关键词: 糖尿病, 2型, 动脉粥样硬化, 下肢, 单核细胞/高密度脂蛋白比值, 影响因素分析

Abstract: Background　Lower extremity atherosclerosis disease（LEAD） is a common complications of type 2 diabetes mellitus （T2DM），which may be associated with increased risk of lower extremity gangrene and amputation，and may also has an association with cardiovascular and cerebrovascular diseases，seriously affecting the quality of life.Monocyte / high-density lipoprotein ratio （MHR） is a newly discovered inflammatory marker，which has close correlation with vascular diseases.Objective　To explore the correlation between MHR and LEAD in patients with T2DM.Methods　From September 2018 to September 2019，400 T2DM patients from Department of Endocrinology，the Fourth Affiliated Hospital of China Medical University were selected.Clinical and laboratory data as well as calculated MHR were collected.According to Color Doppler ultrasound-detected severity of lower extremity atherosclerosis（AS），participants were divided into four groups:T2DM+AS1 group （n=109，T2DM without LEAD），T2DM+AS2 group （n=97，T2DM with intimal thickening in lower limb arteries），T2DM+AS3 group （n=109，T2DM with plaques in lower limb arteries），T2DM+AS4 group （n=85，T2DM with stenosis of lower limb arteries）.Results　Gender ratio，mean age，course of T2DM，BMI，MHR，monocyte count，glycosylated hemoglobin，fasting plasma glucose，high-density lipoprotein，and creatinine，and prevalence of smoking history，hypertension history，and insulin treatment in the 4 groups were all significantly different （P<0.05）.Spearman rank correlation analysis showed that MHR increased with increasing degrees of BMI （rs=0.176，P<0.001），neutrophil count （rs=0.426，P<0.001），monocyte count （rs=0.739，P<0.001），lymphocyte count （rs=0.261，P<0.001），triacylglycerol （rs=0.215，P<0.001），uric acid （rs=0.203，P<0.001），and creatinine （rs=0.127，P=0.011），but decreased with increasing degrees of total cholesterol（rs=-0.200，P<0.001），high-density lipoprotein（rs=-0.630，P<0.001），and low-density lipoprotein（rs=-0.102，P=0.042）.Multivariate Logistic regression analysis showed that older age 〔OR=1.853，95%CI（1.398，2.456） 〕，longer course of T2DM 〔OR=1.323，95%CI（1.002，1.746）〕，smoking history 〔OR=2.854，95%CI（1.440，5.658）〕，hypertension history〔OR=2.116，95% CI（1.281，3.661）〕，and elevated MHR 〔OR=1.777，95%CI （1.190，2.653）〕 were associated with increased risk of lower extremity AS，while elevated BMI 〔OR=0.590，95%CI （0.422，0.824）〕 was associated with decreased risk of lower extremity AS （P<0.05）.Multivariate Logistic regression analysis fount that older age was a risk factor for 2-4 grade lower extremity AS（P<0.05）；smoking history，hypertension history and elevated MHR were risk factors for 3-4 grade lower extremity AS（P<0.05）；longer course of T2DM was a risk factor for 4 grade lower extremity AS（P<0.05）；elevated BMI was a protective factor for 2-4 grade lower extremity AS（P<0.05）.Conclusion　MHR may have a close correlation with LEAD and its severity in T2DM patients.Elevated MHR increased with increasing degrees of lower extremity AS，which was mainly manifested in T2DM patients with 3-4 grade lower extremity AS.

Key words: Diabetes mellitus, type 2；Atherosclerosis；Lower extremity；MHR；Root cause analysis