Hasil untuk "Specialties of internal medicine"

Eri Ohta, Eri Ohta, Etsuko Okada et al.

Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening inflammatory disease characterized by neutrophilic pustules and systemic inflammation. We report a case of severe GPP triggered by SARS-CoV-2 infection in a 46-year-old woman with a long history of psoriasis. Eleven days after recovery from COVID-19 pneumonia, she developed widespread pustules and fever. Histopathology revealed subcorneal spongiform pustules and dermal neutrophilic infiltration consistent with GPP. Systemic corticosteroids followed by etretinate and deucravacitinib achieved complete remission. A literature review identified 11 infection- and 10 vaccine-related GPP cases. Compared with vaccine-associated cases, infection-related flares showed longer latency and higher corticosteroid use. Mechanistically, both SARS-CoV-2 infection and vaccination may be associated with IL-36 axis activation, potentially via spike protein–driven, Toll-like receptor–mediated innate immune signaling. This case highlights that distinct immune kinetics may underlie infection- and vaccine-related GPP, while supporting a putative role of IL-36–driven inflammation in COVID-19–associated disease exacerbation.

C. Tatarelli, M. Breccia, M. Santopietro et al.

Background With increasing life expectancy, there has been a progressive rise in the proportion of patients (pts) aged ≥80 years diagnosed with myeloproliferative neoplasms (MPNs). However, data specifically focusing on very elderly pts with polycythemia vera (PV) remain limited. Aim: To describe the clinical characteristics and disease course of PV in a real-life cohort of pts aged ≥80 years. Methods: Between 1/2000 and 06/2024, 125 consecutive pts aged ≥80 years were diagnosed with PV across nine hematology centers. These pts were enrolled in the retrospective and prospective databases of the Latial group for Ph-negative MPNs. Diagnoses were reviewed according to WHO 2022 criteria. Results: Main characteristics at diagnosis are shown in the Table. Bone marrow (BM) biopsy was performed in 18 of 114 evaluable pts (15.8%). Median JAK2 V617F allele burden was 38.8% (IQR 11.4–65). At diagnosis, symptoms were reported in 24 of 81 evaluable pts (29.6%), with pruritus present in 10 (41.6%). A history of thrombotic events was found in 33 pts (26.4%). Hydroxyurea (HU) was initiated in 121 pts, typically within one month from diagnosis (IQR 0.1–3.8). HU was discontinued in 23 pts (18.8%), mainly due to intolerance (16/23). Of these, only 3 pts (13%) received ruxolitinib as 2nd line therapy, while 13 (56.6%) received no further cytoreductive treatment. During follow-up, thrombotic events occurred in 11 pts (8.8%), and disease progression to fibrotic or blastic phase was observed in 4 cases. At the last follow-up, 34 pts had died, 33 were lost to follow-up, 58 were alive. The 60- and 120-month cumulative overall survival (OS) rates were 71% (95%CI 82.2–59.8) and 31.9% (95%CI 49.2–14.6), respectively. Conclusion: This real-life cohort study of very elderly PV patients reveals key insights into current clinical practice. BM biopsy was infrequently performed, and nearly all pts received HU promptly after diagnosis. However, there was a noticeable hesitancy in initiating 2nd line therapy with ruxolitinib following HU discontinuation. The high rate of pts lost to follow-up, likely due to challenges in accessing care, limits the robustness of survival analysis. Nevertheless, the observed OS was comparable to that of the general population in the same age group.  

Paula-Anca Sulea, Ioan Tilea, Florin Stoica et al.

Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal strain (cfPWV/GLS) ratio, in a Romanian primary care cohort. Methods: The prospective cohort analysis was performed on 81 adults (49 females, mean age 50.27 ± 12.93 years). Physical activity was quantified through anamnesis using metabolic equivalents (METs) according with Compendium of Physical Activities, and patients were stratified into four groups: G1 (METs < 1.5, <i>n</i> = 39), G2 (METs = 1.5–2.9, <i>n</i> = 2), G3 (METs = 3–5.9, <i>n</i> = 23), and G4 (METs ≥ 6, <i>n</i> = 17). Demographic and echocardiographic data were recorded to explore associations between physical activity and VAC. Results: The cfPWV/GLS ratio differed significantly across groups (<i>p</i> = 0.012), with the lowest values present in the moderate-intensity group (G3). VAC ≥ 0.391 can predict sedentary lifestyles (AUC = 0.730; CI: 0.617–0.833, <i>p</i> > 0.001). Multivariate analysis revealed that age, arterial age, and hypertension independently predict VAC. Conclusions: Higher physical activity is inversely associated with VAC (cfPWV/GLS ratio) and can predict sedentary lifestyles. Encouraging moderate-to-vigorous exercise in primary care may improve cardiovascular function and aid prevention.

