2型糖尿病足溃疡患者外周血miRNA-144表达及与病程发生发展的相关性

Expression of miRNA-144 in peripheral blood of patients with type 2 diabetes foot ulcer and its correlation with pathogenesis

目的探讨miRNA-144在2型糖尿病足溃疡(DFU)患者外周血中的表达及与病程发生发展的相关性。方法回顾性选取2020年3月至2022年6月中国人民解放军西部战区总医院收治的106例DFU患者作为观察组,另选取同期本院收治的未患有DFU的106例2型糖尿病(T2DM)患者作为对照组。根据DFU患者外周血miRNA-144表达水平的中位数作为分割点,将观察组的106例患者分为低表达组和高表达组。比较观察组和对照组的临床资料,分析不同miRNA-144表达水平与DFU患者临床特征的关系;对DFU患者病程发生发展的相关因素进行多因素分析并构建列线图模型进行模型验证。结果观察组糖尿病病程、空腹血糖(FPG)、红细胞沉降率(ESR)、糖化血红蛋白(HbA_(1c))、白细胞计数(WBC)、C反应蛋白(CRP)、促肾上腺皮质激素释放激素(CRH)、白细胞介素-6(IL-6)、肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)以及miRNA-144表达水平显著高于对照组,而经皮氧分压(TcPO_(2))、踝肱指数(ABI)、甘油三酯(TG)和血红蛋白(Hb)则显著低于对照组,差异均有统计学意义(均P<0.05)。miRNA-144高表达组DFU患者8周后溃疡愈合率、Wagner分级、溃疡病程与低表达组比较差异有统计学意义(均P<0.05)。多因素回归分析结果显示,糖尿病病程>5年、HbA_(1c)>8.5%、TcPO_(2)<60 mmHg、CRP>10 mg/L、Cor>190μg/L以及miRNA-144表达水平>35是T2DM患者发生DFU的独立危险因素,以上因素构建列线图预测模型后总分315分,对应DFU发生发展概率为72.56%。结论DFU患者外周血中miRNA-144表达水平与病程发生发展有显著相关性,且糖尿病病程以及HbA 1c、TcPO_(2)、CRP、Cor水平变化均为DFU发生发展的独立危险因素,临床应重点关注。

Objective To investigate the expression of miRNA-144 in the peripheral blood of patients with type 2 diabetes foot ulcer(DFU)and its correlation with the pathogenesis of the disease.Methods A total of 106 patients with DFU admitted to the General Hospital of the Western Theater Command of the Chinese People′s Liberation Army from March 2020 to June 2022 were retrospectively selected as the observation group,and 106 patients with type 2 diabetes mellitus(T2DM)who did not have DFU admitted to our hospital during the same period were selected as the control group.According to the median expression level of miRNA-144 in peripheral blood of DFU patients as the segmentation point,106 patients in the observation group were divided into low expression group and high expression group.We compared the clinical data of the observation group and the control group,and analyzed the relationship between different levels of miRNA-144 expression and clinical characteristics of DFU patients;A multivariate analysis was conducted on the factors related to the occurrence and development of the disease course in DFU patients,and a column chart model was constructed for model validation.Results The course of diabetes,fasting blood glucose(FPG),erythrocyte sedimentation rate(ESR),glycosylated hemoglobin(HbA_(1c)),white blood cell count(WBC),C-reactive protein(CRP),corticotropin releasing hormone(CRH),interleukin-6(IL-6),adrenaline(E),norepinephrine(NE),cortisol(Cor)and miRNA-144 expression levels in the observation group were significantly higher than those in the control group,while transcutaneous partial pressure of oxygen(TcPO_(2)),ankle brachial index(ABI),triglyceride(TG)and hemoglobin(Hb)were significantly lower than those in the control group,the difference was statistically significant(all P<0.05).There were statistically significant differences in foot ulcer healing rate,Wagner grading,and ulcer course between the high expression group of miRNA-144 and the low expression group of DFU patients after 8 weeks(all P<0.05).Multivariate regression analysis showed that the duration of diabetes>5 years,HbA_(1c)>8.5%,TcPO_(2)<60 mmHg,CRP>10 mg/L,Cor>190μg/L,and miRNA-144 expression level>35 were independent risk factors for the occurrence of DFU in T2DM patients.The total score of 315 points after constructing the nomogram prediction model for the above factors,and the corresponding probability of occurrence and development of DFU was 72.56%.Conclusions The expression level of miRNA-144 in the peripheral blood of DFU patients is significantly related to the occurrence and development of the disease course,and the course of diabetes and the changes of HbA 1c,TcPO_(2),CRP,Cor levels are independent risk factors for the occurrence and development of DFU,which should be focused on clinically.