【摘要】 目的：研究糖调节受损患者血清25(OH)D和免疫相关因子对亚临床动脉粥样硬化（AS）的影响。方法：选取2019年12月至2021年4月枣庄市立医院收治的142例糖调节受损患者，根据经颈动脉超声检查和臂踝脉搏波传导速度分组，仅糖调节受损患者为对照组（n=86），并发亚临床AS为观察组（n=56）。比较两组患者血清25(OH)D和免疫因子，应用颈动脉超声检测测定颈动脉内中膜厚度，Pearson法测定血清颈动脉内中膜厚度与血清25(OH)D和免疫因子的相关性。采集基线资料和血液学指标，单因素和多因素Logistic回归分析确定亚临床AS的影响因素，应用ROC曲线评估血清25(OH)D和免疫因子对亚临床AS的诊断效能。结果：观察组患者血清25(OH)D [(24.01±4.87)mmol/L vs 3(0.74±5.01)mmol/L,t=7.909,P=0.000）明显低于对照组，观察组患者TNF-α[(48.32±8.02)ng/L vs (33.21±9.00)ng/L,t=10.199,P=0.000）和IL-6[(41.22±9.43)ng/L vs(30.21±7.01)ng/L,t=7.492,P=0.000）明显高于对照组。颈动脉内中膜厚度与血清25(OH)D呈负相关（r=-0.428,P<0.001），颈动脉内中膜厚度与血清TNF-α和IL-6呈正相关（r=0.574,0.577,P<0.001）。Logistic回归分析结果表明，血清25(OH)D (OR=0.520,95%CI:0.401～0.675)、血清TNF-α(OR=1.667,95%CI:1.131～2.457)和血清IL-6(OR=1.478,95%CI:1.213～1.802)等是亚临床AS发生的影响因素。ROC曲线结果显示，血清25(OH)D最佳截断值为28.32 mmol/L，其对应的敏感度为69.64%，特异度为70.93%,AUC为0.803(95%CI:0.749～0.855)；血清TNF-α临界值为40.56 ng/L，其对应的敏感度为71.43%，特异度为72.09%,AUC为0.761(95%CI:0.717～0.823)；血清IL-6截断值为36.13 ng/L，其对应的敏感度为60.71%，特异度为60.47%,AUC为0.627(95%CI:0.566～0.702)；回归分析对应的敏感度为85.71%，特异度为81.40%,AUC为0.889(95%CI:0.830～0.915)。结论：血清25(OH)D与免疫相关因子单独和联合回归检测可有效预测亚临床AS的发生，上述指标与颈动脉内中膜厚度相关，且血清25(OH)D和免疫相关因子是亚临床AS发生的预测指标，临床宜根据指标进行针对性干预，值得进一步研究。更多还原

【Abstract】 Objective: To explore the correlation between abnormal expression of serum 25(OH)D and immune-related factors and subclinical atherosclerosis(AS) in patients with impaired glucose regulation. Methods: A total of 142 patients with impaired glucose regulation admitted to Zaozhuang Municipal Hospital from December 2019 to April 2021 were selected. The patients with impaired glucose regulation were selected as the control group(n=86) and patients with subclinical atherosclerosis were selected as the observation group(n=56) according to carotid ultrasound examination and bramolecular pulse wave conduction velocity. The serum 25(OH)D and immune factors were compared between the two groups. Carotid ultrasound was used to measure the carotid intimedia thickness, and Pearson method was used to determine the correlation between the intimedia thickness, 25(OH)D and immune factors. Baseline data and hematological indicators were collected, univariate and multivariate Logistic regression analysis was performed to determine the influencing factors of subclinical atherosclerosis, and ROC curve was used to evaluate the diagnostic efficacy of serum 25(OH)D and immune factors in subclinical atherosclerosis. Results: The serum 25(OH)D [(24.01±4.87)mmol/L vs(30.74±5.01)mmol/L, t=7.909, P=0.000) in the observation group was significantly lower than that of control group. TNF-α [(48.32±8.02)ng/L vs(33.21±9.00)ng/L, t=10.199, P=0.000) and IL-6 [(41.22±9.43)ng/L vs(30.21±7.01)ng/L, t=7.492, P=0.000) in observation group were significantly higher than those in control group. Carotid intima-media thickness was negatively correlated with serum 25(OH)D(r=-0.428, P<0.001), and was positively correlated with serum TNF-α and IL-6(r=0.574, 0.577, P<0.001). Logistic regression analysis showed that serum 25(OH)D(OR=0.520, 95%CI: 0.401～0.675), serum TNF-α(OR=1.667, 95%CI: 1.131～2.457) and serum IL-6(OR=1.478, 95%CI: 1.213～1.802) were the influencing factors of subclinical atherosclerosis. ROC curve showed that the optimal cut-off value of serum 25(OH)D was 28.32 mmol/L, and the corresponding sensitivity, specificity and AUC were 69.64%, 70.93% and 0.803(95%CI: 0.749～0.855), respectively. The critical value of serum TNF-α was 40.56 ng/L, corresponding sensitivity was 71.43%, specificity was 72.09%, and AUC was 0.761(95%CI: 0.717～0.823). Serum IL-6 cut-off value was 36.13 ng/L, corresponding sensitivity was 60.71%, specificity was 60.47%, and AUC was 0.627(95%CI: 0.566～0.702). The sensitivity, specificity and AUC of regression analysis were 85.71%, 81.40% and 0.889(95%CI: 0.830～0.915). Conclusion: Serum 25(OH)D and immune-related factors alone and in combination can effectively predict the occurrence of subclinical atherosclerosis, which is correlated with carotid intima-media thickness, and serum 25(OH)D and immune-related factors are predictors of subclinical atherosclerosis.更多还原