MHR、sCD14-ST、ApoM与糖尿病足溃疡预后的关系及对预后的预测价值

Relationship between MHR,sCD14-ST and ApoM and Prognosis of Patients with Diabetic Foot Ulcer and their Predictive Values on Prognosis

目的:探讨单核细胞数/高密度脂蛋白胆固醇比值(MHR)、可溶性白细胞分化抗原14亚型(sCD14-ST)、载脂蛋白M(ApoM)与糖尿病足溃疡(DFU)患者预后的关系及对预后的预测价值。方法:选取2018年1月-2020年12月本院收治的100例DFU患者资料进行回顾性分析,记录其性别、年龄、病程、体重指数(BMI)等一般临床资料以及空腹血糖、MHR、sCD14-ST、ApoM等实验室指标,并对纳入的100例患者进行6个月的随访,获得患者DFU愈合、截肢及死亡例数。采用单因素分析以及二元Logistics回归分析MHR、sCD14-ST、ApoM与DFU患者预后的关系,并采用ROC曲线检测MHR、sCD14-ST、ApoM水平及三项指标联合检测对不良预后的预测价值。结果:预后不良患者DFU病程、Wagner分级、MHR、sCD14-ST、ApoM水平均与预后良好患者有统计学差异(P<0.05)。随着MHR、sCD14-ST水平的升高,不良结局发生率呈上升趋势(P<0.05);随着ApoM水平升高,不良结局发生率呈下降趋势(P<0.05)。二元Logistic回归分析结果显示,DFU病程、MHR、sCD14-ST为DFU患者不良结局发生的独立危险因素(P<0.05),而ApoM为保护因素(P<0.05)。ROC曲线分析显示,MHR、sCD14-ST、ApoM以及三项指标联合检测对DFU患者不良结局发生的预测线下面积(AUC)分别为0.731、0.729、0.763和0.864,其中联合检测的预测效能最高,其预测敏感度为68.57%、特异度为89.23%。结论:MHR、sCD14-ST、ApoM均与DFU患者的预后存在相关性,三项指标联合检测具有一定的预后预测价值。

Objective:To investigate the relationship between monocyte count/high-density lipoprotein cholesterol ratio(MHR),soluble CD14 subtype(sCD14-ST) and apolipoprotein M(ApoM) and prognosis of patients with diabetic foot ulcer(DFU) and their predictive values on prognosis.Methods:The data of 100 patients with DFU treated in our hospital from January 2018 to December 2020were retrospectively analyzed.The general clinical data such as gender,age,course of disease,body mass index(BMI) and laboratory indexes such as fasting blood glucose,MHR,sCD14-ST and ApoM were recorded.The 100 patients were followed up for 6 months to obtain the number of patients with DFU healing,amputation and death.Univariate analysis and binary logistic regression were used to analyze the relationship between MHR,sCD14-ST and ApoM and the prognosis of patients with DFU,and ROC curve was used to detect the predictive value of the MHR,sCD14-ST and ApoM levels and the combined detection of the three indicators for poor prognosis.Results:The course of disease,Wagner Grade,MHR,sCD14-ST and APOM levels in patients with poor prognosis were significantly different from those with good prognosis(P<0.05).The incidence of adverse outcomes increased with the increase of MHR and sCD14-ST levels(P<0.05) and decreased with the increase of ApoM levels(P<0.05).Binary logistic regression analysis showed that the course of DFU,MHR and sCD14-ST were independent risk factors for adverse outcomes in patients with DFU(P<0.05),while ApoM was protective factor(P<0.05).ROC curve analysis showed that the area under the curve(AUC) of MHR,sCD14-ST,ApoM and the combined detection of the three indicators for the prediction of adverse outcomes in patients with DFU were 0.731,0.729,0.763 and 0.864 respectively,and the prediction efficiency of the combined detection was the highest,with a prediction sensitivity of 68.57% and a specificity of 89.23%.Conclusions:MHR,sCD14-ST and ApoM are correlated with the prognosis of patients with DFU,and the combined detection of the three indicators has a certain predictive value for the prognosis.