Christian Basile, Stefan D. Anker, Gianluigi Savarese

Heart failure with reduced ejection fraction (HFrEF) exhibits significant sex-based differences in clinical presentation, management, and outcomes. This study aimed to evaluate these differences using data from the Swedish Heart Failure Registry (SwedeHF). We analyzed 65,605 patients with HFrEF (EF <40%) from the SwedeHF registry. Baseline characteristics, treatment patterns, and outcomes were compared between females and males. Multivariable logistic regression was used to evaluate predictors of treatment use. Cox proportional hazards models were used to assess the risk of cardiovascular mortality and heart failure (HF) hospitalization, adjusting for demographic and clinical variables. Odds ratios (OR) were reported for treatment use, and hazard ratios (HR) were used for outcome analyses. Females (29.0%) were older than males and had a higher prevalence of hypertension (61.3% vs 49.8%) and valvular disease (17.2% vs 11.1%), while males had a higher prevalence of ischemic heart disease (70.5% vs 40.1%) and diabetes (31.6% vs 28.4%). Males were less likely to receive beta-blockers (OR: 0.76, 95% CI 0.71-0.81), and more likely to receive sodium-glucose co-transporter-2 inhibitors (OR: 1.27, 95% CI 1.17-1.38) and implantable cardioverter-defibrillators/cardiac resynchronization therapy (OR: 1.41, 95% CI 1.30-1.52). During a median follow-up of 2.1 years, males had a higher risk of the composite outcome of cardiovascular death or HF hospitalization (HR: 1.19, 95% CI 1.16-1.22), cardiovascular death (HR: 1.33, 95% CI 1.28-1.37), and HF hospitalization (HR: 1.16, 95% CI 1.12-1.19). In this large cohort of patients with HFrEF, males had worse outcomes across all major cardiovascular endpoints. These findings highlight the need for tailored strategies to address sex-based disparities in HF management and improve outcomes for both sexes.

Akash Bihari Pati, Pritinanada Mishra, Santosh K Mahalik et al.

Introduction: Proximal hypospadias repair has many postoperative complications such as urethrocutaneous fistulae, wound dehiscence, and urethral stricture. The beneficial effect of estrogen to promote wound healing has been known. We designed a study to determine whether preoperative stimulation of tissue with estrogen can reduce the postoperative complications associated with wound healing in patients undergoing hypospadias repair. Methods: Patients with proximal hypospadias requiring two-stage repairs (chordee correction followed by urethral tubularization) were randomized to estrogen and control groups before the second stage of surgery. In the former, topical estrogen cream (0.5 mg of estriol) was applied to the ventral penis for a month, whereas normal saline gel was applied to the latter; the urethroplasty was carried out thereafter. Patients were followed up for complications. Results: There were 29 patients in the estrogen group and 31 in the placebo group after the exclusion criteria were met. There was no significant difference in the overall postoperative complications between the estrogen group (44.8%) and the placebo group (51.6%). The occurrence of urethrocutaneous fistula (37.9% vs. 51.6%) and dehiscence (41.4% vs. 45.2%) was not significantly different between the estrogen and placebo groups. Neourethral stricture occurred in four patients in the estrogen group, while none of the patients in the placebo group developed stricture. Conclusions: The preoperative application of topical estrogen cream to the ventral penis failed to demonstrate any significant effect on wound healing and complications.

Peter A. Tauber, Bernhard Kratzer, Philipp Schatzlmaier et al.

