血管内皮生长因子与老年糖尿病患者症状性下肢血管病变的关系

Association of vascular endothelial growth factor with symptomatic peripheral artery disease in the elderly diabetics

目的 探讨老年糖尿病患者血浆血管内皮生长因子（VEGF）水平及外周血单个核细胞（PBMCs） VEGF的mRNA表达与糖尿病下肢血管病变（PAD）的关系.方法 选取2009年1月至2012年1月于唐山市工人医院就诊的40例单纯2型糖尿病未合并下肢血管病变患者（DM组）、46例糖尿病合并间歇性跛行患者（IC组）和40例糖尿病合并临界性肢体缺血患者（CLI组）.分别检测3组患者血浆VEGF水平和PBMCs的VEGF的mRNA表达水平,并计算VEGF诊断PAD的切点.组间差异比较应用方差分析x2检验或秩和检验.结果 3组间血浆VEGF水平及PBMCs VEGF mRNA表达差异有统计学意义（F=37.87、36.41,均P＜0.05）;且CLI组血浆VEGF水平及PBMC的VEGFmRNA表达均显著高于IC组[（568±201）比（392±144） ng/L;4.47（2.20～9.06）比2.58（1.21～5.50）,均P＜0.05];当血浆VEGF≥345.58 ng/L时,诊断PAD的灵敏度和特异度最高.3组中血浆VEGF水平和PBMC的VEGF mRNA表达与踝肱指数（ABI）呈负相关（r=-0.495 ～-0.319,均P＜0.05）.IC组和CLI组血浆VEGF水平与PBMC的VEGF mRNA表达呈正相关（r=0.341、0.409,均P＜0.05）.结论 VEGF与糖尿病PAD密切相关.

Objective To investigate plamsa levels of vascular endothelial growth factor（VEGF） and its mRNA expression levels in peripheral blood mononuclear cells （PBMCs） from type 2 diabetes mellitus （T2DM） patients with peripheral artery disease （PAD） and their correlation with PAD among T2DM patients.Methods Total of 126 T2DM patients were enrolled from January 2009 to January 2012 in Tangshan Gongren Hospital in this study; and the patients were divided into three groups including T2DM patients without PAD （DM group,n =40）,T2DM with intermittent claudication （IC group,n =46）,and T2DM with critical limb ischemia （CLI group,n =40）.Plasma level of VEGF and its expression level in PBMCs in the three groups were detected by enzyme-linked immunosorbent assay （ELISA） and real-time polymerase chain reaction（RT-PCR）,respectively,and the cutoff value of VEGF to diagnose T2DM with PAD was evaluated.Statistical analysis were performed by using one-way analysis of variance,x2 test,and nonparameter test for multiple-group comparisons.Results There was significant difference in plasma levels of VEGF and its mRNA levels in PBMCs among the three groups （F =37.87,36.41,both P〈0.05）.Moreover,both plasma levels of VEGF and its mRNA levels in PBMCs were significantly increased in CLI group compared with those in IC group [（568 ±201） vs （392 ± 144） ng/L,4.47（2.20-9.06） vs 2.58 （1.21-5.50）,both P 〈0.05].The VEGF plasma level ≥345.58 ng/L for the diagnosis of T2DM with PAD was the cutoff value with the highest sensitivity and specificity.Plasma levels of VEGF and its mRNA levels in PMBCs were negatively correlated with ankle brachial index among DM group,IC group and CLI group （r =-0.495--0.319,all P 〈 0.05）.Conclusion VEGF is closely associated with PAD in diabetics.