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中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (02) : 147 -152. doi: 10.3877/cma.j.issn.1673-9450.2024.02.009

论著

2型糖尿病患者下肢动脉硬化的影响因素分析
王卉1, 薛宝睿1, 李恭驰2, 刘慧真1, 雷霞1, 李炳辉1,†()   
  1. 1. 430077　武汉，华中科技大学同济医学院附属梨园医院创面修复中心　湖北省慢性创面及糖尿病足医学临床研究中心
    2. 430022　武汉，华中科技大学同济医学院附属协和医院手外科
  • 收稿日期:2023-11-30 出版日期:2024-04-01
  • 通信作者: 李炳辉
  • 基金资助:
    国家自然科学基金青年科学基金项目(81801922); 国家重大疾病多学科合作诊疗能力建设项目(国卫办医函〔2019〕542号); 湖北省慢性创面及糖尿病医学临床研究中心资助项目(2018BCC340); 湖北省科技厅重点研发计划项目(2020BCB029)

Analysis of influencing factors of lower extremity arteriosclerosis in patients with type 2 diabetes mellitus

Hui Wang1, Baorui Xue1, Gongchi Li2, Huizhen Liu1, Xia Lei1, Binghui Li1,†()   

  1. 1. Wound Repair Center, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center of Chronic Wound and Diabetic Foot Medicine, Wuhan 430077, China
    2. Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2023-11-30 Published:2024-04-01
  • Corresponding author: Binghui Li
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引用本文：

王卉, 薛宝睿, 李恭驰, 刘慧真, 雷霞, 李炳辉. 2型糖尿病患者下肢动脉硬化的影响因素分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(02): 147-152.

Hui Wang, Baorui Xue, Gongchi Li, Huizhen Liu, Xia Lei, Binghui Li. Analysis of influencing factors of lower extremity arteriosclerosis in patients with type 2 diabetes mellitus[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(02): 147-152.

目的

探讨2型糖尿病(T2DM)患者合并下肢动脉硬化(LEA)的独立影响因素。

方法

回顾性分析2021年1月至2022年12月华中科技大学同济医学院附属梨园医院创面修复中心收治的420例T2DM患者资料，其中275例患者合并LEA，145例患者无LEA。收集性别、年龄、基础疾病(包括冠心病、脑梗死、高血压、高脂血症)、D-二聚体、白细胞数(WBC)、红细胞数(RBC)、血红蛋白(HGB)、空腹血糖、糖化血红蛋白(HbA1c)、补体C1q、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、B型脑钠肽(BNP)等指标，分析与T2DM患者合并LEA密切相关的影响因素。数据分析采用t检验、Mann-Whitney U检验、χ2检验，以及logistic回归分析。

结果

收集420例T2DM患者，275例合并LEA，发生率为65.5%，其余145例患者无LEA。是否合并LEA的患者比较发现，冠心病、脑梗死、D-二聚体、HGB、HbA1c、HDL-C、LDL-C、BNP可能与LEA发生有关(P<0.05)，其余变量两组比较差异无统计学意义(P>0.05)。单因素logistic回归分析结果显示，冠心病、D-二聚体、HbA1c、LDL-C、BNP可能是LEA的影响因素(P<0.05)。进一步建立多元logistic回归模型发现，有冠心病、D-二聚体高、HbA1c高和BNP高是T2DM患者发生LEA的独立影响因素(P<0.05)。

结论

合并冠心病、D-二聚体高、HbA1c高或BNP高是T2DM患者合并LEA的独立影响因素。

关键词: 糖尿病，2型, 下肢动脉硬化, 影响因素, Logistic回归分析
Objective

To explore the risk factors of lower extremity arteriosclerosis (LEA) in T2DM patients.

Methods

Data of 420 patients with T2DM admitted to Wound Repair Center, Liyuan hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2021 to December 2022 were retrospectively reviewed including 275 patients with LEA and 145 patients without LEA. The data of gender, age, basic diseases (including coronary heart disease, cerebral infarction, hypertension, hyperlipidemia), D-dimer, white blood cell count (WBC), red blood cell count (RBC), hemoglobin (HGB), fasting blood glucose, glycated hemoglobin (HbA1c), complement C1q, alanine transaminase (ALT), aspartate transaminase (AST), triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and brain natriuretic peptide (BNP) indicators were collected and analyzied. Data were analyzed by t test, Mann-Whitney U test, chi-square test and logistic regress analysis.

Results

Among 420 patients with T2DM, 275 patients had LEA with the incidence rate of 65.5%, and the remaining 145 patients did not have LEA. Compared between the patients with LEA or not, it was found that coronary heart disease, cerebral infarction, D-dimer, HGB, HbA1c, HDL-C, LDL-C and BNP were posiblely related with LEA in T2DM patients (P<0.05), while the other variables had no statistical significance between the two groups (P>0.05). Univariate logistic regression analysis showed that coronary heart disease, D-dimer, HbA1c, LDL-C and BNP were the influencing factors of LEA (P<0.05). The multivariate logistic regression analysis showed that coronary heart disease, high D-dimer, high HbA1c and high BNP were independent risk factors for T2DM patients with LEA (P<0.05).

