血清Hsa_circ_0057362在糖尿病足溃疡中的表达及其预测病情严重程度及预后的价值

Expression of serum Hsa_circ_0057362 in diabetic foot ulcer and its value in predicting severity and prognosis

目的探讨血清Hsa_circ_0057362在糖尿病足溃疡(DFU)患者中的表达及其预测病情严重程度及预后的价值。方法为病例对照研究。回顾性选取2020年1月至2023年3月海南省第三人民医院收治的116例DFU患者作为DFU组,选择我院同期收治的90例单纯2型糖尿病(T2DM)患者作为T2DM组,另选择同期来我院体检的正常人群60名作为对照组。根据Wagner分级标准,116例DFU患者中1级25例、2~3级54例、4~5级37例。按DFU感染严重程分为1~2级55例(无或轻度感染),3~4级61例(中重度感染)。根据DFU患者6个月预后情况分为预后良好组(68例)和预后不良组(48例)。使用实时荧光聚合酶链反应技术检测Hsa_circ_0057362水平,化学发光免疫分析法检测降钙素原(PCT)水平,酶联免疫吸附法检测血清白细胞介素-6(IL-6)水平,采用方差分析、SNK-q检验和t检验比较血清各组IL-6、CRP及Hsa_circ_0057362水平的差异。应用二元logistic回归分析法分析DFU患者预后不良的影响因素。绘制受试者工作特征曲线(ROC)分析Hsa_circ_0057362、CRP及IL-6预测DFU患者预后不良的价值。采用Spearman相关分析法分析DFU患者血清Hsa_circ_0057362表达水平与感染分级和Wagner分级的相关性。结果DFU组和T2DM组血清PCT、IL-6及Hsa_circ_0057362水平均明显高于对照组,且DFU组高于T2DM组(P<0.05)。预后不良组DFU病程、Wagner分级、血肌酐、尿酸、PCT、IL-6及Hsa_circ_0057362水平均明显高于预后良好组(P<0.05)。3~4级感染DFU患者血清Hsa_circ_0057362表达水平明显高于1~2级(分别为4.36±2.08和3.25±1.57,P<0.001)。随着Wagner分级增加,DFU患者Hsa_circ_0057362表达水平逐渐升高(4~5级为4.95±2.37,2~3级为3.56±1.79,1级为2.70±0.95,P<0.001)。多因素logistic回归分析结果显示,PCT(OR=2.793,95%CI 1.966~7.104)、IL-6(OR=2.376,95%CI 1.584~5.710)及Hsa_circ_0057362(OR=3.106,95%CI 2.624~10.248)水平升高是DFU患者预后不良的影响因素(P<0.05)。ROC曲线显示,Hsa_circ_0057362≥3.80预测DFU患者预后不良的AUC最大(0.891,95%CI 0.828~0.953),灵敏度为88.4%,特异度为86.2%。Spearman相关分析结果显示,DFU患者血清Hsa_circ_0057362表达水平与Wagner分级呈正相关(r=0.782,P<0.001)。结论Hsa_circ_0057362在DFU患者中呈高表达,其水平升高与病情严重程度及预后不良有关,是预测DFU患者预后不良的有用指标。

Objective To investigate the expression of serum Hsa_circ_0057362 in patients with diabetic foot ulcer(DFU)and its value in predicting the severity and prognosis.Methods This study was a case-control study.A total of 116 patients with DFU admitted to the Third People′s Hospital of Hainan Province from January 2020 to March 2023 were retrospectively selected as the DFU group,90 patients with simple type 2 diabetes mellitus(T2DM)admitted to our hospital during the same period were selected as the T2DM group,and 60 normal people who came to our hospital for physical examination during the same period were selected as the control group.According to Wagner′s grading standard,116 patients with DFU were divided into 25 cases of grade 1,54 cases of grade 2-3,and 37 cases of grade 4-5.According to the severity of DFU infection,55 cases were classified as 1-2 levels(no or mild infection),and 61 cases as 3-4 levels(moderate to severe infection).According to the prognosis of DFU patients,they were divided into a good prognosis group(68 cases)and a poor prognosis group(48 cases).Real-time fluorescent polymerase chain reaction was used to detect Hsa_circ_0057362 levels,chemiluminescence immunoassay was used to detect procalcitonin(PCT)levels,and enzyme-linked immunosorbent assay was used to detect serum interleukin-6(IL-6)levels.The levels of serum IL-6,CRP and Hsa_circ_0057362 in each group were compared by ANOVA,SNK-q test and t test.Binary logistic regression was used to analyze the risk factors for poor prognosis in patients with DFU.Receiver operating characteristic(ROC)curve was drawn to analyze the value of Hsa_circ_0057362,CRP and IL-6 in predicting poor prognosis of DFU patients.Spearman correlation was used to analyze the correlation between serum Hsa_circ_0057362 expression level and infection grade and Wagner grade in DFU patients.Results The serum PCT,IL-6 and Hsa_circ_0057362 levels in DFU and T2DM groups were significantly higher than those in control group,and those in DFU group were higher than those in T2DM group(P<0.05).The DFU course,Wagner grade,serum creatinine,uric acid,PCT,IL-6 and Hsa_circ_0057362 levels in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).The serum Hsa_circ_0057362 expression level in patients with DFU infection of grade 3-4(4.36±2.08 vs.3.25±1.57)was significantly higher than that of grade 1-2(P<0.001).The expression level of Hsa_circ_0057362 in DFU patients increased with the increase of Wagner grade(grade 4-5 was 4.95±2.37,grade 2-3 was 3.56±1.79,grade 1 was 2.70±0.95,P<0.001).Multivariate Logistic regression analysis showed that the duration of PCT(OR=2.793,95%CI 1.966-7.104),IL-6(OR=2.376,95%CI 1.584-5.710)and Hsa_circ_0057362(OR=3.106,95%CI 2.624-10.248)high level was a risk factor for poor prognosis in DFU patients(P<0.05).ROC curve showed that Hsa_circ_0057362≥3.80 had the highest AUC(0.891,95%CI 0.828-0.953)in predicting poor prognosis in DFU patients,sensitivity was 88.4%,specificity was 86.2%.Spearman correlation analysis showed that serum Hsa_circ_0057362 expression level of DFU patients was positively correlated with Wagner grade(r=0.782,P<0.001).Conclusion Hsa_circ_0057362 is highly expressed in patients with DFU,and its elevated level is associated with disease severity and poor prognosis,making it a useful index for predicting poor prognosis in patients with DFU.