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中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (01) : 34 -40. doi: 10.3877/cma.j.issn.1673-9450.2024.01.007

论著

血管腔内介入治疗糖尿病足合并下肢动脉硬化闭塞症患者术后再狭窄与血清炎症因子的相关性
孙艺玮†(), 陈炜, 秦巍, 杜景辰, 孟昕, 周永军   
  1. 150036　哈尔滨，黑龙江省医院香坊院区周围血管外科
    151500　绥化，兰西县人民医院外科
  • 收稿日期:2023-11-19 出版日期:2024-02-01
  • 通信作者: 孙艺玮

Correlation between postoperative restenosis and serum inflammatory factors in patients with diabetic foot complicated with lower extremity atheroscle-rotic occlusive disease treated with intravascular intervention

Yiwei Sun†(), Wei Chen, Wei Qin, Jingchen Du, Xin Meng, Yongjun Zhou   

  1. Department of Peripheral Vascular Surgery, Heilongjiang Provincial Hospital Xiangfang District, Harbin 150036, China
    Department of Surgery, Lanxi People′s Hospital, Suihua 151500, China
  • Received:2023-11-19 Published:2024-02-01
  • Corresponding author: Yiwei Sun
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引用本文：

孙艺玮, 陈炜, 秦巍, 杜景辰, 孟昕, 周永军. 血管腔内介入治疗糖尿病足合并下肢动脉硬化闭塞症患者术后再狭窄与血清炎症因子的相关性[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(01): 34-40.

Yiwei Sun, Wei Chen, Wei Qin, Jingchen Du, Xin Meng, Yongjun Zhou. Correlation between postoperative restenosis and serum inflammatory factors in patients with diabetic foot complicated with lower extremity atheroscle-rotic occlusive disease treated with intravascular intervention[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(01): 34-40.

目的

探讨血管腔内介入治疗糖尿病足(DF)合并下肢动脉硬化闭塞症(LEASO)患者术后再狭窄与血清炎症因子的相关性。

方法

选取2020年1月至2022年12月黑龙江省医院香坊院区周围血管外科复诊的50例糖尿病足合并LEASO患者作为研究对象，开展回顾性分析。根据患者是否发生再狭窄，分为未狭窄组(21例)和再狭窄组(29例)。收集两组患者的性别、年龄、糖尿病史、体质量指数(BMI)、空腹血糖(FBG)、收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等临床资料进行分析。分析两组高敏感度C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、基质金属蛋白酶-9(MMP9)、内皮素-1(ET1)、高迁移率族蛋白B1(HMGB1)与再狭窄的相关性。

结果

再狭窄组患者HbA1c、血管狭窄率、hs-CRP、IL-6、MMP9、ET1、HMGB1均高于未狭窄组，差异具有统计学意义(P<0.05)。血管狭窄率与hs-CRP(r＝0.423，P＝0.002)、IL-6(r＝0.337，P＝0.017)、MMP9(r＝0.543，P<0.001)、ET1(r＝0.670，P<0.001)、HMGB1(r＝0.71，P<0.001)、HbA1c(r＝0.516，P<0.001)均为正相关关系，影响血管狭窄率的因素有ET1、HMGB1。各类因子AUC大小顺序为HMGB1>ET1>MMP9>HbA1c＝hs-CRP>IL-6(Z＝5.000，P＝0.416)。

结论

DF合并LEASO患者血管再狭窄的发生与hs-CRP、IL-6、MMP9等炎症因子升高呈正相关。

关键词: 糖尿病足, 闭塞性动脉硬化, 下肢, 术后再狭窄, 血清炎症因子
Objective

To study the relationship between restenosis and serum inflammatory factors in patients with diabetic foot (DF) complicated with arteriosclerosis obliterans after endovascular intervention.

