The Relative Study Between Von Willebrand Factor, Platelet α-granule Membrance Protein 140 And Lower Extremity Vascular Disease Of Type 2 Diabetes

Objective: Diabetic lower extremity vascular disease is one of the macrovascular complications of diabetes.The prevalence of diabetic lower extremity vascular disease is higher than non-diabetic by 7-10 times. Many of them may have acral gangrene because of occlusion or narrow of blood vessels, leading to amputation. Researchs has shown that macrovascular disease is closely related to age, smoking, high blood pressure, hyperglycemia, dyslipidemia, hypercoagulable state,etc. In recent years,clinical studies have shown that there were vascular endothelial injury and platelet activation in patients of diabetic lower extremity vascular disease.The relationship between lower extremity vascular disease and Von Willebrand factor (vWF),plateletα-granule membrane protein 140 (GMP-140) need further study.vWF synthesis and secretion from endothelial cells and macrophages. The level of vWF in blood circulation is considered a sign of endothelial injury. GMP-140 is specific markers of platelet activation. GMP-140 can also reflect the degree of platelet activation. In this study, by observing the changes of GMP- 140 and vWF in patients with type 2 diabetes and vascular complications,we discuss the relationship between vWF, GMP-140 and the lower extremity vascular disease,to provide a theoretical basis for early diagnosis, early prevention and treatment.Methods: Select 90 cases was hospitalized in Hebei Medical University Second Hospital patients with type 2 diabetes (the diagnosis in line with the 1999 WHO diagnostic criteria) , of which 45 cases of male, female 45 cases, with an average age (57.43±9.61) years, mean diabetes duration (9.37±5.76) years. All patients detecting femoral artery, popliteal artery,anterior tibial artery,posterior tibial artery, dorsalis pedis artery by color Doppler.According to the lower extremity vascular disease diagnostic criteria①artery intima-media thickness≥1 mm.②endometrial non-thickness but enhanced echo③plaque (single-shot,multiple,diffuse)④narrow. Assessment of disease extent①lesions without were normal②only one nature of the disease were mild③two nature were moderate lesions④three or more nature were severe.According to the degree of lower extremity vascular disease will be divided into three groups, non-vessel disease group (A group, 30 cases), mild vascular disease group (B group, 30 cases), severe vascular disease group (C group , 30). All subjects were ruled out infection, smoking, acute metabolic disorders, liver and kidney disease, diabetic nephropathy (UAER≥20ug/min), diabetic retinopathy (dilation by the ophthalmologist for professional eye examination), heart failure, cancer , rheumatoid autoimmune diseases, use of drugs that impact on platelet function and blood pressure within two weeks. All subjects taken on morning fasting venous blood of elbow,.Collecting plasma preserved at -70℃. Measured plasma vWF, GMP-140 using ELISA method at the same time. Determination of systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (HDL-C),fib- rinogen (FIB).Record age, course of disease, waist,circum- ference, hip circumference and other indicators. The content of change in each group of plasma vWF, GMP-140 were analysis. The lower extremity vascular disease of type 2 diabetes risk factors were analysisThe data were deal with statistical software packages SPSS13.0. Data expressed using average addition and subtraction standard deviation ( ±s). Comparative analysis between the many groups using completely randomized design analysis of variance. Between the two groups were compared using two-sample t test. whether or not has vascular disease (no = 0, has = 1) for the variables. Disease risk factors for Logistic Regression Analysis. P <0.05 has statistically significant.Results: 1.A, B, C the content of three groups vWF and GMP-140 were significantly different (P <0.01)and followed by rising trend.2.A, B, C comparison with the three groups of sex, triglycerides, high-density lipoprotein cholesterol, diastolic blood pressure was non-significant (P > 0.05); B and C combined to one group , between two groups of triglycerides were significantly different (P <0.05). Group A and B, C compared , age, systolic blood pressure, glycated hemoglobin, total cholesterol were significantly different (P <0.01), B, C compared , age, systolic blood pressure, glycated hemoglobin, total cholesterol non-significant (P > 0.05).A, C compared, waist-hip ratio, fibrinogen, low-density lipoprotein cholesterol were significantly different (P <0.01), A and B , B and C compared,waist-hip ratio, fibrinogen, low - Density lipoprotein cholesterol were non-significant (P>0.05).3.whether or not has vascular disease (no = 0, has = 1) for the variables.Age, waist-hip ratio, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, fibrinogen, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, vWF, GMP-140 were analysis using Logistic regression. Age, waist-hip ratio, systolic blood pressure, total cholesterol, triglyceride, vWF, GMP-140 were to enter the regression equation ,were risk factors of diabetic lower extremity vascular disease.Conclusion: 1. Compared with patients without lower extremity vascular disease ,there was a significant endothelial injury and platelet activation in patients with lower extremity vascular disease of type 2 diabetes.The specific performance of it was the increasing of plasma content of vWF, GMP-140. Platelet activation and endothelial damage played an important role in the occurrence and development of type 2 diabetes lower extremity vascular disease.Plasma vWF and GMP-140 may be effective indicators to detect lower extremity vascular disease of type 2 diabetes.2.Age, waist-hip ratio, systolic blood pressure, total cholesterol, triglycerides, vWF, GMP-140 were risk factors of type 2 diabetes lower extremity vascular disease. It showed that a number of factors, such as abdominal obesity, high blood pressure, high cholesterol, age, injury of endothelial and platelet activation , promoted the occurrence and development lower extremity vascular disease of type 2 diabetes.3.Taking the combined therapy in early type 2 diabetes,including protection of endothelial function and anti-platelet activation, can effectively prevent and delay the development of lower extremity vascular diseasein.