糖尿病下肢血管病变患者血清MMP-9和TGF-β1表达意义研究

Significance of serum MMP-9 and TGF-β1 expression in patients with diabetic lower extremity angiopathy

目的 2型糖尿病(type 2 diabetes mellitus,T2DM)下肢血管病变(lower-extremity arterial disease,LEAD)是在T2DM基础上发生的下肢动脉粥样硬化,基质金属蛋白酶9(matrix metalloproteinase 9,MMP-9)和转化生长因子β1(transforming growth factor 1,TGF-β1)与动脉粥样硬化密切相关。本研究分析T2DM的LEAD患者血清中MMP-9和TGF-β1表达临床意义,为T2DM患者LEAD防治提供依据。方法选择2016-08-05-2018-03-30泰安市第四人民医院内分泌科收治的T2DM患者80例,根据下肢超声结果,分为无下肢血管病变(non-lower extremity arterial disease,NLEAD)组(42例)和LEAD组(38例),选择本院同期30名健康体验者纳入NC组,检测各组MMP-9和TGF-β1水平。结果 NLEAD组MMP-9水平为(81.23±10.63)ng/mL,LEAD组为(129.34±21.48)ng/mL,高于NC组的(52.32±9.31)ng/mL,F=2 083.023,P<0.001,且LEAD组高于NLEAD组,t=15.642,P=0.001。NLEAD组TGF-β1水平为(19.98±4.11)ng/mL,LEAD组为(32.65±7.48)ng/mL,高于NC组的(12.26±3.05)ng/mL,F=579.110,P<0.001,且LEAD组高于NLEAD组,t=7.453,P=0.002。多因素Logistic回归分析结果显示,空腹血糖(OR=2.105,95%CI为1.554～2.853,P<0.001)、收缩压(OR=1.312,95%CI为1.108～1.563,P=0.001)、MMP-9(OR=2.145,95%CI为1.471～3.286,P<0.001)、TGF-β1(OR=2.675,95%CI为1.436～4.982,P=0.002)和吸烟史(OR=1.468,95%CI为0.455～0.663,P<0.001)是T2DM合并LEAD的独立危险因素,而高密度脂蛋白胆固醇(OR=0.549,95%CI为0.455～0.662,P<0.001)是保护因素。结论血清MMP-9和TGF-β1表达水平与T2DM的LEAD有关联,两者均升高,共同促进T2DM患者LEAD的发生发展。

OBJECTIVE Lower extremity arterial disease(LEAD)inpatients with type 2 diabetes mellitus(T2DM is a lower extremity atherosclerosis based on T2DM.Matrix metalloproteinase-9(MMP-9)and transforming growth factorβ1(TGF-β1)are closely related to atherosclerosis.This study aims to analyze the clinical significance of MMP-9 and TGF-β1 expression in serum of patients with T2DM and to provide evidence for prevention and treatment of LEAD in patients with T2DM.METHODS A total of 80 cases with T2DM were collected in the Department of Endocrinology,the Fourth People’s Hospital of Taian City from August 5,2016 to March 30,2018.According to the results of lower limb ultrasound,80 inpatients were divided into NLEAD group(n=42)and LEAD group(n=38).Thirty healthy people were selected to be included in NC group in the same period.The level of MMP-9 and TGF-β1 in each group were detected.RESULTS The level of MMP-9 in the NLEAD group[(81.23±10.63)ng/ml]and the LEAD group[(129.34±21.48)ng/ml]were higher than that in the NC group[(52.32±9.31)ng/ml](F=2 083.023,P<0.001).And it in the LEAD group was higher than that of the NLEAD group(t=15.642,P=0.001).The level of TGF-β1 in the NLEAD group[(19.98±4.11)ng/ml]and the LEAD group[(32.65±7.48)ng/ml]were higher than that in the NC group[(12.26±3.05)ng/ml](F=579.110,P<0.001).And it in the LEAD group was higher than that of the NLEAD group(t=7.453,P=0.002).Multivariate Logistic regression analysis showed that fasting blood glucose(OR=2.105,95%CI was 1.554-2.853,P<0.001),systolic blood pressure(OR=1.312,95%CI was 1.108-1.563,P=0.001),MMP-9(OR=2.145,95%CI was 1.471-3.286,P<0.001),TGF-β1(OR=2.675,95%CI was 1.436-4.982,P=0.002)and smoking history(OR=1.468,95%CI was 0.455-0.663,P<0.001)were independent risk factors for LEAD in patients with T2DM,and high density lipoprotein cholesterol(OR=0.549,95%CI was 0.455-0.662,P<0.001)was the protective factor.CONCLUSION Serum levels of MMP-9 and TGF-β1 are associated with LEAD in patients with T2DM.Both of them increase,which promote the occurrence and development of LEAD.