胰岛素样生长因子1及体脂在2型糖尿病足及下肢血管病患者中的研究

发布时间：2018-04-19 21:52

本文选题：2型糖尿病 + 糖尿病足　；参考：《安徽医科大学》2015年硕士论文

【摘要】：2型糖尿病足病患者胰岛素生长因子1的研究目的:研究糖尿病足溃疡患者血清胰岛素样生长因子1(IGF-1)水平的变化及不同溃疡程度的皮肤组织中IGF-1的表达,及其对糖尿病足溃疡的影响。方法:选择2012.01-2014.06在解放军第306医院内分泌科住院的74例2型糖尿病足患者(糖尿病足组,年龄59.99岁±11.74岁,病程155.90月±84.44月,其中Wagner1-2级患者35例,Wagner3级患者28例,Wagner4级11例),及年龄/病程匹配的同期住院的81例无足病的2型糖尿病患者(糖尿病组,年龄63.02岁±9.51岁,病程131.12月±71.82月),检测患者血清IGF-1水平及临床生化指标,观察糖尿病足组IGF1水平改变情况,分析血清IGF-1水平对糖尿病足溃疡的影响。留取糖尿病足病患者足部难愈性溃疡的皮肤共15例,其中男性10例,女性5例,年龄60.23岁±5.31岁,糖尿病病程150.14月±54.62月,按wagner分级分为wagner2级5例,wagner3级5例,wagner4级5例。患者清创换药过程中,留取病变交界部分的皮肤。用组织学观察伤口皮肤成纤维细胞及新生血管,免疫组织化学观察其足部组织的IGF-1的表达。结果:糖尿病足组与糖尿病组比较,血清IGF-1水平显著降低(118.12ng/ml± 49.96ng/ml vs136.51ng/ml± 46.14ng/ml p=0.018)。糖尿病足组按Wagner分级,Wagner4级较Wagner1-2级患者的血清IGF-1水平显著降低(67.88ng/ml± 22.98ng/ml vs 139.23 ng/ml±52.43ng/ml p=0.000)。IGF-1在Wagner1-2级为139.23ng/ml± 52.43ng/ml,Wagner3级为109.82ng/ml± 39.06ng/ml,在Wagner4级为67.88ng/ml± 22.98ng/ml,3组间存在显著差异。Spearman相关分析显示糖尿病足组血清IGF-1水平与ABI呈正相关(r=0.251,P=0.039),与糖化血红蛋白(Hb A1c)呈负相关(r=-0.233,P=0.046)。回归分析提示糖尿病足组血清IGF-1与ABI(β=36.805,t=2.165,P=0.034)及糖化血红蛋白(Hb A1c)(β=-4.439,t=-2.051,P=0.044)之间均存在线性回归关系。HE染色结果显示,wagner4级患者溃疡皮肤中成纤维细胞及新生血管数量较wagner3级患者减少,wagner3级患者溃疡皮肤中成纤维细胞及新生血管数量较wagner2级患者减少。免疫组化结果提示,Wagner4级较wagner3级IGF-1积分光密度降低(32.44au±9.88au vs 53.10au±14.49au p=0.017p=0.017),Wagner3级较wagner2级IGF-1积分光密度降低(53.10au±14.49au vs86.48au±10.60au p=0.001)。结论:糖尿病足溃疡患者血清IGF-1降低,且IGF-1水平越低溃疡越重;IGF-1水平的降低的同时Hb A1c的升高及ABI的降低,可能对糖尿病足溃疡严重程度产生影响。同时糖尿病足患者足溃疡创面IGF-1表达随着溃疡程度加重而减少,提示IGF-1的表达下调可能参与了糖尿病足的发病。趾臂指数与体脂关系及其在在2型糖尿病下肢血管病变风险评估中作用的研究目的:通过分析2型糖尿病患者趾臂指数(TBI)与体脂之间的关系,了解体脂对2型糖尿病患者TBI的影响,探讨TBI及体脂在糖尿病下肢血管病风险评估中的意义。方法:选择收集踝肱指数(ABI)及TBI均正常范围的2型糖尿病患者123例,收集患者一般资料,临床生化指标,应用BCA-2A型人体成分分析仪定量测量身体不同部分的主要成分。将TBI按二分位数分为2组,TBI较高组:0.82≤TBI1.12,TBI较低组:0.6TBI0.82。将各组间身体成分进行比较,分析体脂成分与TBI之间的关系。结果:两组患者的2型糖尿病病程、糖化血红蛋白(Hb A1c)、空腹及餐后血糖、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、胰岛素抵抗指数均无明显差异,而TBI较低组与TBI较高组比较,卧位收缩压(133.53±15.35mm Hg vs 123.85±26.95 mm Hg,p=0.007),卧位血压差(61.40±15.49 mm Hg vs51.80±25.52 mm Hg,p=0.014),体脂百分比(29.09±6.10 vs 26.75±6.28,p=0.038),身体年龄(63.19±14.04岁vs 56.77±13.50岁,p=0.011),内脏脂肪/躯干肌肉(0.45±0.13 vs 0.40±0.13,p=0.045),上肢脂肪/上肢肌肉(0.45±0.13 vs 0.40±0.13,p=0.043),下肢脂肪/下肢肌肉(0.45±0.13 vs 0.40±0.13,p=0.038)升高。多元逐步回归分析提示身体年龄(β=-0.002,p=0.003)、立位压差(β=-0.002,p=0.013)、体脂百分比(β=-00.004 p=0.014)为TBI降低的独立危险因素。结论:我们的研究发现,在ABI正常的2型糖尿病患者中TBI越低,体脂含量越多,身体年龄及脉压差越大,体脂含量增多与身体年龄及脉压差增大均为TBI降低的独立风险因素。重视TBI及体脂检测,对于2型糖尿病患者下肢血管病变风险早发现及早干预有积极的作用。
[Abstract]:The study of insulin growth factor 1 in patients with type 2 diabetic foot disease: To study the changes of serum insulin like growth factor 1 (IGF-1) level and the expression of IGF-1 in the skin tissues of different levels of ulceration and its effect on diabetic foot ulcers in patients with diabetic foot ulcers. Methods: to select 2012.01-2014.06 in the endocrinology of PLA 306th hospital. 74 cases of type 2 diabetic foot patients (diabetic foot group, age 59.99 years old + 11.74 years old, 155.90 months of age 155.90 + 84.44 months, 35 cases of Wagner1-2, 28 cases, 11 Wagner4), and 81 patients with non foot disease in the same period of age / course of illness (diabetes group, age 63.02 years old, 9.51 years, course of illness) .12 month + 71.82 months), the level of serum IGF-1 and clinical biochemical indexes were detected and the changes of IGF1 level in diabetic foot group were observed and the effects of serum IGF-1 level on diabetic foot ulcers were analyzed. There were 15 cases of foot refractory ulcer in diabetic foot disease patients, including 10 cases of male, 5 women, 60.23 years old and 5.31 years of diabetes. From 150.14 months to 54.62 months, 5 cases of wagner2 grade, 5 cases of wagner3 grade and 5 cases of wagner4 grade were divided according to the grade of Wagner. The skin of the junctional part of the lesion was retained during the debridement and change of the debridement. The expression of IGF-1 in the foot tissue was observed by histology and immunohistochemistry. Results: diabetic foot group and sugar In the urine sickness group, the serum IGF-1 level was significantly lower (118.12ng/ml 49.96ng/ml vs136.51ng/ml + 46.14ng/ml p=0.018). The serum IGF-1 level of the diabetic foot group was significantly lower than that of the Wagner1-2 patients (67.88ng/ml + 22.98ng/ml 139.23). 