Methods

50 patients with DF complicated with lower extremity arteriosclerosis obliterans (LEASO) who comed for a follow-up visit in Department of Peripheral Vascular Surgery, Heilongjiang Provincial Hospital Xiangfang District from January 2020 to December 2022 were enrolled, and a retrospective analysis was carried out. According to whether the patients had restenosis, they were divided into unstenosis (n=21) and restenosis (n=29). Gender, age, diabetes history, body mass index (BMI), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were collected. Analyzed relationship between the levels of high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP9), endothelin-1 (ET1), and high mobility group box 1 (HMGB1) and restenosis in two groups.

Results

HbA1c, vascular stenosis rate, hs-CRP, IL-6, MMP9, ET1 and HMGB1 in restenosis group were higher than those in non-stenosis group, and the differences were significant (P<0.05). The vascular stenosis rate was correlated with hs-CRP (r=0.423, P=0.002), IL-6 (r=0.337, P=0.017), MMP9 (r=0.543, P<0.001), ET1 (r=0.670, P<0.001), HMGB1 (r=0.71, P<0.001), HbA1c (r=0.516, P<0.001). The factors affecting the rate of vascular stenosis were ET1 and HMGB1. The order of AUC size was HMGB1>ET1>MMP9>HbA1c=hs-CRP>IL-6(Z=5.000, P=0.416).

Conclusion

Vascular restenosis in DF patients with LEASO is positively correlated with hs-CRP, IL-6, MMP9 and other inflammatory factors.

