2型糖尿病足溃疡合并营养不良患者血清Tol样受体9、糖化血红蛋白、25羟维生素D检测的临床意义

Clinical Significance of Serum Tol Receptor 9,Glycosylated Hemoglobin and 25 Hydroxyvitamin D in Patients with Type 2 Diabetic Foot Ulcer Complicated with Malnutrition

目的:检测2型糖尿病足溃疡合并营养不良患者血清Tol样受体9(TLR9)、糖化血红蛋白(HbA1c)、25羟维生素D[25-(OH)D3]的水平,并分析其临床意义。方法:选择2018年3月~2019年3月我院收治的2型糖尿病足溃疡患者81例,根据预后营养指数(PNI)对患者营养状况进行评估并分组,PNI≤50患者作为营养不良组27例,PNI>50患者作为营养正常组54例,检测并比较两组营养指标、体重指数(BMI)、PNI值、血糖、血脂、TLR9、HbA1c、25-(OH)D3。结果:营养不良组患者PNI值、BMI、血清总蛋白(TP)、血清白蛋白(ALB)、血清前白蛋白(PA)显著低于营养正常组(P<0.05),而营养不良组患者空腹血糖(FBG)、餐后2 h血糖(PBG)显著高于营养正常组(P<0.05)。两组患者总胆固醇(TC)、三酰甘油(TG)水平无显著差异(P>0.05),营养不良组患者血清TLR9、HbA1c水平显著高于营养正常组(P<0.05),而25-(OH)D3水平显著低于营养正常组(P<0.05)。血清TLR9、HbA1c与PNI值、BMI、TP、ALB、PA均呈显著负相关关系(P<0.05),而与FBG、PBG呈显著正相关关系(P<0.05);血清25-(OH)D3与PNI值、BMI、TP、ALB、PA均呈显著正相关关系(P<0.05),而与FBG、PBG呈显著负相关关系(P<0.05)。结论:2型糖尿病足溃疡合并营养不良患者血清TLR9、HbA1c及25-(OH)D3水平与机体营养状况及血糖控制密切相关,有望成为患者疾病监测及营养风险评估的潜在指标。

Objective:To detecte the tol receptor 9(TLR9),glycosylated hemoglobin(HbA1 c)and 25 hydroxyvitamin D[25-(OH)D3]levels in patients with type 2 diabetic foot ulcer complicated with malnutrition,and to analyze their clinical significance.Methods:81 patients with type 2 diabetic foot ulcer who were admitted to our hospital from March 2018 to March 2019 were selected.The nutritional status of the patients was evaluated and grouped according to the prognostic nutritional index(PNI).27 patients with PNI≤50 were treated as malnutrition group,and 54 patients with PNI>50 were treated as normal nutrition group.Nutritional indicators,body mass index(BMI),PNI,blood glucose,blood lipids,TLR9,HbA1c 25-(OH)D3 were measured and compared between the two groups.Results:PNI value,BMI,serum total protein(TP),serum albumin(ALB)and serum prealbumin(PA)in the malnutrition group were significantly lower than those in the normal nutrition group(P<0.05).Fasting blood glucose(FBG)and 2 h postprandial blood glucose(PBG)in the malnutrition group were significantly higher than those in the normal nutrition group(P<0.05).There were no significant differences in total cholesterol(TC)and triacylglycerol(TG)levels between the two groups(P>0.05).Serum TLR9 and HbA1 c levels in the malnutrition group were significantly higher than those in the normal nutrition group(P<0.05),while the 25-(OH)D3 level was significantly lower than that in the normal nutrition group(P<0.05).Serum TLR9 and HbA1 c were significantly negatively correlated with PNI,BMI,TP,ALB and PA(P<0.05),while serum FBG and PBG were significantly positively correlated(P<0.05).Serum 25-(OH)D3 was significantly positively correlated with PNI,BMI,TP,ALB and PA(P<0.05),while significantly negatively correlated with FBG and PBG(P<0.05).Conclusion:Serum TLR9,HbA1 c and 25-(OH)D3 levels in patients with type 2 diabetic foot ulcer complicated with malnutrition are closely related to nutritional status and blood glucose control,and which are expected to be potential indicators for disease monitoring and nutritional risk assessment in patients.