可溶性选择素P及chemerin与2型糖尿病下肢动脉病变的相关性研究

发布时间：2018-02-15 11:49

本文关键词： 糖尿病下肢动脉病变 chemerin 可溶性选择素P　出处：《川北医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨2型糖尿病下肢动脉病变与可溶性选择素p及chemerin的相关性,为2型糖尿病下肢动脉病变发表机制提供一定依据。以血管彩超作为诊断下肢动脉病变的参考标准,初步探讨踝肱指数诊断2型糖尿病下肢动脉病变的截点值。方法：1.选择川北医学院附属医院2013年1月-2014年11月住院的2型糖尿病患者(诊断符合1999年WHO诊断标准)共90例,以多普勒超声结果为依据,将2型糖尿病组分为2型糖尿病无下肢血管病变组(NPAD组)30例和2型糖尿病伴下肢血管病变组(PAD组)60例,并对伴有下肢血管病变的糖尿病组按病变严重程度分为轻度、中度和重度三个亚组。同期选取我院体检中心健康体检者为健康对照组(健康组)共30例。2.所有受检者采空腹12小时后晨起静脉血,采用酶联免疫吸附法测定可溶性选择素P、chemerin含量,同时对研究对象进行一般资料得采集,测定踝肱指数及相关生化资料。结果：1.PAD、NPAD和健康组之间chemerin比较,健康组NPAD组PAD组,呈逐渐增加的趋势(P0.05)；PAD、NPAD和健康组之间选择素P比较,两两比较有统计差异NPAD组健康组(P0.05),PAD组NPAD组(P0.05)。PAD组和NPAD组的ABI比较分析结果提示PAD组ABI水平低于NPAD组,具有统计学意义(P0.05)。2.PAD组、NPAD组、健康组三组间两两比较,FPG、HbAlc、hs-CRP指标存在显著性差异,具有统计学差异(P0.05)。与健康组比较,PAD组和NPAD组总胆固醇水平显著升高,有统计意义(P0.05)。3.糖尿病下肢动脉病变各亚组之间HbAlc、年龄之间无统计学差异(P0.05)；组间可溶性选择素P比较： P3明显高于P2。和于P1,且具有统计学差异(P0.05),P1小于P2组间比较有统计学差异。组间| chemerin水平比较： P3明显高于P1,具有统计学差异；P3高于P2,但无统计学差异。4.以血管超声诊断PAD为参考标准,ROC分布曲线提示ABI用于糖尿病下肢动脉血管病变的截点值为0.95, ABI诊断PAD的特异性为90%,灵敏性为86.7%,ABI与chemerin、可溶性选择素P水平成负相关。5.直线相关分析显示,chemerin水平与TC、hs-CRP、病程、HbAlc成正相关；可溶性选择素P与病程、HbAlc、hs-CRP成正相关,Chemerin与可溶性选择素P成正相关。Logistic分析显示,糖尿病下肢动脉血管病变的独立危险因素有病程、hs-CRP、TC、可溶性选择素P、FPG。结论：1.chemerin与糖尿病下肢动脉病变可能有关,可能参与2型糖尿病下肢动脉病变发生发展。chemerin与可溶性选择素P在2型糖尿病下肢动脉病变中可能存在协同作用。2.本研究认为可溶性选择素P可能是2型糖尿病下肢动脉病变危险因素,并且可溶性选择素P可能与PAD严重程度密切相关。3.本研究得出ABI0.95为诊断下肢血管病变的截点值,该研究结果考虑可能受样本量太小因素影响。
[Abstract]:Objective: to investigate the correlation between lower extremity arterial lesions and soluble selectin p and chemerin in type 2 diabetes mellitus, and to provide a basis for the publication of lower extremity arterial lesions in type 2 diabetes mellitus. Methods 1. 90 patients with type 2 diabetes mellitus who were hospitalized in the affiliated Hospital of North Sichuan Medical College from January 2013 to November 2014 were selected. The diagnosis met the diagnostic criteria of 1999 WHO. Based on the results of Doppler ultrasound, type 2 diabetes mellitus group was divided into two groups: type 2 diabetes without lower extremity vascular lesion group (n = 30) and type 2 diabetes with lower extremity vascular disease group (n = 60). The diabetic patients with vascular disease of lower extremity were divided into mild and mild according to the severity of the lesion. Three subgroups of moderate and severe. 30 healthy persons were selected as healthy control group (healthy group). All the subjects were collected venous blood 12 hours after fasting. The content of soluble selectin was determined by enzyme-linked immunosorbent assay (Elisa). At the same time, the general data were collected, and the ankle brachial index and related biochemical data were measured. Results: 1. Chemerin was compared between NPAD group and healthy group, PAD group in healthy group. There was a statistical difference between P0.05 P0.05 pad and healthy group. The results of ABI comparison between NPAD group and NPAD group in NPAD group showed that ABI level in PAD group was lower than that in NPAD group, which had statistical significance P0.05. 2. Pad group was significantly lower than that of NPAD group, and there was no significant difference in ABI level between PAD group and healthy group (P 0.05. 2. Pad group), and the results showed that the ABI level in PAD group was significantly lower than that in NPAD group, and there was a significant difference between two groups (P 0.05, P 0.05, P 0.05, P 0.05, P < 0.05). There was significant difference in HbAlcs-CRP between the three groups in healthy group (P 0.05). The total cholesterol level in pad group and NPAD group was significantly higher than that in healthy group. There was no significant difference in HbAlc among the subgroups of diabetic lower extremity arterial lesion (P 0.05), but there was no significant difference in age (P 0.05). The soluble selectin P ratio between groups was significantly higher than that in P 2 and P 1, and there was statistical difference between P 0.05 P 1 and P 0 05 P 1 in P 0 05 P 1 and P 0 05 P 1 in P 0 05 P < P 0 05 P 1 in P 2 group. Statistical differences. Comparison of chemerin levels between groups: P3 was significantly higher than P1, P 3 was higher than P 2, but there was no statistical difference. 4. Using vascular ultrasound diagnosis of PAD as reference standard, ABI distribution curve suggested that ABI could be used in diabetic lower extremity artery. The cut-off point of vascular lesion was 0.95.The specificity of ABI in the diagnosis of PAD was 90, the sensitivity was 86.7 and the level of soluble selectin P was negatively correlated .5.The linear correlation analysis showed that the level of chemerin was positively correlated with PAD and HbAlc. There was a positive correlation between soluble selectin P and HbAlccs-CRP. Logistic analysis showed that Chemerin had positive correlation with soluble selectin P. The independent risk factors of diabetic lower extremity arteriopathy were the course of disease and the soluble selectin PfFPG.Conclusion 1. Chemerin may be associated with diabetic lower extremity arterial lesion. There may be synergistic effect between chemerin and soluble selectin P in type 2 diabetes mellitus. 2. This study suggests that soluble selectin P may be a type 2 diabetes mellitus. Risk factors for arterial lesions in lower extremities, And soluble selectin P may be closely related to the severity of PAD. In this study, we obtained that ABI0.95 is the cut-off point for the diagnosis of lower extremity vascular diseases. The results of this study may be affected by too small sample size.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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