Retrospective Study Of Hemorheological Indicators And Related Clinical Data In Type 2 Diabetic Patients

ObjectiveThis study was to research the relationship of blood viscosity,erythrocyte deformability(ED),erythrocyte aggregation(EA)with glycosylated hemoglobin(HbA1c),blood glucose,serum lipids,vitamin D and other clinical indicators in patients with type 2 diabetes mellitus(T2DM),which was of great significance to improve the quality of life of diabetic patients and to prevent and delay the occurrence and development of diabetic vascular complications.The present study was divided into 2 parts: Part 1: To investigate the association of ED with HbA1 c level and the cut-off point of HbA1 c level leading to the impairment of ED in patients with T2DM;Part 2: To evaluate the relationship of serum 25-hydroxy vitamin D(25(OH)VitD)concentration with the blood viscosity in T2 DM patients,aimed to provide valuable clinical research on the mechanism and prevention of diabetic vascular disease from the perspective of hemorheology.MethodsPart1HbA1c level and whole blood viscosity at different shear rates(1mPa/S ? 200mPa/S)were measured by high pressure liquid chromatography and suspension shaft cone-plate method respectively in300 T2 DM patients.High shear reductive viscosity(HSRV)which could indirectly estimate ED was then calculated.Fasting plasma glucose(FPG)and serum lipids were also measured.Through receiver operating characteristics(ROC)curve analysis,we determined the optimal cut-off value of HbA1 c for the increasing HSRV.Based on the obtained cut-off value and glycemic control criteria,we divided all the cases into different groups to assess the association of HSRV with HbA1 c level and to confirm the accuracy of the cut-off value.Part2Serum 25(OH)VitD concentration and whole blood viscosity at different shear rates(1mPa/S ? 5mPa/S ? 30mPa/S ? 200mPa/S)were measured by enzyme-linked immunosorbent assay and suspension shaft cone-plate method respectively in 213 T2 DM patients.Fasting plasma glucose and serum lipids were also measured.The patients were divided into four quartile groups according to the serum 25(OH)VitD levels(Q1:<31.50 nmol/L,53 cases;Q2: 31.50 ~ 38.60 nmol/L,54 cases;Q3:38.60~42.70 nmol/L,53 cases;Q4: >42.70 nmol/L,53 cases)to assess the association of serum 25(OH)VitD concentration with the blood viscosity at different shear rates.And then the subjects were analyzed bygender stratification statistics.ResultsPart1Spearman correlation analysis showed that HSRV was positively associated with HbA1c(r=0.27,P<0.0001)in 300 T2 DM patients.Multivariate regression analysis suggested that HSRV correlated independently with HbA1 c in this study(?=0.244,P<0.0001).ROC curve illustrated that the optimal cut-off value of HbA1 c level corresponded to9.05% for the increasing HSRV.According to the cut-off value and glycemic control criteria,subjects were classified into five groups: Group A(HbA1c<6.5%,46 cases),group B(6.5%?HbA1c?8.0%,83 cases),Group C(8.0%<HbA1c?9.05%,55 cases),Group(9.05%< HbA1c?10.0%,40 cases),Group E(HbA1c>10.0%,76 cases).HSRV increased significantly in patients with HbA1 c level >9.05% in comparison to patients in groups A,B and C.No significant difference between Group A,Group B and Group C was found.There was no significant difference between Group D and Group E in this presentation likewise.Compared with Group A(HbA1c<6.5%),the odds ratio of the T2 DM patients experiencing the significantly increasing HSRV in Group D(9.05%<HbA1c?10.0%)and Group E(HbA1c>10.0%)was 3.21(95%confidence interval:1.09-9.49)and 3.47(95% confidence interval:1.30-9.24)respectively.Part2The whole blood viscosity at different shear rates(1mPa/S?5mPa/S?30mPa/S ? 200mPa/S)in high concentration group(Q4 group)were significantly higher than those in other low concentration groups(Q1?Q2?Q3 group)(P<0.0001)in T2 DM patients,which was in accordance with that in female patients.Spearman correlation analysis showed that serum 25(OH)VitD concentration was positively associated with the whole blood viscosity at different shear rates(25(OH)VitD vs 1mPa/S:r=0.24,P=0.0005;5mPa/S: r=0.23,P=0.0007;30mPa/S: r=0.21,P=0.0019;200mPa/S: r=0.17,P=0.011).Multivariate regression analysis suggested that serum 25(OH)VitD concentration in female patients correlated independently with the blood viscosity at different shear rates(1mPa/S?5mPa/S?30mPa/S)in this study(1mPa/S: ?=0.179,P=0.021;5mPa/S: ?=0.173,P=0.016;30mPa/S: ?=0.182,P=0.031).Conclusion1?Our results suggested HbA1 c level showed the significantly negative association with ED and ED decreased significantly as soon as HbA1 c level was higher than 9.05% in T2 DM patients.2?In T2 DM patients,especially in female patients,serum 25(OH)VitD concentration showed significantly positive association with the blood viscosity.We should pay more attention to the monitoring of the blood viscosity in the process of vitamin D supplementation in the course of thetreatment of diabetes mellitus.