Key words: Diabetic foot, Arteriosclerosis obliterans, Lower extremity, Postoperative restenosis, Serum inflammatory factors
表1 两组患者术后基线资料对比
项目 未狭窄(n＝21) 再狭窄(n＝29) 总计 χ2值/t值 P值
性别[例(%)]          
女 11(52.38) 17(58.62) 28(56.00) 0.192 0.661
男 10(47.62) 12(41.38) 22(44.00)    
吸烟史[例(%)]          
无 16(76.19) 18(62.07) 34(68.00) 1.116 0.291
有 5(23.81) 11(37.93) 16(32.00)    
饮酒史[例(%)]          
无 10(47.62) 13(44.83) 23(46.00) 0.038 0.845
有 11(52.38) 16(55.17) 27(54.00)    
冠心病[例(%)]          
无 15(71.43) 22(75.86) 37(74.00) 0.124 0.724
有 6(28.57) 7(24.14) 13(26.00)    
治疗方法[例(%)]          
支架植入术 6(28.57) 12(41.38) 18(36.00) 1.902 0.386
药物球囊血管成形术 8(38.10) 12(41.38) 20(40.00)    
其他 7(33.33) 5(17.24) 12(24.00)    
年龄(岁，±s) 74.24±5.58 75.31±4.31 74.86±4.86 －0.767 0.447
血糖(mmol/L，±s) 8.67±1.28 8.34±1.93 8.48±1.68 0.708 0.482
BMI(kg/m2，±s) 24.47±1.57 24.28±1.12 24.36±1.32 0.46 0.649
FBG(mmol/L，±s) 8.48±0.80 8.47±0.83 8.47±0.81 0.062 0.951
SBP(mmHg，±s) 128.10±8.48 125.66±8.93 126.68±8.74 0.974 0.335
DBP(mmHg，±s) 91.05±2.87 90.83±2.94 90.92±2.88 0.264 0.793
HbA1c(%，±s) 7.40±1.14 9.02±1.11 8.34±1.37 －4.995 <0.001
TC(mmol/L，±s) 4.57±0.86 4.43±0.79 4.49±0.81 0.58 0.565
TG(mmol/L，±s) 1.88±0.65 1.94±0.67 1.91±0.66 －0.343 0.733
HDL-C(mmol/L，±s) 1.16±0.19 1.15±0.17 1.15±0.17 0.142 0.888
LDL-C(mmol/L，±s) 3.36±0.86 3.33±0.70 3.34±0.76 0.134 0.894
血管狭窄率(%，±s) 33.50±9.26 69.39±10.00 54.31±20.3 －12.915 <0.001
hs－CRP(mg/L，±s) 5.29±1.98 8.45±2.73 7.12±2.88 －4.74 <0.001
IL－6(ng/mL，±s) 18.13±8.93 26.74±8.31 23.12±9.51 －3.505 <0.001
MMP9(ng/mL，±s) 20.26±8.30 33.71±8.53 28.06±10.71 －5.566 <0.001
ET1(pg/mL，±s) 39.79±6.87 59.01±9.08 50.94±12.58 －8.155 <0.001
HMGB1(ng/mL，±s) 7.70±1.91 16.24±3.20 12.65±5.05 －11.775 <0.001
图1 相关性热图分析
表2 再狭窄与血清炎症因子相关性分析
项目 血管狭窄率 hs-CRP IL-6 MMP9 ET1 HMGB1 HbA1c
血管狭窄率              
r值 1 0.423 0.337 0.543 0.67 0.71 0.516
P值 － 0.002 0.017 <0.001 <0.001 <0.001 <0.001
hs-CRP              
r值 0.423 1 0.163 0.377 0.453 0.419 0.363
P值 0.002 － 0.258 0.007 0.001 0.002 0.01
IL-6              
r值 0.337 0.163 1 0.352 0.486 0.376 0.215
P值 0.017 0.258 － 0.012 <0.001 0.007 0.135
MMP9              
r值 0.543 0.377 0.352 1 0.476 0.564 0.595
P值 <0.001 0.007 0.012 － <0.001 <0.001 <0.001
ET1              
r值 0.67 0.453 0.486 0.476 1 0.579 0.31
P值 <0.001 0.001 <0.001 <0.001 － <0.001 0.028
HMGB1              
r值 0.71 0.419 0.376 0.564 0.579 1 0.524
P值 <0.001 0.002 0.007 <0.001 <0.001 － <0.001
HbA1c              
r值 0.516 0.363 0.215 0.595 0.31 0.524 1
P值 <0.001 0.01 0.135 <0.001 0.028 <0.001 －
图2 影响回归系数95%CI
表3 患者术后再狭窄多因素分析
项目 未标准化系数 标准化系数Beta t值 P值 95%置信区间 共线性统计
B 标准误 下限 上限 容差 VIF
常量 －19.114 13.452   －1.421 0.163 －46.243 8.015    
HbA1c 2.515 1.79 0.17 1.405 0.167 －1.095 6.125 0.575 1.74
hs-CRP 0.094 0.764 0.013 0.124 0.902 －1.446 1.634 0.718 1.393
IL-6 －0.116 0.23 －0.054 －0.503 0.617 －0.579 0.348 0.73 1.37
MMP9 0.107 0.243 0.056 0.439 0.663 －0.383 0.596 0.516 1.938
ET1 0.635 0.207 0.393 3.063 0.004 0.217 1.052 0.513 1.951
HMGB1 1.513 0.523 0.376 2.892 0.006 0.458 2.568 0.499 2.006
图3 hs-CRP、IL-6、MMP9、ET1、HMGB1、HbA1c的ROC曲线
表4 hs－CRP、IL6、MMP9、ET1、HMGB1、HbA1c对DF合并LEASO患者的血管再狭窄预测价值分析
检验结果变量 AUC SE. P值 95%CI 约登指数 临界值 敏感度 特异性
HbA1c 0.824 0.057 <0.001 0.712～0.937 0.586 9.07 0.586 1
hs-CRP 0.824 0.058 <0.001 0.71～0.939 0.603 6.13 0.793 0.81
IL-6 0.755 0.073 0.002 0.612～0.899 0.49 16.485 0.966 0.524
MMP9 0.887 0.047 <0.001 0.794～0.98 0.672 26.955 0.862 0.81
ET1 0.939 0.033 <0.001 0.875～1 0.836 45.225 0.931 0.905
HMGB1 0.997 0.004 <0.001 0.988～1 0.952 10.48 1 0.952
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