Conclusion

Coronary heart disease, high D-dimer, high HbA1c and high BNP are independent risk factors for T2DM patients with LEA.

Key words: Diabetes mellitus, type 2, Arteriosclerosis of lower extremities, Influencing factors, Logistic regression analysis
表1 是否合并LEA糖尿病患者一般资料比较
组别 例数 年龄[岁，M(QL，QU)] 性别[例(%)]
男 女
LEA组 275 62 (56，69) 166(60.4) 109(39.6)
NLEA组 145 62 (56，68) 76(52.4) 69(47.6)
Z值/ χ2值   0.194 2.457
P值   0.846 0.117
表2 两组可能相关影响因素比较
项目 LEA组(n＝275) NLEA组(n＝145) χ2值/Z值/t值 P值
基础疾病[例(%)]        
冠心病 108(39.3) 38(26.2) 7.147 0.008
脑梗死 75(27.3) 27(18.6) 3.865 0.049
高血压 167(60.7) 90(62.1) 0.072 0.788
高脂血症 122(44.4) 74(51.0) 1.697 0.193
D-二聚体[mg/L，M(QL，QU)] 0.38(0.34，0.43) 0.35(0.30，0.43) 3.000 0.003
WBC[109/L，±s] 5.89±1.33 5.80±1.14 0.708 0.480
RBC(1012/L，±s) 4.53±0.51 4.57±0.49 0.661 0.509
HGB(g/L，±s) 139.29±8.10 140.93±8.05 1.977 0.049
HbA1c(%，±s) 9.03±1.18 8.74±1.22 2.561 0.011
C1q(mg/L，±s) 181.13±34.36 175.44±32.70 1.639 0.102
ALT[U/L，M(QL，QU)] 23.50(20.70，28.00) 24.20(21.70，27.75) 1.138 0.255
AST(U/L，±s) 22.62±5.08 23.43±3.76 1.853 0.065
空腹血糖[mmol/L，M(QL，QU)] 11.66(11.10，12.62) 11.61(10.96，12.32) 1.505 0.132
TG[mmol/L，M(QL，QU)] 1.87(1.53，2.33) 1.95(1.62，2.33) 0.868 0.385
TC(mmol/L，±s) 5.10±0.90 5.09±0.51 0.096 0.924
HDL-C(mmol/L，±s) 1.24±0.18 1.20±0.16 1.999 0.046
LDL-C(mmol/L，±s) 2.99±0.86 2.81±0.93 1.990 0.046
BNP[pg/ml，M(QL，QU)] 85.60(79.30，92.00) 82.60(74.65，89.00) 2.926 0.003
表3 自变量赋值情况
自变量 变量说明 赋值情况
基础疾病-冠心病 分类变量 无＝0，有＝1
基础疾病-脑梗死 分类变量 无＝0，有＝1
D-二聚体 连续变量 -
HGB 连续变量 -
HbA1c 连续变量 -
HDL-C 连续变量 -
LDL-C 连续变量 -
BNP 连续变量 -
表4 患者发生LEA的单因素logistic回归分析
因素 β SE WaId P值 OR值 95%CI
基础疾病-冠心病 0.599 0.226 7.057 0.008 1.821 1.170，2.834
基础疾病-脑梗死 0.494 0.253 3.823 0.051 1.639 0.999，2.689
D-二聚体 4.228 1.407 9.028 0.003 68.573 4.349，1081.222
HGB -0.025 0.013 3.854 0.050 0.975 0.951，1.000
HbA1c 0.223 0.088 6.389 0.011 1.250 1.051，1.487
HDL-C 1.174 0.615 3.646 0.056 3.236 0.969，10.804
LDL-C 0.234 0.118 3.945 0.047 1.264 1.003，1.592
BNP 0.038 0.011 11.245 0.001 1.039 1.016，1.062
表5 多因素logistic回归分析T2DM患者发生LEA的影响因素
因素 β SE WaId P值 OR值 95%CI
基础疾病-冠心病 0.563 0.233 5.831 0.016 1.757 1.112，2.775
D-二聚体 4.078 1.453 7.872 0.005 59.007 3.418，1018.614
HbA1c 0.194 0.092 4.415 0.036 1.214 1.013，1.456
LDL-C 0.165 0.123 1.800 0.180 1.179 0.927，1.501
BNP 0.032 0.012 7.750 0.005 1.033 1.010，1.057
常数 -5.956 1.359 19.193 <0.001 - -
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