Correlation Between Albumin Globulin Ratio And Diabetes Mellitus Complicated With Lower Extremity Arterial Disease

BackgroudMore than 200 million people in the world suffer from Peripheral arterial disease(PAD),and the prevalence of PAD increases with age,which affects a considerable proportion of the elderly population.Peripheral arterial disease generally refers to a group of diseases with arterial stenosis and/or occlusion in other parts except coronary artery and aorta,and Lower extremity Arterial Disease(LEAD)is the most main and common type.Diabetic LEAD has three highs:high incidence rate,high disability rate and high mortality rate,but the current form shows three low diagnostic rate,treatment rate and awareness rate;It is urgent to strengthen the early screening of diabetic LEAD.Previous studies on Albumin globulin ratio(AGR)mainly focused on tumor,liver disease and other fields.In recent years,some studies have confirmed the predictive value of AGR in cardiovascular field,but there is no study on the relationship between AGR and LEAD.Therefore,this study designed a retrospective study to explore its relationship with coronary heart disease and its clinical application value.ObjectivesTo explore the correlation between albumin globulin ratio and diabetes mellitus complicated with LEAD,and we hope it can provide theoretical basis for clinical diagnosis and treatment of LEAD.Methods430 patients with type 2 diabetes who completed the Ankle-brachial index(ABI)examination in the endocrinology department of Southern Hospital of Southern Medical University from January 1,2019 to October 30,2021 were collected and divided into LEAD group and non-LEAD group according to ABI value.The LEAD group was further divided into mild arterial disease group and moderate to severe arterial disease group according to ABI detection value.Analyze the relationship between AGR and LEAD and its severity,and analyze the correlation between AGR and other clinical variables through Sperman rank correlation.The risk factors of LEAD were analyzed by binary logistic regression.According to the median of Albumin globulin ratio(AGR)(median=1.3),all patients and LEAD group were respectively divided into LOW_AGR group(AGR≤1.3)and HIGH_AGR group(AGR>1.3),To analyze the relationship between AGR and other diabetic complications.ResultsAccording to ABI value,all patients with type 2 diabetes were divided into LEAD group(ABI≤0.9)and non-LEAD group(ABI>0.9),and the AGR of LEAD group was significantly lower than that of non-LEAD group.The AGR in mild arterial disease group(0.71≤ABI≤0.9)and moderate to severe arterial disease group(ABI<0.71)was significantly lower than that in non-LEAD group(ABI>0.9)(all P<0.001).Spearman correlation analysis showed that AGR was negatively correlated with fibrinogen,neutrophils,platelets,C-reactive protein(CRP),leukocytes and globulin,and the correlation coefficients were-0.438,-0.359,-0.356,-0.418,-0.345 and-0.747,P<0.001)respectively,and was positively correlated with Albumin(r=0.749,P<0.001).The ROC curve shows that the area under the curve of AGR for predicting LEAD is 0.704(95%CI 0.650,0.758).WhenAGR=1.15,it is the best cutoff value for diagnosing LEAD,with sensitivity and specificity of 45.5%and 85.8%respectively.The ROC curve shows that the area under the curve of CRP/AGR for predicting LEAD is 0.753(95%CI 0.703,0.804).When CRP/AGR=4.35,it is the best cutoff value for diagnosing LEAD,with sensitivity and specificity of 61.9%and 79.1%respectively.AGR was still negatively correlated with LEAD(OR=0.166,95%CI 0.058,0.474).Diabetic nephropathy(70.1%vs 46.3),diabetic foot(72.4%vs 13.9%)and diabetic retinopathy(67.9%vs 55.4%)in the LEAD group were higher than those in the non-LEAD group,and the differences were statistically significant(P<0.05),showed by regression analysis after correcting the potential risk factors.Compared with the HIGH_AGR group,the LOW_AGR group in LEAD patients had significantly higher diabetic nephropathy(75.5%vs 55.6%,P<0.05)and diabetic foot(78.6%vs 55.6%,P<0.05).Conclusion1.Low level of AGR is an independent risk factor for LEAD in patients with type 2 diabetes;AGR combined with CRP has certain predictive value for LEAD;2.LEAD patients with Low level AGR are more likely to be complicated with diabetic foot and diabetic nephropathy.