血清碱性磷酸酶、同型半胱氨酸及半胱氨酸蛋白酶抑制剂C与糖尿病足下肢动脉粥样硬化的关系

Relationship between serum alkaline phosphatase,homocysteine,cystein C and lower limb atherosclerosis in the diabetic foot

目的分析糖尿病足患者血清碱性磷酸酶(ALP)、同型半胱氨酸(Hcy)、半胱氨酸蛋白酶抑制剂C(Cys-C)水平与糖尿病足及下肢动脉粥样硬化(AS)的关系。方法收集2021年1月至2021年12月于山东中医药大学附属医院住院治疗的80例糖尿病足患者和36例同期健康体检者的临床资料,分别设为观察组和对照组。根据彩色多普勒超声测定的下肢股动脉内-中膜厚度(FAIMT)测定结果将观察组患者分为FAIMT增厚组(n=39)和斑块组(n=41)。比较各组患者的临床特征、血液指标[ALP、Hcy、Cys-C、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及空腹血糖(FBG)],采用多因素Logistic回归模型分析糖尿病足发生的危险因素,通过受试者操作特征(ROC)曲线确定ALP、Hcy、Cys-C对糖尿病足的诊断价值。结果观察组的年龄大于对照组,ALP、Hcy、Cys-C、FBG水平均高于对照组,TC、HDL-C水平均低于对照组,差异均有统计学意义(P﹤0.05)。斑块组患者的Hcy水平高于FAIMT增厚组患者,差异有统计学意义(P﹤0.05)。多因素分析结果显示,年龄、FBG、ALP、Hcy、Cys-C均是糖尿病足发生的独立危险因素(P﹤0.05)。ROC曲线分析结果显示,ALP、Hcy、Cys-C诊断糖尿病足的AUC分别为0.724、0.640、0.895,对糖尿病足均具有较好的诊断价值。结论ALP、Hcy、Cys-C与糖尿病足的发生密切相关,且与下肢AS程度有关,对糖尿病足患者病情的诊断具有重要临床意义。

Objective To analyze the association between serum alkaline phosphatase(ALP),homocysteine(Hcy),cystatin C(Cys-C)levels and diabetic foot and lower limb atherosclerosis(AS)in patients with diabetic foot.Method The clinical data of 80 patients with diabetic foot who were hospitalized in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2021 to December 2021 and 36 healthy physical examination patients were collected at the same period,and were respectively set as the observation group and the control group.The observation group was divided into 39 cases of femoral artery intima-medial thickness(FAIMT)thickening group and 41 cases of plaque group according to the results of lower limb FAIMT measurement using color Doppler ultrasound.The general characteristics and blood indexes[ALP,Hcy,Cys-C,total cholesterol(TC),triacylglycerol(TG),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C)and fasting blood glucose(FBG)]of each group were compared,and the risk factors related to diabetic foot were analyzed by multivariate Logistic regression model,and receiver operator characteristic(ROC)curve were drawn to analyze the diagnostic value of ALP,Hcy and Cys-C in diabetic foot.Result The age in the observation group was larger than that in the control group,ALP,Hcy,Cys-C,and FBG levels in the observation group were higher than those in the control group,and TC and HDL-C levels were lower than those in the control group,all the differences above were statistically significant(P<0.05).The Hcy level of patients in the plaque group were higher than those in the FAIMT thickening group,with statistically significant differences(P<0.05).Multivariate analysis showed that age,ALP,Hcy,Cys-C and FBG were independent risk factors for diabetic foot(P<0.05).ROC curve analysis results showed that area under the curve(AUC)of ALP,Hcy and Cys-C in the diagnosis of diabetic foot were 0.724,0.640,and 0.895,respectively,which had good diagnostic value for diabetes foot.Conclusion ALP,Hcy and Cys-C are risk factors for diabetic foot and correlated with the degree of AS of the lower limbs,which are clinically important for the diagnostic of diabetes foot.