Association Of Serum Amyloid A With Macroangiopathy In Patients With Type 2 Diabetes

Objective To explore the relationship between serum amyloid A(SAA) and macroangiopathy in patients of type 2 diabetes mellitus.Methods 148 T2 DM patients in the Department of Endocrinology, Anhui Provincial Hospital during the period October 2013 through April 2014 were involved in this study. Gender, age, height, weight, blood pressure, and medical histories were collected at admission. First-morning blood samples were from a ulnar vein. Fasting plasma glucose(FPG), glycosylated hemoglobin A1c(Hb A1c), total cholesterol(TC),triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), 25-hydroxyvitamin D(25(OH)D3), serum amyloid A(SAA) were estimated. And then calculate the body mass index(BMI) and homeostasis model assessment for insulin resistance(HOMA-IR) index. The carotid intima-media thickness( CIMT) and brachial-ankle artery pulse wave velocity(ba PWV) were systematically measured. The patients were divided into three groups, which included IMT normal group(n=41), thickness group(n=62), and plaque group(n=45). And compare basic clinical characteristics, biochemical indicators, SAA, ba PWV, and 25(OH)D among the three groups.Results(1) Baseline clinical and biochemical indicators: ①The main baseline demographic(sex, age, smoking history) and clinical(blood pressure, TG, LDL-C) characteristics are comparable(P value>0.05).②Compared with IMT normal group, thickness group and plaque group had significantly higher levels of BMI, FPG, FINS, HOMA-IR, Hb Alc, and TC(P value<0.05); thickness group and plaque group had significantly lower levels of HDL-C(P value<0.05). ③Compared with IMT thickness group, plaque group had significantly higher levels of BMI, FINS, HOMA-IR, Hb Alc, and FPG(P value<0.05).(2) SAA、CIMT and 25(OH)D:①Compared with IMT normal group, thickness group and plaque group had significantly higher levels of SAA and ba-PWV(P value<0.05); thickness group and plaque group had significantly lower levels of 25(OH)D(P value<0.05). ② Compared with IMT thickness group, plaque group had significantly higher levels of SAA and ba-PWV(P value<0.05); plaque group had significantly lower levels of 25(OH)D(P value<0.05).(3) The association between SAA and biochemical indicators: SAA was positively associated with course of disease, BMI, FINS, HOMA-IR, TC, ba-PWV, and CIMT(P value<0.05) and negatively associated with HDL-C and 25(OH)D(P value<0.05).(4) The association between CIMT and biochemical indicators: carotid IMT was positively associated with age, BMI, Hb A1 c, FPG, FINS, HOMA-IR, TC, SAA, ba PWV(P value<0.05) and negatively associated with HDL-C and 25(OH)D(P value<0.05).(5) The association between ba PWV and biochemical indicators: ba PWV was positively associated with age, course of disease, BMI, SBP, DBP, FINS, HOMA-IR, Hb A1 c, TC, CIMT,SAA(P value<0.05) and negatively associated with 25(OH)D(P value<0.05).(6) The association between 25(OH)D and biochemical indicators: 25(OH)D was positively associated with HDL-C(P value<0.05) and negatively associated with BMI, SBP, TG, FINS, HOMA-IR, CIMT, ba PWV, SAA(P value<0.05).(7) Logistic regression analysis of carotid intima-media thickness:single-factor logistic regression analysis showed that smoking,obesity,high levels of Hb A1 c, FPG, FINS, HOMA-IR, TC, SAA, low levels of HDL-C and 25(OH)D may contribute to higher levels of carotid intima-media thickness. Multi-factors logistic regression analysis showed the same results.(8) Logistic regression analysis of ba PWV:single-factor logistic regression analysis showed that age,smoking,obesity,course of disease,high levels of SBP FINS, HOMA-IR, Hb A1 c, FPG, TC, SAA, low levels of 25(OH)D may contribute to higher levels of ba PWV. Multi-factors logistic regression analysis showed that age,smoking,obesity,course of disease,high levels of SAA, FINS, HOMA-IR, low levels of 25(OH)D may contribute to higher levels of ba PWV.Conclusions(1) SAA may be closely related with carotid atherosclerosis among type 2 diabetes mellitus patients, plays an important role in the genesis and development. And SAA may be involved in the development of Type 2 diabetes macroangiopathy.(2) Ba PWV was positively associated with CIMT among type 2 diabetes mellitus patients and can be used as an index to predict the development of the type 2 diabetes peripheral arteriosclerosis.(3) SAA, 25(OH) D and ba PWV can be used as index to estimate the efficience of diagnosis of type 2 diabetes macroangiopathy patients and used to judge the severity. The combined detection of SAA, 25(OH) D, ba PWV and CIMT can be evaluated the early type 2 diabetes macroangiopathy, prompting the importance of early clinical intervention of levels of SAA and controlling of microvascular and macrovascular diseases.