| Type 2 diabetes mellitus (2TDM) is one of the diseases severely impacting human health, in which diabetic macroangiopathy plays an important role in the disability and death of 2TDM patients. Recent studies show that matrix metalloproteinase-9 (MMP-9) may be strongly associated with diabetes mellitus (DM) and its macroangiopathy, a common diabetic complication. As an indicator of inflammatory activity, C-reactive protein (CRP), significantly linked to atherosclerosis (AS) and it's progress, is of some clinical value in the initiation and development of 2TDM and its macroangiopathy.OBJECTIVE: To investigate the association of serum MMP-9 and CRP levels to lower extremity vascular disease in 2TDM.METHODS: Serum MMP-9 (by ELISA) and other clinical parameters, such as hs-CRP and HbA1c , FIB , TC , TG , FPG , ALB/Cr, were measured in normal controls (n=24) and 2TDM patients (n=80). Based on ultrasonic Doppler exam results, the 2TDM patients were divided into two groups (the DM group consisting of 24 patients without macroangiopathy of lower extremities and the macroangiopathy DM group consisting of 56 cases with lower extremity vascular diseases), and the latter group (n=56) was divided into three subgroups (the mild subgroup with mild angiopathy, the medium subgroup with more angiopathy, and the severe subgroup with severe angiopathy, respectively). The changes of serum MMP-9, hs-CRP and other parameters among the threegroups (normal controls, DM group and macroangiopathy DM group) and three subgroups were observed and compared. RESULTS:1. The prevalence and the cure rate of hypertention, diabetic nephropathy and diabetic retinopathy did not show significant difference between the DM group and the macroangiopathy DM group.2. The level of serum MMP-9 in macroangiopathy DM group (291.5 ± 127.6ng/ml) was significantly higher than that in the DM group (190.8 ± 107.4ng/ml, P < 0.01) and the normal controls ( 126.8 ± 54.5ng/ml, P < 0.01 ) . The serum MMP-9 levels between the latter two groups also showed large difference ( P < 0.05). The hs-CRP level in the macroangiopathy DM group(3.95±3.50mg/L) was higher than that in the DM group (2.09 ±2.35mg/L, P< 0.01 ) and the normal controls(1.24 ±0.93mg/L, P <0.01).3. Among the three subgroups, levels of serum MMP-9 and hs-CRP in severe subgroup (463.2±94.7 ng/ml, 9.45 ±1.10mg/L, respectively) were higher than those in the medium subgroup (328.2±91.7ng/ml, 4.56±3.50mg/L, P <0.01) and the mild subgroup (241.3 ±116.4ng/ml, 2.64±2.66mg/L, P <0.01) . Serum MMP-9 and hs-CRP levels between medium and mild subgroups also showed a statistical difference (P<0.05) .4. Serum MMP-9 level showed the positive correlation with CRP (r=0.397, P <0.01 ) in the 2TDM patients. The degree of macroangiopathy in lower extremity was positively correlated with age (r=0.423, P<0.01) , duration of the disease (r=0.294, P<0.01) , smoking (r=0.612, P<0.01) , FIB (r=0.263, P <0.05) ,CRP (r=0.416, P<0.01) , and serum MMP-9 (r=0.554, P<0.01) .CONCLUSIONS: 1. The serum levels of MMP-9 and CRP in 2TDM patients with or withoutlower extremity vascular disease were higher than that of the normal controls. And the MMP-9 and CRP levels may reflect vascular pathological changes in 2TDM patients to a certain extent.2. The level of serum MMP-9 was positively correlated with the level of CRP, indicating that chronic inflammation can increase the serum level of MMP-9.
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