血清胱抑素-C水平与糖尿病足溃疡严重程度的关系研究

Relationship between Serum Cystatin C Levels and Wagner Levels of Foot Ulcerations in Type 2 Diabetic Patients

目的 探讨血清高胱抑素-C水平与糖尿病足溃疡（DFU）严重程度是否存在联系.方法 本研究为横断面研究,纳入上海市糖尿病临床医学中心2014年1月～2015年2月就医的975例2型糖尿病（T2DM）患者,其中足溃疡（DFU）患者110例,865例无足病者（NDF）作为对照组.收录患者血清、一般临床数据、糖代谢指标、血脂、肝肾功能、胱抑素C、C反应蛋白、血常规等生化指标检测结果.采取t检验、方差分析、卡方检验、Spearman相关分析、多元Logistic回归分析等统计学方法研究Cys C与DFU严重程度的关系.结果 DF组年龄、病程、吸烟比例、空腹血糖、血肌酐、血清CysC、糖化血红蛋白水平均明显高于非足病组（NDF）,差异有统计学意义（P均＜0.01）.DFU患者不同Wagner水平间单因素方差分析显示,DFU患者的Wagner分级越高,Cys C升高越明显（F=11.27,P＜0.01）;且血肌酐、尿素氮、糖化血红蛋白水平越高（F=4.9、4.9、3.18,P均＜0.05）.Spearman相关分析表明,ABI水平与DFU的Wagner分级呈负相关（r=-0.241,P＜0.05）,吸烟史、Cys C、肌酐、尿酸、糖化血红蛋白水平与DFU患者的Wagner分级呈正相关（r=0.205、0.344、0.237、0.231、0.053,P均＜0.05）.Logistic回归分析显示,排除其他DFU严重程度的传统影响因子后,Cys C升高仍是DFU Wagner分级级别的独立影响因素（β=1.381,95％CI：1.039～15.228,P＜0.01）.结论 血清胱抑素-C水平与糖尿病足溃疡密切相关,高胱抑素-C水平提示糖尿病足溃疡更严重.

Objective To investigate the relationship between serum cystatin C levels and the Wagner level for diabetic foot （DF）.Methods This cohort study was carried out at Shanghai Clinical Medical Centre of Diabetes during January 2014 to February 2015.Total 975 patients with type 2 diabetes were recruited,including 110 patients with diabetic foot ulcer.Clinical parameters were collected from electronic medical records system.The severity of foot ulcerations and its association with serum cystatin C were compared and analysed.Results Serum cystatin C,age,smoking,FPG,BUN,HbA1c levels were significantly higher in patients with DF than those without DF （all,P ＜ 0.01）.ANOVA analysis showed that the greater Wagner level was accompanied with the higher Cys C,BUN,SCr,HbA1c levels （F =11.27,4.9,4.9,3.18,all P ＜ 0.05）.Spearman analysis showed that serum cystatin C,smoking,SCr,UA,HbA1c were positively correlated to Wagner level of diabetic foot ulceration （r =0.344,0.205,0.237,0.231,0.053,all P ＜ 0.05）,but ABI was negatively associated with it （r =-0.241,P ＜ 0.05）.Logistic regression analysis further revealed that cystatin C was still an independent impact factor for DFU （β =1.381,95％ CI：1.039-15.228,P ＜ 0.01） even after adjusting for all potential confounders.Conclusion There is a strong and independent association between high cystatin C and Wagner level of diabetic foot ulceration.