ApoB ratio are independent risk factors of LEAOD in patients with T2DM. The risk of LEAOD is negatively correlated with APN and ApoA1/ApoB ratio, and positively correlated with CysC.