BackgroundTreg cells have been shown to be an important part of immune-homeostasis and IL-2 which is produced upon T cell receptor (TCR)-dependent activation of T lymphocytes has been demonstrated to critically participate in Treg development.ObjectiveTo evaluate small molecule inhibitors (SMI) for the identification of novel IL-2/Treg enhancing compounds.Materials and methodsWe used TCR-dependent and allergen-specific cytokine secretion of human and mouse T cells, next generation messenger ribonucleic acid sequencing (RNA-Seq) and two different models of allergic airway inflammation to examine lead SMI-compounds.ResultsWe show here that the reported 3-phosphoinositide dependent kinase-1 (PDK1) SMI BX-795 increased IL-2 in culture supernatants of Jurkat E6-1 T cells, human peripheral blood mononuclear cells (hPBMC) and allergen-specific mouse T cells upon TCR-dependent and allergen-specific stimulation while concomitantly inhibiting Th2 cytokine secretion. RNA-Seq revealed that the presence of BX-795 during allergen-specific activation of T cells induces a bona fide Treg cell type highly similar to iTreg but lacking Foxp3 expression. When applied in mugwort pollen and house dust mite extract-based models of airway inflammation, BX-795 significantly inhibited Th2 inflammation including expression of Th2 signature transcription factors and cytokines and influx into the lungs of type 2-associated inflammatory cells such as eosinophils.ConclusionsBX-795 potently uncouples IL-2 production from Th2 inflammation and induces Th-IL-2 cells, which highly resemble induced (i)Tregs. Thus, BX-795 may be a useful new compound for the treatment of allergic diseases.

Pankaj N. Maheshwari, Amandeep Arora, Mahesh S. Sane et al.

Objective: To report our experience with supracostal percutaneous nephrolithotomy (SC-PNL) and evaluate factors which could predict the risk of hydrothorax following SC-PNL. Methods: We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019. Patients were assessed for demographic characteristics, indication for the supracostal access, level of supracostal access, anatomy of the kidney (normal or malrotated), site of the puncture in relation to the mid-scapular line (medial or lateral), and whether another subcostal tract for stone clearance was required or not. Patients were assessed for the incidence of hydrothorax and requirement of intercostal drain depending on the level of percutaneous access. In addition, a multivariable logistic regression analysis model was developed to identify factors which could predict the occurrence of hydrothorax following SC-PNL. Results: Of the 347 patients with SC-PNL, 248 (71.5%) underwent a supra-12th rib approach, while the rest needed a supra-11th (n=85; 24.5%) or a supra-10th (n=14; 4.0%) rib tract. Overall, 17 (4.9%) patients developed a hydrothorax, while an intercostal-drain was required in seven of these 17 patients for 48 h. None of the patients with a supra-12th rib puncture required an intercostal-drain. More than a third of the patients with a supra-10th puncture developed a hydrothorax (35.7%) and all of them required an intercostal drain. Factors such as anteriorly malrotated kidney (odds ratio [OR]=2.722; 95% confidence interval [CI]=1.042–5.617, p=0.03), puncture medial to the mid-scapular line (OR=1.669; CI=0.542–1.578, p=0.03), and an access higher than the supra-12th level (OR=5.265; CI=1.292–9.342, p<0.001) proved to be independent predictors of hydrothorax following a SC-PCNL on multivariable analysis. Conclusion: Incidence of clinically significant hydrothorax requiring an intercostal-drain after SC-PNL is very low. Knowledge of the predicting factors will help to anticipate the risk of hydrothorax in a particular patient and take necessary peri-operative measures.

Veronica Ghini, Gaia Meoni, Lorenzo Pelagatti et al.

Metabolomics and lipidomics have been used in several studies to define the biochemical alterations induced by COVID-19 in comparison with healthy controls. Those studies highlighted the presence of a strong signature, attributable to both metabolites and lipoproteins/lipids. Here, 1H NMR spectra were acquired on EDTA-plasma from three groups of subjects: i) hospitalized COVID-19 positive patients (≤21 days from the first positive nasopharyngeal swab); ii) hospitalized COVID-19 positive patients (>21 days from the first positive nasopharyngeal swab); iii) subjects after 2-6 months from SARS-CoV-2 eradication. A Random Forest model built using the EDTA-plasma spectra of COVID-19 patients ≤21 days and Post COVID-19 subjects, provided a high discrimination accuracy (93.6%), indicating both the presence of a strong fingerprint of the acute infection and the substantial metabolic healing of Post COVID-19 subjects. The differences originate from significant alterations in the concentrations of 16 metabolites and 74 lipoprotein components. The model was then used to predict the spectra of COVID-19>21 days subjects. In this group, the metabolite levels are closer to those of the Post COVID-19 subjects than to those of the COVID-19≤21 days; the opposite occurs for the lipoproteins. Within the acute phase patients, characteristic trends in metabolite levels are observed as a function of the disease severity. The metabolites found altered in COVID-19≤21 days patients with respect to Post COVID-19 individuals overlap with acute infection biomarkers identified previously in comparison with healthy subjects. Along the trajectory towards healing, the metabolome reverts back to the "healthy" state faster than the lipoproteome.

