| ObjectiveTo Investigate the relationship of vascular cell adhesion molecule-1(VCAM-1),fibroblast growth factor2(FGF2) and other inflammatory cytokines with the occurrenceand prognosis of refractory diabetic foot (DF), and provide evidence for the earlyprevention and clinical treatment of DF..MethodsA total of145patients with diabetic foot (DF group),65patients with type2diabetes mellitus(T2DM) and non-foot ulcers (T2DM group) were enrolled for the basicclinical data, fasting blood were collected for the determinations of VCAM-1, FGF2,tumor necrosis factor-α (TNF-α), interleukin-6(IL-6), fasting blood glucose (FPG),2-hour postprandial blood glucose (2h-PG), glycated hemoglobin Alc (HbAlc), glycatedalbumin (GA-L), total cholesterol(TC), high density lipoprotein cholesterol (HDL-C),lipoprotein(a)[Lp(a)],C-reactive protein (CRP) and other indicators. DF group werefollowed for6to10months and their endpoint events were recorded. The results wereanalyzed statistically. According to Wagner grade, DF group was classified into WagnerⅢ(37cases),WagnerⅣ(92cases) and WagnerⅤ(16cases).Results1.Between DF group and T2DM groups, sex, body mass index (BMI), FPG,2h-PG,HbAlc and GA-L had no statistical significance (P>0.05). The levels of VCAM-1,FGF2, TNF-α, IL-6, CRP, FIB, WBC, NEUR, ESR, PLT, PT, APTT, TT, D-D, Lp(a),HCY, CR, CYSC, age and duration of T2DM in DF group were significantly higherthan those in T2DM group, RBC, HGB, TG, TC, HDL-C, apo A1, ALB, PA, TBA andALT were significantly lower(P <0.05,P <0.01). Multivariate Logistic regressionanalysis showed that VCAM-1, TNF-α, IL-6, FIB, ESRand NEUR were theindependent risk factors of diabetic foot while PA was the independent protectivefactor. 2. The levels of serum IL-6, CRP, FIB, WBC, PLT and D-D were incrementedwhile ALB and PA were decremented with Wagner classification. Age, levels of RBC,HGB, HDL-C and apo A1in Wagner Ⅴ group were significantly lower than those ofgrade Ⅲ and Ⅳ,and NEUR, APTT and ESR were significantly higher than those ofgrade Ⅲ and Ⅳ.The levels of FGF2, PT, HbA1c and GA-L in Wagner Ⅴ groupwere significantly higher than those in grade Ⅲ(P <0.05,P <0.01).3. Follow-up rate of DF group was95.17%(138/145).In the follow-up subgroups,DPN (χ2=7.312, P <0.05), Wagner classification (χ2=33.226, P <0.01) and numbness(χ2=10.659, P <0.01) had statistical significances, levels of FGF2, FIB, NEUR, CRPand Lp(a) in amputation group was higher than non-amputation group (P <0.05, P<0.01). DPN (OR=10.000，95%CI：1.168～85.594，P=0.036) was an independent riskfactor of diabetic foot amputation.Conclusions1. There is an expansion of inflammatory response in patients with diabetic foot,the elevated levels of serum VCAM-1, FGF2and other inflammatory cytokines play animportant role in the occurrence and development of diabetic foot. It could help to slowdown the disease progression of diabetic foot if we promptly monitoring bloodconcentrations of FIB and paying more attention to the anti-inflammatory therapy,especially selecting specific blockers against signaling pathways of inflammatorycytokines.2. The poor nutritional status and infection deteriorating of patients with diabeticfoot are both risk factors of the occurrence and worse development of diabetic foot. Totake the real-time monitoring of serum CRP, ESR levels and carry onpreventive professional treatment during the courses of diabetic foot, treated withanticoagulation therapy and proper nutrition support at the same time can helpimproving the prognosis and reducing amputation rates. |
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