The Relationship Between Blood Vessel Endothelium And Extremitas Inferior Vascular Disease In Type 2 Diabetes Mellitus Patients

Objective: The foundation of extremitas inferior vascular disease in type 2 diabetes mellitus(T2DM) is artherosclerosis(AS). At present, dysfunction of blood vessel endothelium is the earlier period manifestation of AS. Many researches show that, von Willebrand factor(vWF) and monocyte chemoattractant protein 1(MCP-1) are the markers of endothelium dysfunction. The aim of this study is to investigate the association between vWF, MCP-1and extremitas inferior vascular disease in type 2 diabetes mellitus and the correlation between vWF, MCP-1and various kinds of factors of extremitas inferior vascular disease in type 2 diabetes mellitus.Methods: 71 in-ward patients with T2DM hospitalized in the Second Hospital of Hebei Medicine University from January, 2007 to August, 2007. To examine both femoral artery, popliteal artery, arteria dorsalis pedis by color Doppler ultrasound. According to the degree of extremitas inferior vascular disease divide four group. There are 26 patients (A group) without extremitas inferior vascular disease, 16 males and 10 females, average aged 55.73±7.38 years old; There are 17 patients (B group) with light degree of extremitas inferior vascular disease, 10 males and 7 females, average aged 54.18±9.37 years old; There are 15 patients (C group) with midrange of extremitas inferior vascular disease, 9 males and 6 females, average aged 57.27±8.49 years old; There are 13 patients (D group) with critical degree of extremitas inferior vascular disease, 8 males and 5 females, average aged 58.92±5.74 years old. Normal control (N group) 30 men, 19 males and 11 females, average aged 54.67±7.5 years old. The diagnosis of T2DM accorded with the new diagnosis criteria of WHO in 1999. The determination of hematoplasma vWF, MCP-1 is based on ELISA. Compared the differences of the common conditions, blood lipid, blood pressure, intima-media thickness(IMT)of carotid artery, vWF,MCP-1 and so on in five groups and study the association between vWF, MCP-1and extremitas inferior vascular disease in type 2 diabetes mellitus.Result:1 There was no difference in age, sexuality, among five groups (p>0.05). Morbidity rate of hypertension, coronary artery disease, cerebral infarction was difference among A, B, C, D groups (p<0.05).2 Compared with N group Hematoplasma MCP-1and vWF level was higher in T2DM group(p<0.01). Compared with A group Hematoplasma MCP-1and vWF level was higher in T2DM with extremitas inferior vascular disease group(p<0.01). There was difference among B, C, D groups (p<0.01).3 Compared with N groups, TC, LDL was higher in A, B, C, D groups. Compared with A, B,C groups, TC, LDL was higher in D group(p<0.01), there was no difference among A,B, C groups(p>0.05). And was no difference in TG among A,B, C, D groups(p>0.05). But there was no difference in HDL among five groups(p>0.05).4 Compared with N groups, course of diabetes mellitus was longer in C and D groups(p<0.01). Compared with B groups, course of diabetes mellitus was longer in D group(p<0.01). There was no difference between C and D groups(p>0.05). But there was no difference in HbA1c among A, B, C, D groups(p>0.05).5 Compared with N group, body mass index(BMI), waist hip rate(WHR), HOMA-IR was higher in A, B, C, D groups (p<0.05). But there were no difference in BMI, WHR, HOMA-IR among A, B, C, D groups (p>0.05).6 There was no difference in IMT between B and C groups(p>0.05), but there were difference in IMT among rest groups(p<0.01). Compared with N, A groups, systolic blood pressure(SBP) was higher in B, C, D groups(p<0.01). Compared with N groups, SBP was higher in A group(p<0.01). But there was no difference in diastolic blood pressure(DBP) among five groups(p>0.05).7 Hematoplasma MCP-1 level was positively correlated with course of diabetes mellitus(r=0.367,p=0.02), IMT(r=0.701,p<0.001),TC(r=0.351,p=0.003),LDL(r=0.459, p<0.001), vWF(r=0.965,p<0.001), SBP(r=0.472,p<0.001), DBP (r=0.252,p=0.034). Hematoplasma vWF level was positively correlated with course of diabetes mellitus (r=0.356, p=0.002), IMT(r=0.699,p<0.001),TC(r=0.323,p=0.006),LDL(r=0.421,p<0.001),MCP-1(r=0.965,p<0.001),SBP(r=0.478,p<0.001),DBP(r=0.276,p=0.02). Correlation between hematoplasma MCP-1, vWF level and the other factor has not been found, such as age,BMI, WHR, HOMA-IR, TG, HDL, HBA1c. Score of extremitas inferior vascular was positively correlated with MCP-1(r=0.926,p<0.001), vWF(r=0.942,p<0.001).Conclusion: Hematoplasma MCP-1, vWF level, as the representative of blood vessel endothelium function, was obviously increased in T2DM and extremitas inferior vascular disease patients and was obviously increased as the aggravation of extremitas inferior vascular disease. With the degree of extremitas inferior vascular disease, Hematoplasma MCP-1, vWF level was significantly increased. With the hematoplasma MCP-1, vWF level increased other macrovascular complications such as hypertension, coronary heart disease, the incidence of cerebral infarction also significantly increased. Hematoplasma MCP-1, vWF level had a close correlation with course of diabetes mellitus, IMT, TC, LDL, SBP, DBP. Hematoplasma MCP-1, vWF as a sign of endothelial dysfunction in T2DM and extremitas inferior vascular disease complications maybe play a role of bridge in the complicated process of a pathophysiology. We clinical physicians can also take advantage of it to improve endothelial function , try to control the type 2 diabetes the progress of vascular complications and improve the quality of life in diabetes patients.