Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China.
Cardiovasc Diabetol. 2024 Jul 25;23(1):275. doi: 10.1186/s12933-024-02361-5.
The aim of this study was to investigate the associations of blood phosphorus levels with the risk of developing medial arterial calcification (MAC) in lower-limb arteries and diabetic foot (DF) in diabetes patients. We sought to enhance the understanding of the pathophysiology of diabetic complications and develop strategies to mitigate diabetes-related risks.
We conducted a retrospective analysis of 701 diabetic patients from the Department of Endocrinology at Sun Yat-Sen Memorial Hospital (2019-2023). We utilized multimodel-adjusted logistic regression to investigate the associations of serum phosphorus levels and the risk of developing MAC and DF. Restricted cubic spline plots were employed to model the relationships, and threshold analysis was used to identify inflection points. Subgroup analyses were performed to explore variations across different demographics. The diagnostic utility of phosphorus concentrations was assessed via the C index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Of the 701 patients (mean age 63.9 years; 401 (57.20%) were male), 333 (47.50%) had MAC, and 329 (46.93%) had DF. After controlling for numerous confounding variables, each one-unit increase in phosphorus concentrations was associated with an increased risk of developing MAC (OR 2.65, 95% CI 1.97-3.57, p < 0.001) and DF (OR 1.54, 95% CI 1.09-2.18, p = 0.014). Phosphorus levels demonstrated a linear risk association, with risk not being uniform on either side of the inflection point, which was approximately 3.28 mg/dL for MAC and varied for DF (3.26 to 3.81 mg/dL). Adding the phosphorus as an independent component to the diagnostic model for MAC and DF increased the C index, NRI, and IDI to varying degrees.
Elevated serum phosphorus levels are significantly associated with an increased risk of developing MAC and DF among diabetic people. These findings suggest that phosphorus management could be integrated into routine diagnostic processes to improve the identification and management of lower-extremity diabetic complications.
本研究旨在探讨血磷水平与下肢动脉中膜钙化（MAC）和糖尿病足（DF）的发病风险之间的关系。我们旨在深入了解糖尿病并发症的病理生理学，并制定减轻与糖尿病相关风险的策略。
我们对中山大学孙逸仙纪念医院内分泌科的 701 例糖尿病患者（2019-2023 年）进行了回顾性分析。我们采用多模型调整逻辑回归来探讨血清磷水平与 MAC 和 DF 发病风险的关系。采用受限立方样条图来构建关系模型，并进行阈值分析以确定拐点。采用亚组分析探讨不同人群之间的差异。通过 C 指数、净重新分类改善（NRI）和综合判别改善（IDI）评估磷浓度的诊断效能。
在 701 例患者中（平均年龄 63.9 岁；401 例[57.20%]为男性），333 例（47.50%）患有 MAC，329 例（46.93%）患有 DF。在校正了许多混杂因素后，磷浓度每增加一个单位，MAC 的发病风险增加 2.65 倍（95%CI 1.97-3.57，p<0.001），DF 的发病风险增加 1.54 倍（95%CI 1.09-2.18，p=0.014）。磷水平与风险之间呈线性关系，拐点两侧的风险并不均匀，拐点大约在 3.28mg/dL 左右，而 DF 的拐点范围在 3.26-3.81mg/dL 之间。将磷作为独立成分添加到 MAC 和 DF 的诊断模型中，可在不同程度上提高 C 指数、NRI 和 IDI。
血清磷水平升高与糖尿病患者 MAC 和 DF 的发病风险显著相关。这些发现表明，磷管理可以整合到常规诊断流程中，以改善下肢糖尿病并发症的识别和管理。
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