Changes And Significance Of OPN And SVCAM-1 Levels In Patients With Type 2 Diabetes Mellitus With Peripheral Arterial Disease Before And After Interventional Therapy

Objective: By measuring the plasma levels of osteopontin?OPN?and soluble vascular cell adhesion molecule-1?s VCAM-1?in patients with type 2 diabetes mellitus?T2DM?complicated with peripheral arterial disease?PAD?,T2 DM patients and healthy people,and the changes of their concentration before and after lower extremity arteriography,balloon dilatation or stent implantation in patients with T2 DM with PAD,to explore its significance in the process of PAD and restenosis after intervention,and to provide a theoretical basis for the clinical prevention and treatment of PAD and restenosis after surgery.Methods: Selected 27 patients who were hospitalized in endocrinology department of our hospital from June 2015 to December 2016 and were diagnosed with T2 DM with PAD and successfully underwent lower extremity arterial angiography,balloon dilatation or stent implantation as the study group?group PTA?,and another 27 patients who were hospitalized in our hospital and who had been diagnosed as T2 DM in the same period as simple diabetes group?group T2DM?,the diagnosis can be excluded from diabetes complications and related diseases,in addition,27 outpatients were selected as control group?group Control?at the same time.We drew 4ml venous blood?venous blood before intervention?from cubital vein of all three group who were under supine position and fasting conditions,to test the levels of fasting blood glucose?FBG?,glycosylated hemoglobin?Hb A1c?,cholesterol?TC?,triglyceride?TG?,high-density lipoprotein cholesterol?HDL-C?,lowdensity lipoprotein cholesterol?LDL-C?,OPN and s VCAM-1.And also ABI and TcPO₂ were measured before and after intervention in group PTA.During the interventional treatment in group PTA,After the arterial sheath was placed successfully,4 ml of arterial blood?arterial blood before intervention?was drawn,when guide wire,catheter smoothly through the narrow or occlusion arterial segment,4 ml arterial blood?ischemic area prior-interventional arterial blood?was taken from the distal end of the lesion artery,after balloon dilatation or stent implantation,4 ml arterial blood?ischemic area post-interventional arterial blood?was taken in the same place.And then on the first day and the 14 th day after intervention,4ml venous blood?venous blood after intervention 1d,14d?were taken in the supine position from cubital vein.The levels of OPN and s VCAM-1 in the specimens were measured by enzyme-linked immunosorbent assay?ELISA?double antibody sandwich method,and operate strictly in accordance with the instructions.Use automatic biochemical analyzer to detect the general indicators.SPSS13.0 software was used for statistical analysis,with P <0.05 for the difference was considered statistically significant.Results:1 The comparison of FBG and Hb A1 c among groups:The levels of FBG,Hb A1 c in group PTA were respectively?8.97±1.45?mmol/L,?8.82±0.87?%,in group T2 DM were respectively?8.90±1.21?mmol/L,?8.76±0.89?%,and in group Control were respectively?5.28±0.30?mmol/L,?5.21±0.42?%.The levels of FBG and Hb A1 c in group PTA and group T2 DM were significantly higher than those in group Control?P<0.01?,but there was no significant difference between group PTA and group T2DM?P>0.05?;2 The comparison of blood lipid among groups:The levels of TC,TG,LDL-C,HDL-C in group PTA were respectively?5.49±0.55?mmol/L,?2.24±0.46?mmol/L,?3.74±0.46?mmol/L,?1.02±0.16?mmol/L;the lev-els of them in group T2 DM were respectively?5.11±0.63?mmol/L,?1.93±0.51?mmol/L,?3.43±0.51?mmol/L,?1.11±0.25?mmol/L;and in group Control were respectively?4.63±0.86?mmol/L,?1.53±0.45?mmol/L,?3.03± 0.45?mmol/L,?1.24±0.16?mmol/L.Compared with the control group,the levels of TC,TG and LDL-C in group PTA were significantly higher?P<0.01,P<0.01,P<0.01?,and the levels of HDL-C were significantly lower?P<0.01?;Compared with group Control,the levels of TC,TG and LDL-C in group T2 DM were significantly higher?P<0.05,P<0.01,P<0.01?,and the levels of HDL-C were significantly lower?P<0.05?;Compared with group T2 DM,the levels of TC,TG and LDL-C in group