MHR、UACR、25（OH）D3与2型糖尿病患者下肢动脉病变的关系研究

摘要 目的：探讨单核细胞/高密度脂蛋白胆固醇（HDL-C）比值（MHR）、尿白蛋白/尿肌酐比值（UACR）、25-羟维生素D3[25（OH）D3]与2型糖尿病（T2DM）患者下肢动脉病变（LEAD）的关系。方法：选择2017年1月至2021年6月延边大学附属医院西区医院收治的195例T2DM患者，根据LEAD检查结果将患者分为LEAD组（104例）和非LEAD组（91例）。检测单核细胞、HDL-C、尿白蛋白、尿肌酐、25（OH）D3水平，计算MHR、UACR。比较两组MHR、UACR、25（OH）D3差异，单因素及多因素Logistic回归分析影响T2DM患者发生LEAD的危险因素，受试者工作特征（ROC）曲线分析MHR、UACR、25（OH）D3预测T2DM患者发生LEAD的价值。结果：LEAD组年龄、体质量指数大于非LEAD组，吸烟史、高血压比例高于非LEAD组，T2DM病程长于非LEAD组，总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）高于非LEAD组，高密度脂蛋白胆固醇（HDL-C）低于非LEAD组（均P＜0.05）。LEAD组MHR、UACR高于非LEAD组，25（OH）D3水平低于非LEAD组（P＜0.05）。多因素Logistic回归分析显示，年龄过大、T2DM病程过长、高MHR、高UACR是T2DM患者发生LEAD的危险因素（P＜0.05），高25（OH）D3是其保护因素（P＜0.05）。MHR、UACR、25（OH）D3预测T2DM患者发生LEAD的曲线下面积分别为0.728、0.755、0.759，联合三项指标后预测T2DM患者发生LEAD的曲线下面积为0.888，高于单独指标预测。结论：MHR、UACR增高和25（OH）D3水平降低与T2DM患者发生LEAD有关，联合三项指标在预测T2DM患者并发LEAD方面具有较高的价值。

Study on the Relationship between MHR, UACR, 25 (OH) D3 and Lower Extremity Arterial Disease in Type 2 Diabetes Patients

ABSTRACT Objective: To investigate the relationship between monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR), urinary albumin/creatinine ratio (UACR), 25 hydroxyvitamin D3 [25 (OH) D3] and lower extremity arterial disease (LEAD) in patients with type 2 diabetes (T2DM). Methods: 195 T2DM patients who were admitted to Western District Hospital, Affiliated Hospital of Yanbian University from January 2017 to June 2021 were selected, the patients were divided into LEAD group (104 cases) and non LEAD group (91 cases) based on the LEAD examination results. The levels of monocytes, HDL-C, urinary albumin, urinary creatinine and 25 (OH) D3 were detected, and MHR and UACR were calculated. The differences in MHR, UACR, and 25 (OH) D3 between two groups were compared. The risk factors of LEAD in T2DM patients using univariate and multivariate logistic regression analysis was analyzed, and the value of MHR, UACR, and 25(OH) D3 in predicting LEAD in T2DM patients was analyzed by receiver operating characteristic (ROC) curve analysis. Results: The age and body mass index of the LEAD group were higher than those of the non LEAD group, and the smoking history and proportion of hypertension were higher than those of the non LEAD group, the course of T2DM was longer than that of the non LEAD group, and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG) were higher than those of the non LEAD group, while HDL-C was lower than that of the non LEAD group (all P<0.05). The MHR and UACR levels in the LEAD group were higher than those in the non LEAD group, and the 25 (OH) D3 levels was lower than that in the non LEAD group (P<0.05). Multivariate logistic regression analysis showed that older age, longer course of T2DM, higher MHR, and higher UACR were risk factors for LEAD in T2DM patients (P<0.05), while higher 25 (OH) D3 was a protective factor (P<0.05). The area under the curve predicted by MHR, UACR, and 25 (OH) D3 for the occurrence of LEAD in T2DM patients was 0.728, 0.755, and 0.759, respectively. After combining the three indicators, the area under the curve predicted for the occurrence of LEAD in T2DM patients was 0.888, which was higher than that predicted by individual indicators. Conclusion: Elevated MHR, UACR, and decreased 25 (OH) D3 levels are associated with the occurrence of LEAD in T2DM patients. Combined detection of these three indicators has high value in predicting the occurrence of LEAD in T2DM patients.