糖尿病足溃疡患者血清TGF-β1、25(OH)维生素D及维生素B12水平与病情严重性及愈合率的相关性

Association of serum TGF-β1,25(OH)vitamin D and vitamin B12 levels with disease severity and healing rate of patients with diabetic foot ulcer

目的:探讨糖尿病足溃疡(DFU)患者血清转化生长因子β1(TGF-β1)、25(OH)维生素D[25(OH)D]及维生素B12(VitB12)水平与病情严重性及愈合率的相关性。方法:选取160例DFU患者为DFU组,同期50例单纯2型糖尿病患者为T2DM组,同期50名健康体检者为NC组。比较各组对象临床生化指标[空腹血糖(FPG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、甘油三酯(TG)、胰岛素抵抗指数(HOMA-IR)]及血清指标[TGF-β1、25(OH)D、VitB12]水平;DFU组再按照Wagner标准分为1级(n=21)、2级(n=38)、3级(n=32)、4级(n=43)、5级(n=26)5个亚组,比较5个亚组患者血清TGFβ1、25(OH)D、VitB12水平;Perason相关性分析血清TGF-β1、25(OH)D、VitB12水平与Wagner分级的相关性;随访足溃疡愈合状况,Logistics回归分析血清TGF-β1、25(OH)D、VitB12对DFU愈合率的影响。结果:T2DM组及DFU组患者FPG、HbAlc、TG、HOMA-IR及血清TGFβ1水平均高于NC组(P<0.05);DFU组患者HbAlc、TG、HOMA-IR及血清TGF-β1水平高于T2DM组(P<0.05)。NC组、T2DM组及DFU组患者血清25(OH)D、VitB12水平均依次降低(P<0.05);Wagner 1~5级血清TGF-β1水平依次升高,25(OH)D、VitB12水平均依次降低(P<0.05)。相关性分析显示,血清TGF-β1水平与Wagner分级呈正相关(P<0.05),血清25(OH)D、VitB12水平与Wagner分级均呈负相关(P<0.05)。回归分析显示,血清TGF-β1、25(OH)D、VitB12为影响DFU愈合率的独立影响因素(P<0.05)。结论:DFU患者血清TGF-β1表达上调,25(OH)D、VitB12下调,三者均与患者病情程度及愈合率有关。

Objective:To explore the correlation between levels of serum transforming growth factor β1(TGF-β1),25(OH)vitamin D[25(OH)D]and vitamin B12(VitB12)and disease severity and healing rate of patients with diabetic foot ulcer(DFU).Methods:160 patients with DFU were included in DFU group,and 50 patients with type 2 diabetes mellitus were selected as T2DM group,and 50 healthy subjects with physical examination were enrolled as NC group during the same period.The clinical biochemical indicators[fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlc),total cholesterol(TC),triglyceride(TG),homeostasis model assessment of insulin resistance(HOMA-IR)]and levels of serum indicators[TGF-β1,25(OH)D,VitB12]were compared among the groups.Patients with DFU were further divided into five subgroups according to Wagner criteria:1 grade(n=21),2 grade(n=38),3 grade(n=32),4 grade(n=43),5 grade(n=26).Serum levels of TGF-β1,25(OH)D and VitB12 among the five subgroups were compared,and the correlation between serum levels of TGF-β1,25(OH)D and VitB12 and Wagner grading was analyzed by Perason correlation analysis.The healing status of foot ulcer was followed up,and the effects of serum TGF-β1,25(OH)D and VitB12 on healing outcome were analyzed by Logistics regression analysis.Results:The FPG,HbAlc,TG,HOMA-IR and serum TGFβ1 in T2DM group and DFU group were higher than those in NC group(P<0.05),and the HbAlc,TG,HOMA-IR and serum TGF-β1 in DFU group were higher than those in T2DM group(P<0.05).Serum 25(OH)D and VitB12 levels in NC group,T2DM group and DFU group were decreased successively(P<0.05).The level of serum TGF-β1 in patients with Wagner 1~5 grade was enhanced successively,while the levels of 25(OH)D and VitB12 were reduced successively(P<0.05).Perason correlation analysis showed that serum TGF-β1 level was positively correlated with Wagner grading(P<0.05),and serum 25(OH)D and VitB12 levels were negatively correlated with Wagner grading(P<0.05).Logistics regression analysis showed that serum TGF-β1,25(OH)D and VitB12 were independent influencing factors of healing rate of DFU(P<0.05).Conclusion:The expression of serum TGF-β1 in patients with DFU is up-regulated while 25(OH)D and VitB12 are down-regulated,and the above three indicators are related to the disease severity and healing rate of patients.