PTA were significantly higher?P<0.05,P<0.01,P<0.05?,and the levels of HDL-C were significantly lower?P<0.05?.The above differences were statistically significant.3 The comparison of ABI and TcPO₂:The levels of ABI and TcPO₂ in group PTA the day before intervention were respectively 0.61±0.08,?29.23±3.12?mm Hg,which the day after intervention were 0.88±0.10,?55.56±3.23?mm Hg.Both of them were higher than the levels before intervention?t=23.371,P<0.01;t=45.731,P<0.01?,the differences were statistically significant.4 The levels of OPN in plasma:The levels of OPN in venous blood of group PTA before intervention,group T2 DM and group Control were respectively?12.15±2.36?ng/ml,?6.79±2.03?ng/ml,?4.34±0.87?ng/ml,the OPN level in group PTA and group T2 DM were higher than that in group Control?P<0.01;P<0.01?,the level of OPN in group PTA was higher than that in group T2DM?P<0.01?;In group PTA,the levels of OPN in arterial blood before intervention,ischemic area prior-interventional arterial blood and ischemic area post-interventional arterial blood were respectively?12.73±2.56?ng/ml,?14.11±2.43?ng/ml,?16.15±2.28?ng/ml,the level of OPN in ischemic area prior-interventional arterial blood was higher than that before intervention?P<0.05;P<0.05?,and lower than that in ischemic area post-interventional arterial blood?P<0.05?;The levels of OPN in venous blood before intervention,1d and 14 d after intervention were respectively?12.15±2.36?ng/ml,?18.17±3.05?ng/ml,?22.31±3.42?ng/ml,compared with the level before intervention,the levels of 1d and 14 d after intervention were significantly higher?P<0.01;P<0.01?,the level of OPN in 14 d after intervention was higher than that in 1d after intervention?P<0.01?,the above differences were statistically significant.But there was no significant difference between venous blood and arterial blood about the levels of OPN before intervention?P>0.05?.5 The levels of s VCAM-1 in plasma: The levels of s VCAM-1 in venous blood of group PTA before intervention,group T2 DM and group Control were respectively?56.44±7.42?ng/ml,?45.13±4.87?ng/ml,?27.39±5.94?ng/ml,the s VC AM-1 level in group PTA and group T2 DM were higher than that in group Control?P<0.01;P<0.01?,the level of s VCAM-1 in group PTA was higher than that in group T2DM?P<0.01?;In group PTA,the levels of s VCAM-1 in arterial blood before intervention,ischemic area prior-interventional arterial blood and ischemic area post-interventional arterial blood were respectively?60.24±6.35?ng/ml,?72.08±6.49?ng/ml,?85.58±7.63?ng/ml,the level of s VCAM-1 in ischemic area prior-interventional arterial blood was higher than that before intervention?P<0.01;P<0.01?,and lower than that in ischemic area post-interventional arterial blood?P<0.01?;The levels of s VCAM-1 in venous blood before intervention,1d and 14 d after intervention were respectively?56.44±7.42?ng/ml,?123.11±18.21?ng/ml,?292.45±20.05?ng/ml,compared with the level before intervention,the levels of 1d and 14 d after intervention were significantly higher?P<0.01;P<0.01?,the level of s VCAM-1 in 14 d after intervention was higher than that in 1d after intervention?P<0.01?,the above differences were statistically significant.But there was no significant difference between venous blood and arterial blood about the levels of s VCAM-1 before intervention?P>0.05?.6 The correlation between OPN and s VCAM-1:We used liner correlation analysis to explore the correlation between the levels of OPN and s VCAM-1 in the venous blood before intervention in group PTA.They were positively related?r=0.940,P<0.01?,the difference was statistically significant.Conclusions:1 There is severe dyslipidemia in patients with T2 DM and patients with T2 DM complicated with PAD;2 The levels of OPN and s VCAM-1 in plasma of T2 DM patients with PAD were significantly increased,suggesting that OPN and s VCAM-1 may play a role in the development and progression of PAD;3 The levels of OPN and s VCAM-1 in group PTA were significantly higher than that before intervention,which is one of the risk factors leading to restenosis after intervention,and which may provide a new idea for inhibiting smooth muscle cell proliferation,migration and anti-inflammatory therapy.