Huapeng Lu, Qinling Yang, Fang Tian et al.

Objective. To study the association between sleep duration and the incidence of type 2 diabetes mellitus (T2DM) and to provide a theoretical basis for the prevention of T2DM through a meta-analysis. Methods. PubMed, Web of Science, Scopus, Embase, Cochrane Library, ProQuest, CNKI, Wanfang, VIP, and SINOMED were searched from their inception until May 2020. All cohort studies on the relationship between sleep duration and T2DM in adults were included. According to the inclusion and exclusion criteria, two authors independently assessed the literature and extracted the data. Metaregression and publication bias were evaluated, and sensitivity and meta-analyses were conducted with RevMan 5.3. Results. A total of 17 studies were collected, involving 737002 adults. The incidence of T2DM was 4.73% in short sleep duration (SSD) (t≤6 h), 4.39% in normal sleep duration (NSD) (6 h<t<9 h), and 4.99% in long sleep duration (LSD) (t≥9 h). The meta-analysis demonstrated that SSD increased the risk of T2DM compared with NSD (RR=1.22, 95% CI: 1.15-1.29, P<0.001), LSD increased the risk of T2DM compared with NSD (RR=1.26, 95% CI: 1.15-1.39, P<0.001), and the risk of T2DM has no significant difference between SSD and LSD (RR=0.97, 95% CI: 0.89-1.05, P=0.41). The sensitivity of each study was robust and the publication bias was weak. Conclusion. SSD or LSD can increase the risk of T2DM.

Janneke Witteveen, Saskia Boonzajer Flaes, Pé Mullenders et al.

Felicia Scaggs Huang, David I. Bernstein, Karen S. Slobod et al.

SeVRSV is a replication-competent Sendai virus (SeV)-based vaccine carrying the respiratory syncytial virus (RSV) fusion protein (F) gene. Unmanipulated, non-recombinant SeV is a murine parainfluenza virus type 1 (PIV-1) and serves as a Jennerian vaccine for human PIV-1 (hPIV-1). SeV protects African green monkeys (AGM) from infection after hPIV-1 challenge. The recombinant SeVRSV additionally targets RSV and protects AGM from lower respiratory infections after RSV challenge. The present study is the first to report on the safety, viral genome detection, and immunogenicity following SeVRSV vaccination of healthy adults. Seventeen and four healthy adults received intranasal SeVRSV and PBS, respectively, followed by six months of safety monitoring. Virus genome (in nasal wash) and vaccine-specific antibodies (in sera) were monitored for two and four weeks, respectively, post-vaccination. The vaccine was well-tolerated with only mild to moderate reactions that were also present in the placebo group. No severe reactions occurred. As expected, due to preexisting immunity toward hPIV-1 and RSV in adults, vaccine genome detection was transient. There were minimal antibody responses to SeV and negligible responses to RSV F. Results encourage further studies of SeVRSV with progression toward a clinical trial in seronegative children. Abbreviations: AE-adverse event; SAE-serious adverse event; SeV-Sendai virus; RSV-respiratory syncytial virus; PIV-1-parainfluenza virus-type 1; hPIV-1-human parainfluenza virus-type 1; F-RSV fusion protein; SeVRSV-recombinant SeV carrying the RSV F gene; Ab-antibody; MSW-medically significant wheezing; NOCMC-new onset chronic medical condition, mITT-modified Intent to Treat; ALRI-acute lower respiratory tract infection.

Javadi V, Shiari R, Rahmani K et al.

Vadood Javadi,1 Reza Shiari,1 Khosro Rahmani,1 Nazanin Farahbakhsh2 1Pediatric Rheumatology Department, Mofid Children&rsquo;s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Pediatric Pulmonology Department, Mofid Children&rsquo;s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranCorrespondence: Reza ShiariMofid Children&rsquo;s Hospital, Shariati Ave, Tehran, IranTel/Fax +982122227033Email shiareza@yahoo.comAbstract: Kawasaki disease is a mysterious childhood vasculitis. It presents with multi-systemic involvement in which the prolonged high-grade fever and mucocutaneous and lymph node manifestations are the prominent features. Sometimes, the disease has an unusual, atypical or incomplete presentation. Herein, we present a child with hilar lymphadenopathy as a manifestation of Kawasaki disease.Keywords: Kawasaki disease, children, lymphadenopathy, pulmonary, mediastinum

Rong Zhang, Yonghao Xu, Ling Sang et al.

