红细胞分布宽度、纤维蛋白原与D-二聚体预测糖尿病足发生发展风险的价值

Value of erythrocyte distribution width, fibrinogen and D-dimer in predicting the occurrence and development risk of diabetic foot

背景:血栓形成相关指标红细胞分布宽度、纤维蛋白原、D-二聚体可能是预测糖尿病足发生发展的重要标志。目的:分析红细胞分布宽度、纤维蛋白原、D-二聚体预测糖尿病足发生发展风险的临床价值。方法:收集糖尿病足患者81例、2型糖尿病患者82例、健康人67例做回顾性病例-对照分析。临床研究的实施符合南方医科大学第三附属医院对研究的相关伦理要求。所有受试者及家属对试验过程均知情同意,并签署知情同意书。对比3组受试者红细胞分布宽度、纤维蛋白原、D-二聚体;Logistic回归分析糖尿病患者糖尿病足的相关危险因素;应用受试者工作特征曲线得出红细胞分布宽度、纤维蛋白原、D-二聚体对预测糖尿病足发生的最佳切点及其敏感性、特异性;利用Spearman相关分析分析红细胞分布宽度、纤维蛋白原与D-二聚体的相关性。结果与结论:①糖尿病足组红细胞分布宽度、纤维蛋白原、D-二聚体均高于2型糖尿病组及健康组(P=0.000);②二元逻辑回归分析提示纤维蛋白原升高是糖尿病足的独立危险因素(OR=4.253,P=0.046);红细胞分布宽度、纤维蛋白原、D-二聚体与糖尿病足的相关系数分别为0.616,0.724,0.797,P均小于0.001。③受试者工作特征曲线分析提示,红细胞分布宽度、纤维蛋白原、D-二聚体预测糖尿病足发生的切点分别为40%、3g/L、329mg/L,敏感度分别为77.78%,72.73%、93.33%,特异度分别为71.95%、92.98%,88.24%;④结果说明,红细胞分布宽度、纤维蛋白原、D-二聚体对预测糖尿病足的发生发展风险具有一定的临床意义。

BACKGROUND:Thrombosis-related indexes red blood cell distribution width,fibrinogen and D-dimer may be the important markers of predicting the occurrence and development of diabetic foot.OBJECTIVE:To investigate the clinical value of red blood cell distribution width,fibrinogen and D-dimer in predicting the occurrence and development risk of diabetic foot.METHODS:Eighty-one patients with diabetic foot and 82 patients with type 2 diabetes mellitus,and 67 healthy people were enrolled to conduct respective case-control analysis.The study was in accordance with the ethical guidance of the Third Affiliated Hospital of Southern Medical University.All patients and their relatives signed the informed consents.The red blood cell distribution width,fibrinogen,and D-dimer were compared among groups.The related risk factors of diabetic foot were analyzed by logistic regression.The best cut-off points,sensitivity and specificity of red blood cell distribution width,fibrinogen and D-dimer for predicting the occurrence of diabetic foot were obtained by receiver operating characteristic curve.The correlation of red blood cell distribution width,fibrinogen and D-dimer was analyzed by Spearman correlation analysis.RESULTS AND CONCLUSION:(1)The red blood cell distribution width,fibrinogen and D-dimer in the diabetic foot group were significantly higher than those in the type 2 diabetes mellitus group and healthy group(P=0.000).(2)Binary logistic regression analysis indicated that elevated fibrinogen was an independent risk factor for diabetic foot(OR=4.253,P=0.046).The correlation coefficients of red blood cell distribution width,fibrinogen,and D-dimer with diabetic foot were 0.616,0.724 and 0.797,respectively(all P<0.001).(3)Receiver operating characteristic curve analysis showed that the cut-off points of red blood cell distribution width,fibrinogen and D-dimer for predicting the occurrence of diabetic foot were 40%,3 g/L and 329 mg/L,with sensitivity of 77.78%,72.73%,93.33% and specificity of 71.95%,92.98% and 88.24%,respectively.(4)To conclude,red blood cell distribution width,fibrinogen and D-dimer have certain clinical significance in predicting the occurrence and development risk of diabetic foot.