| Objective: This study was to explore:①The relationship between theserum monocyte chemoattractant protein-1(MCP-1) levels and lower-extremity arterial disease (LEAD) in the patients with type2diabetes mellitus(T2DM). The changes and clinical value of serum levels of MCP-1beforeand after the intervention of LEAD in the patients with T2DM.Methods:20normal subjects served as the normal control group (NCgroup),8males and12females, mean age (64.55±6.38) years.40patients (24males and16females) with T2DM were selected from the Department ofEndocrinology in the Fourth Hospital of Hebei Medical University fromJanuary2012to January2013, all patients were in line with the provisions of1999WHO diagnostic criteria for diabetes, the40patients acted as the type2diabetic patients group (DM group), mean age (65.08±7.26) years. Accordingto the presence of lower-extremity arterial disease (LEAD), DM group can bedivided into:16cases (10males and6females, average age (66.06±6.50)years) as group without type2diabetic LEAD (DM1group);24cases (14males and10females, average age (65.04±8.13) years) as group with type2diabtic LEAD (DM2group). All patients in DM2group underwentlower-extremity arterial interventional surgery, according to the results ofintraoperative angiography, balloon dilatation was performed in13cases(balloon group) with knee arterial stenosis mainly, and stent implantation wasperformed in11cases (stent group) with stenosis of iliac artery or femoralartery, and or abvious plaques retraction after pure balloon dilatation. Allpeople in NC group fasted10hours later, the next morning5ml of elbowvenous blood was taken. All patients admitted to hospital after fasting for10hours, had5ml of elbow venous blood taken next morning.5ml of elbow venous blood was additionally taken from the patients in DM2group at theday before surgery and24hours after surgery. All venous blood wascentrifuged at a speed of3000r/min for8minutes, then the serum wasisolated, packed with EP tubes and stored in-70℃refrigerator beforemeasuring the MCP-1concentration and general biochemical index. Theserum MCP-1level was measured by using enzyme linked immunosorbentassay (ELISA), operating in strict accordance with the instructions. Thegeneral biochemical index was measured by using automatic biochemicalanalyzer. In addition, all patients (DM1and DM2) were determined ankle armindex (ABI) and percutaneous oxygen partial pressure (TcPO2) by the samedoctor on the following day when they were hospitalized, all patients in DM2group (balloon group and stent group) determined ABI and TcPO2at the daybefore surgery and24hours after surgery again.All statistic work was carried out with software of SPSS13.0. Theenumeration data was shown by rate. The measurement data was shown by(mean±SD). Statistical analysis between two groups was tested by T-test.Statistical analysis among more than two groups was performed by one wayanalysis of variance (one way-ANOVA). The analysis of rate between groupswas performed by chisquare test. Multiple linear regression analysis was usedto assess correlation among multiple factors. Risk factors utilised logisticregression analysis. Inspection standard: a=0.05, a vaule of P less than0.05was considered statistically significant.Results:(1) The difference was not statistically significant in sex, age,BMI, HDL, TC, TG and SBP among NC group, DM1group and DM2group(P>0.05).(2) T2DM course and LDL in DM2group was significantly higherthan that in DM1group, the difference was statistically significant (P<0.01orP <0.05). HbA1c and LDL in DM1and DM2group was significantly higherthan that in NC group, the difference was statistically significant (P<0.01).(3) ABI was1.08±0.13in DM1group and0.67±0.15in DM2group. ABI inDM1group was significantly higher than that in DM2group, the differencewas statistically significant (P<0.01).(4) TcPO2was (70.13±17.66) mmHg in DM1group and (35.80±14.24) mmHg in DM2group. TcPO2in DM1groupwas significantly higher than that in DM2group, the difference wasstatistically significant (P<0.01).(5) The serum MCP-1concentration was(45.22±5.91) pg/ml in NC group,(67.78±5.22) pg/ml in DM1group and(79.79±6.35) pg/ml in DM2group. MCP-1in DM1and DM2group wassignificantly higher than that in NC group, the difference was statisticallysignificant (P<0.01). MCP-1in DM2group was significantly higher than thatin DM1group, the difference was statistically significant (P<0.01).