Abstract Background Intraoperative Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life-support for lung transplantation patients. However, factors associated with this procedure in lung transplantation patients have not yet been characterized. The aim of this study was to identify preoperative factors of intraoperative ECMO support during lung transplantation and to evaluated the outcome of lung transplantation patients supported with ECMO. Methods Patients underwent lung transplantation treated with and without ECMO in Guangzhou Institute of Respiratory Diseases between January 2015 to August 2018 were retrospectively reviewed. Patient demographics and clinical variables were collected and analyzed. Multivariate logistic regression was performed to identify factors independently associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation. Results During the study period, 138 patients underwent lung transplantation at our institution, the mean LAS was (56.63 ± 18.39) (range, 32.79 to 88.70). Fourty four patients were treated with veno-venous/veno-arterial ECMO. Among the patients, 32 patients wean successfully ECMO after operation, 12 patients remain ECMO after operation, and 32 patients (62.74%) survived to hospital discharge. In multiple analysis, the following factors were associated with intraoperative ECMO support: advanced age, high PAP before operation, duration of mechanical ventilation before operation, a higher APACHE II and primary diagnosis for transplantation. The overall survival rates at 1, 3, and 12 months were 90.91, 72.73, and 56.81% in the ECMO group, and 95.40, 82.76, and 73.56% in the non-ECMO group, respectively (log-rank P = 0.081). Patients who underwent single lung transplant had a lower survival rates in ECMO group as compared with non-ECMO group at 1, 3, and 12 months (90.47% vs 98.25, 71.43% vs 84.21, and 52.38% vs 75.44%) (log-rank P = 0.048). Conclusions The preoperative factors of intraoperative ECMO support during lung transplantation included age, high PAP before operation, preoperative mechanical ventilation, a higher APACHE II and primary diagnosis for transplantation based on multivariate analysis.

Hanny Al-Samkari, Rachel P. Rosovsky, Rebecca S. Karp Leaf et al.

Abstract: Platelet autoantibody (PA) testing has previously shown poor sensitivity for immune thrombocytopenia (ITP) diagnosis, but no previous study used both 2011 American Society of Hematology (ASH) guidelines for ITP diagnosis and 2012 International Society on Thrombosis and Haemostasis (ISTH) PA testing recommendations. We therefore performed a comprehensive retrospective study of PA testing in adult patients with ITP strictly applying these criteria. Of 986 PA assays performed, 485 assays in 368 patients met criteria and were included. Sensitivity and specificity of a positive test result for diagnosis of active ITP (n = 228 patients) were 90% and 78%, respectively. Sensitivity and specificity of a negative test result for clinical remission (n = 61 assays) were 87% and 91%. Antibodies against both glycoprotein IIb (GPIIb)/IIIa and GPIb/IX were required for the presence of antibodies against GPIa/IIa in patients with ITP. Logistic regression analysis revealed that more positive autoantibodies predicted more severe disease (relative to nonsevere ITP, relative risk ratio for severe ITP and refractory ITP was 2.27 [P < .001] and 3.09 [P < .001], respectively, per additional autoantibody); however, serologic testing did not meaningfully predict treatment response to glucocorticoids, intravenous immunoglobulin, or thrombopoietin receptor agonists. Sixty-four patients with ITP had multiple PA assays performed longitudinally: all 10 patients achieving remission converted from positive to negative serologic results, and evidence for epitope spreading was observed in 35% of patients with ongoing active disease. In conclusion, glycoprotein-specific direct PA testing performed using ISTH recommendations in patients meeting ASH diagnostic criteria is sensitive and specific for ITP diagnosis and reliably confirms clinical remission. More glycoproteins targeted by autoantibodies predicts for more severe disease.

Sunil Amin, MD, MPH, Russell Dorer, MD, PhD, Shayan Irani, MD

Rebeca Eriksen, Rachel Gibson, Maria Aresu et al.

