| Objective: Various complications, especially large vascularcomplications of diabetes, has become the main cause of diabetic patientsdisability to death. Atherosclerosis is the main pathological basis ofdiabetic macroangiopathy. Atherosclerosis is one of chronic inflammatorylesions. Monocyte chemotactic protein-1(MCP-1), as one of specificitymonocyte chemotactic proteins, plays an important role in the earlyatherosclerosis. Recent studies have shown that active vitamin D not onlyplays a role in the regulation of calcium phosphorus and bone metabolism,but also related to the occurrence of type2diabetes and atherosclerosisclosely, it may be a protective factor for diabetes and diabeticmacroangiopathy. The purpose of our study is to investigate a relationshipamong serum25-hydroxyvitamin D3［25(OH)D3］,monocyte chemotacticprotein-1(MCP-1)，type2diabetes and carotid artery atherosclerosis bydetecting the level of serum25(OH)D3, monocyte chemotacticprotein-1(MCP-1) in type2diabetes patients with or without concurrentcarotid atherosclerosis, then to reveal risk factors for carotidatherosclerosis of type2diabetes patients, and provide basis for diabeticmacroangiopathy prevention and treatment.Methods：Select type2diabetes patients hospitalized from October2013to February2014in the Department of Endocrinology in SecondHospital of Hebei Medical University,55cases were taken to type2diabetes mellitus (T2DM) group， they were all completed carotidultrasound in line with the diabetes diagnosis standards of the WorldHealth Organization (WHO) in1999, Based on the results of the carotidultrasound, diabetes patients were further divided into simple type2 diabetes (Simplex T2DM) group of24patients and type2diabeticpatients with carotid atherosclerosis (T2DM&CAS) group of31patients;over the same period,38healthy people participating in the examination，were taken to the control group. All of the cases should meet thefollowing criteria:1.Without serious liver and kidney dysfunction,osteoporosis and other bone metabolic disorders;2. Without takingvitamin D drugs as well as calcium and other drugs affecting bonemetabolism;3. Without emphysema, cancer, systemic inflammation,recent surgery and other stress.(1) Collect all the clinical data of the object in our study, includinggender, age, smoking history, medical history, family history, weight,height, systolic blood pressure, diastolic blood pressure, and calculate thebody mass index （BMI）.(2) Take subjects’ fasting blood to measure hemoglobin A1c(HbA1c), fasting plasma glucose (FPG),fasting insulin(FINS),andcalculate the Insulin resistance HOMA-IR=FPG(mmol/L)×FINS(mU/L)/22.5, triglycerides (TG), total cholesterol (TC), high densitylipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol(LDL-C) calcium (Ca), phosphorus (P), alkaline phosphatase (ALP),serum25-hydroxy vitamin D3［25(OH)D3］, monocyte chemotacticprotein-1(MCP-1).（3）The same one in the department of ultrasound used the samesets of color B-instrument carotid ultrasound to examine IMT.（4）Statistics were processed by SPSS13.0software, measurementdata are presented as mean±standard deviation(x±s), t test was used tocompare multigroup normally distributed groups, abnormal distributiondata used rank-sum test. Count data were compared by chi-square test,and classification variables were expressed as percentage (%), Logisticregression analysis was chosen to screen predictors of carotidatherosclerotic plaque formation, multiple regression stepwise analysisevaluated factors influencing serum25(OH)D3levels. P <0.05 Results:1T2DM group compared with control group in clinical features55cases were type2diabetes, including27males and28females;38cases were taken into control group, including17males and21females. The sex ratio was no significant difference (P>0.05). People inT2DM group, mean age was55.07±7.83years old, the average SBP was132.40±16.34mmHg, The DBP’s average was82.20±12.50mmHg, theirBMI was26.09±3.98kg/m2; people in control group, average age was52.05±6.08years old, the average of SBP was115.82±8.59mmHg,DBP’s average was74.08±8.35mmHg, BMI was21.75±2.71kg/m2. InT2DM group, The patients’ age, SBP, DBP, BMI were higher than that ofthe control group, and the difference was statistically significant (P<0.05).T2DM group of carotid atherosclerosis is31cases, accounting for56.36%of the number of diabetes group; Normal control group only4cases appear carotid plaques, accounting for10.53%of the control groupnumber.Incidence of T2DM group of CAS is higher than the controlgroup, the difference was statistically significant (P <0.05).2T2DM group compared with control group in metabolic indexFBG、HOMA-IR、TC、TG、LDL-C、HbA1c、MCP-1、Ca、P ofT2DM group were higher than that of the control group, P<0.05, thedifference was statistically significant; HDL-C,25(OH)D3of T2DMgroup were significantly lower than the control group, P<0.05, thedifference was statistically significant; FINS、ALP of T2DM group werehigher than that of the control group, but P>0.05, the difference was notstatistically significant.3The average age of T2DM&CAS group were higher than SimplexT2DM group (P＞0.05), the difference was not statistically significant;BMI, SBP, DBP of T2DM&CAS group were higher than that of SimplexT2DM group, P>0.05, the difference was not statistically significant; TC、 TG、HDL-C、LDL-C、HbA1C、MCP-1of T2DM&CAS group were lowerthan that of Simplex T2DM group, but P>0.05, the difference was notstatistically significant;25(OH)D3of T2DM&CAS group wassignificantly lower than that of Simplex T2DM group, P<0.05, thedifference was statistically significant; Ca, P were no significantdifference.4Logistic regression analysis showed that:25(OH)D3(OR:1.260，95%CI:1.068~1.487，P=0.006），TG(OR:4.741，95%CI:1.022~21.996，P=0.047）were independent predictors of carotid artery plaque. Adjustedfor sex and age, the results show that high triglycerides is the risk factorfor AS.5Multiple regression analysis for25(OH)D3levels showed that,TC、HbA1c were the main factors to effect25(OH)D3level gradually.6The correlation analysis for HOMA-IR howed that,BMI FBGFINS was inersely associated with HOMA-IR were positively correlatedConclusions:25(OH)D3level in T2DM patients was lower than thecontrol group，which level in T2DM&CAS patients was lower thanSimplex T2DM group.25(OH)D3was the independent predictor ofcarotid artery plaque, The main factors to effect25(OH)D3level were TCand HbA1c. MCP-1is higher than the control group. But a closerelationship was not yet found between25(OH)D3level and MCP-1levelin type2diabetes. |
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