(6) At thesecond day after being hospitalized, one day before surgery and24hours aftersurgery, ABI was0.68±0.18,0.67±0.17,0.87±0.08in balloon group. ABI at24hours after surgery was significantly higher than that at the second day afterbeing hospitalized and one day before surgery, the difference was statisticallysignificant (P<0.01).(7) At the second day after being hospitalized, one daybefore surgery and24hours after surgery, ABI was0.63±0.09,0.61±0.11and0.83±0.08in stent group. ABI at24hours after surgery was significantlyhigher than that at the second day after being hospitalized and one day beforesurgery, the difference was statistically significant (P<0.01).(8) At the secondday after being hospitalized, one day before surgery and24hours after surgery,TcPO2was (37.85±18.97) mmHg,(38.46±16.70) mmHg and (61.15±16.52)mmHg in balloon group. TcPO2at24hours after surgery was significantlyhigher than that at the second day after being hospitalized and one day beforesurgery, the difference was statistically significant (P<0.01).(9) At he secondday after being hospitalized, one day before surgery and24hours after surgery,TcPO2was (33.36±4.78) mmHg,(32.82±5.47) mmHg and (59.00±17.27)mmHg in stent group. TcPO2at24hours after surgery was significantly higherthan that at the second day after being hospitalized and one day before surgery,the difference was statistically significant(P<0.01).(10) At the second dayafter being hospitalized, one day before surgery and24hours after surgery,MCP-1was (82.01±6.97) pg/ml,(81.57±6.95) pg/ml and (88.33±4.55) pg/mlin balloon group. MCP-1at24hours after surgery was higher than that at thesecond day after being hospitalized and one day before surgery, the difference was statistically significant (P<0.01or P<0.05).(11) At the second day afterbeing hospitalized, one day before surgery and24hours after surgery, MCP-1was (77.17±4.54) pg/ml,(77.22±4.12) pg/ml and (86.45±3.92) pg/ml in stentgroup. MCP-1at24hours after surgery was significantly higher than that atthe second day after being hospitalized and one day before surgery, thedifference was statistically significant (P<0.01).(12) The results of multiplelinear regression analysis of correlation among the influence factors of MCP-1showed that the serum concentration of MCP-1had correlation with T2DMcourse, HbA1c, ABI and TcPO2, their standardized coefficients were0.228,0.266,-0.318and-0.236, respectively, the difference was statisticallysignificant (P<0.01or P<0.05).(13) The results of Logistic regression analysisof risk factors for LEAD in patients with T2DM showed that the six variables(T2DM course, LDL, HbA1c, ABI, TcPO2and MCP-1) went into regressionequation. The regression coefficients of T2DM course, LDL, HbA1c andMCP-1were5.154,1.496,3.980and4.714, respectively, they were positive,the values of OR, respectively, were73.198,4.463,53.510and8.495, theywere all more than1. The regression coefficients of ABI and TcPO2were-2.467and-3.644, the values of OR were11.789and38.237, all differencehad statistical significance (P<0.05).Conclusions:(1) ABI and TcPO2in patients with type2diabetes mellitus,who also have lower-extremity arterial disease, is significantly lower than thatin patients with type2diabetes mellitus, but who do not have lower-extremityarterial disease, shows that ABI and TcPO2can be considered as one of goodmethods to diagnosis and observe the occurrence and development of lower--extremity arterial disease in patients with type2diabetes mellitus.(2) ABIand TcPO2after balloon dilatation and (or) stent implantation is all gettinghigher than that before balloon dilatation and (or) stent implantation,showsthat the curative efficacy of interventional therapy for lower-extremity arterialdisease is obvious.(3) The serum MCP-1level in patients with type2diabetesmellitus is obviously higher than that in healthy people, which shows thatMCP-1may be related with the occurrence and development of type2 diabetes mellitus.(4) The serum MCP-1level in patients with type2diabetesmellitus, who also have lower-extremity arterial disease, is higher than that inpatients with type2diabetes mellitus, but who do not have lower-extremityarterial disease, which suggests that MCP-1functions a lot in appearance andprogress of lower-extremity arterial disease.(5) In patients who haveundergone balloon dilatation and (or) stent implantation, the postoperativeserum MCP-1level is significantly higher than the preoperative serum MCP-1level, which shows that MCP-1may participate in the complications ofoperation, such as postoperative inflammation and restenosis. |
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