Abstract Introduction Type 2 diabetes (T2D) is multifactorial involving lifestyle, environmental and genetic risk factors. This study aims to investigate the impact of genetic interactions with alcohol and diet quality on glycated haemoglobin A1c (HbA1c) independent of obesity, in a British population. Methods Cross‐sectional study of 14 089 white British participants from Airwave Health Monitoring Study and a subsample of 3733 participants with dietary data. A T2D genetic risk score (GRS) was constructed, and its interactions with diet on HbA1c were assessed. Results GRS was associated with a higher HbA1c% (β = 0.03, P < 0.0001) and a higher risk of prediabetes (OR = 1.09, P < 0.0001) and T2D (OR = 1.14, P = 0.006). The genetic effect on HbA1c% was significantly higher in obese participants (β = 1.88, Pinteraction = 0.03). A high intake of wholegrain attenuated the effect on HbA1c% in high‐risk individuals Pinteraction = 0.04. Conclusion The genetic effect on HbA1c was almost doubled in obese individuals, compared with those with a healthy weight, and independent of weight, there was a modest offset on HbA1c in high‐genetic‐risk individuals consuming a diet high in wholegrain. This supports the importance of a healthy diet high in wholegrains and along with maintaining a healthy weight in controlling HbA1c among high‐genetic‐risk groups.

Paul St Romain, Amanda Boyd, Jiayin Zheng et al.

Introduction and study aims Gastric antral vascular ectasia (GAVE) is a mucosal abnormality associated with multiple conditions, most notably cirrhosis and systemic sclerosis, that causes indolent gastrointestinal bleeding. It is primarily managed with endoscopic therapy. Traditionally, GAVE is endoscopically ablated using argon plasma coagulation (APC) but radiofrequency ablation (RFA) is emerging as an alternative modality. No prior comparison of the 2 modalities has been published. We retrospectively compared the effects of GAVE ablation with either RFA, APC or both in the largest cohort of patients thus far presented. We also attempt to discern what effect concomitant cirrhosis has on response to treatment. Patients and methods After receiving IRB approval, we reviewed our electronic health records to identify all patients who underwent endoscopic evaluation for GAVE between January, 2011 and October, 2016. We compared important variables between APC and RFA, as well as between cirrhosis and non-cirrhosis, using the Chi-square test and the Wilcoxon two-sample test as appropriate. Results During our study period, 81 patients were endoscopically evaluated for GAVE. 24 patients were treated with APC alone, 28 with RFA alone and 25 patients received both treatment modalities. APC-treated patients underwent a mean of 2.4 treatment sessions with a mean of 205 days between treatments. RFA-treated patients underwent a mean of 2.3 treatment sessions with a mean of 100 days between treatments. Hemoglobin values remained stable or increased in all patients during our study period and there were no significant differences in Hgb trend between those treated with APC and those with RFA. Conclusions RFA and APC were both effective in treating bleeding from GAVE. Though we found subtle differences, patients underwent a similar number of treatment sessions and had similar procedure times and a similar time between sessions no matter the treatment modality used.

Wan Zhou, Shan-Dong Ye

The aim of this study was to explore the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and lower extremity arterial disease (LEAD) in type 2 diabetes mellitus (T2DM) patients and to investigate the intervention effect of vitamin D. 145 subjects were assigned to a control group (Group NC), T2DM group (Group DM1), and T2DM complicated with LEAD group (Group DM2); then Group DM2 were randomly divided into Group DM3 who received oral hypoglycemic agents and Group DM4 who received oral hypoglycemic drugs and vitamin D3 therapy. Compared to Group NC, 25(OH)D was significantly lower in Group DM2 and marginally lower in Group DM1. In contrast to baseline and Group DM3, 25(OH)D rose while low density lipoprotein (LDL), retinol binding protein 4 (RBP4), and HbA1c significantly lowered in Group DM4. Statistical analysis revealed that 25(OH)D had a negative correlation with RBP4, duration, HbA1c, homeostasis model assessment for insulin resistance (HOMA-IR), and fasting plasma glucose (FPG). LDL, systolic blood pressure (SBP), FPG, and smoking were risk factors of LEAD while high density lipoprotein (HDL) and 25(OH)D were protective ones. Therefore, we deduced that low level of 25(OH)D is significantly associated with the occurrence of T2DM complicated with LEAD.