自体富血小板凝胶治疗2型糖尿病足患者的临床疗效及对外周血单个核细胞中MALAT1表达的影响

Clinical efficacy of autologous platelet rich gel in the treatment of type 2 diabetic foot patients and its effect on the expression of MALAT1 in peripheral blood mononuclear cells

目的观察自体富血小板凝胶(APG)治疗2型糖尿病足(DF)患者的临床疗效及对外周血单个核细胞(PBMCs)中肺腺癌转移相关转录本1(MALAT1)表达的影响。方法选取2021年2月至2022年5月南京医科大学康达学院附属医院收治的62例DF患者,采用随机数字表法分为对照组(30例)和观察组(32例),对照组采用超声清创换药治疗,观察组采用超声清创联合APG治疗。观察治疗6周后两组患者治疗的有效率、经皮氧分压(TcPO_(2)),血清肿瘤坏死因子(TNF-α)、白介素6(IL-6)、血管内皮生长因子(VEGF)、缺氧诱导因子α(HIF-1α)水平,PBMCs中MALAT1表达,并采用Pearson相关分析MALAT的表达改变(△MALAT1)与治疗总有效率的关系。结果观察组总有效率高于对照组[93.75%(30/32)vs 73.33%(22/30),P<0.05]。治疗后,两组收缩压(SBP)、舒张压(DBP)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA_(1c))、尿微量白蛋白/肌酐(UACR)、尿酸(UA)、白细胞(WBC)、TNF-α和IL-6均较前降低,HIF-1α、VEGF和MALAT1较治疗前升高(均P<0.05);且治疗后,观察组的UA、HIF-1α、VEGF和MALAT1与对照组比较差异有统计学意义(均P<0.05)。Pearson相关分析显示,DF患者△MALAT1与TNF-α(r=-0.61,P=0.02)、IL-6(r=-0.52,P=0.04)、WBC(r=-0.53,P=0.03)呈负相关,与VEGF(r=0.58,P=0.03)、HIF-1α(r=0.54,P=0.03)呈正相关。△MALAT高改变组DF治疗的总有效率更高[88.37%(38/43)vs 73.68%(14/19),P<0.05]。两组的不良反应发生率差异无统计学意义(P>0.05)。结论APG可明显上调MALAT的表达,改善创面组织血液灌注、创面血管生成和炎症反应,促进溃疡愈合,且MALAT表达量的变化有助于判断DF的预后。

Objective To observe the clinical efficacy of autologous platelet rich gel(APG)in the treatment of type 2 diabetic foot(DF)patients and the effect of APG on the expression of metastasis-associated lung adenocarcinoma transcript 1(MALAT1)in peripheral blood mononuclear cells(PBMCs).Methods A total of 62 patients with DF admitted to the Affiliated Hospital of Kangda College of Nanjing Medical University from February 2021 to May 2022 were randomly divided into a control group(30 cases)and an observation group(32 cases)using a random number table method.The control group received ultrasound debridement and dressing change treatment,while the observation group received ultrasound debridement combined with APG treatment.After 6 weeks of treatment,the effective rate,transcutaneous oxygen partial pressure(TcPO_(2)),and serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),vascular endothelial growth factor(VEGF),hypoxia inducible factorα(HIF-1α)and the level of MALAT1 expression in PBMCs of the two groups of patients were observed.The Pearson correlation analysis was used to investigate the relationship between the expression change of MALAT(△MALAT1)and the total effective rate of treatment.Results The total effective rate of the observation group was higher than that of the control group[93.75%(30/32)vs 73.33%(22/30),P<0.05].After treatment,the systolic blood pressure(SBP),diastolic blood pressure(DBP),cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),glycosylated hemoglobin(HbA_(1c)),urinary microalbumin/creatinine(UACR),uric acid(UA),white blood cells(WBC),TNF-αand IL-6 of both groups had decreased compared to before;HIF-1α,VEGF and MALAT1 increased compared to before treatment(all P<0.05);After treatment,there was a statistically significant difference in UA,HIF-1α,VEGF,and MALAT1 between the observation group and the control group(all P<0.05).Pearson correlation analysis showed thatΔMALAT1 in DF patients was negatively correlated with TNF-α(r=-0.61,P=0.02),IL-6(r=-0.52,P=0.04),WBC(r=-0.53,P=0.03),and positively correlated with VEGF(r=0.58,P=0.03)and HIF-1α(r=0.54,P=0.03).The total effective rate of DF treatment was higher in the high change group of△MALAT[88.37%(38/43)vs 73.68%(14/19),P<0.05].There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions APG can significantly upregulate the expression of MALAT,improve wound tissue blood perfusion,wound angiogenesis,and inflammatory response,promote ulcer healing,and changes in MALAT expression can help determine the prognosis of DF.