52.43ng/ml, 109.82ng/ml + 39.06ng/ml and 67.88ng/ml + 22.98ng/ml at Wagner4 level, there were significant differences in.Spearman correlation between the 3 groups. The serum IGF-1 level in the diabetic foot group was positively correlated with ABI (r=0.251, P=0.039), and the regression analysis suggested diabetes. There was a linear regression relationship between IGF-1 and ABI (beta =36.805, t=2.165, P=0.034) and glycosylated hemoglobin (Hb A1c) (beta =-4.439, t=-2.051, P=0.044) in the foot group, which showed that the number of fibroblasts and neovascularization in the ulcer skin of the patients with wagner4 grade was less than that of those in the patients, and the fibroblasts in the ulcer skin were thinner. The number of cell and neovascularization was lower than that of wagner2. The results of immunohistochemistry showed that the light density of Wagner4 level was lower than that of wagner3 IGF-1 integral (32.44au 9.88au vs 53.10au + 14.49au p=0.017p=0.017), and Wagner3 level was lower than that of wagner2 class. Conclusion: diabetic foot ulcer The patients' serum IGF-1 decreased, and the lower the IGF-1 level, the heavier the ulcers, the increase of Hb A1c and the decrease of ABI, which may affect the severity of diabetic foot ulcers, and the IGF-1 expression in the foot ulcer of diabetic foot patients decreased with the aggravation of the ulcer degree, suggesting that the down regulation of IGF-1 expression may be involved in the sugar expression. The relationship between the toe arm index and body fat and its role in the risk assessment of lower extremity vascular lesions in type 2 diabetes. Objective: To investigate the relationship between the toe arm index (TBI) and body fat in type 2 diabetic patients, to understand the effect of body fat on TBI in type 2 diabetic patients and to explore the risk of TBI and body fat in diabetic lower extremity vascular disease. Methods: 123 cases of type 2 diabetic patients who collected the ankle brachial index (ABI) and the normal range of TBI were selected to collect the general data of the patients, the clinical biochemical indexes and the quantitative measurement of the main components of different parts of the body by using the BCA-2A body component analyzer. The TBI was divided into 2 groups according to the two digits, and the higher TBI group: 0.82 < TBI1.12, TBI compared. Low group: 0.6TBI0.82. compared body composition in each group and analyzed the relationship between body fat composition and TBI. Results: two groups of patients with type 2 diabetes, glycosylated hemoglobin (Hb A1c), fasting and postprandial blood glucose, cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and insulin resistance index were not obvious The difference was found in the lower TBI group and the higher TBI group, and the supine systolic pressure (133.53 + 15.35mm Hg vs 123.85 + 26.95 mm Hg, p=0.007), the poor blood pressure (61.40 + 15.49 mm Hg vs51.80 25.52 mm), the percentage of body fat (29.09 + 6.10 26.75 + 6.28,), body age (63.19 + 14.04 years, 56.77 + 26.95), visceral fat / Trunk muscles (0.45 + 0.13 vs 0.40 + 0.13, p=0.045), upper limb fat / upper limb muscles (0.45 + 0.13 vs 0.40 + 0.13, p=0.043), lower limbs fat / lower limb muscles (0.45 + 0.13 vs 0.40 + 0.13, p=0.038). Multivariate stepwise regression analysis suggested that the body age (beta =-0.002, p= 0.003), orthostatic pressure (beta =-0.002, p=0.013), body fat percentage (beta =-00.004 p=0.0) 14) independent risk factors for TBI reduction. Conclusion: our study found that the lower the TBI in patients with type 2 diabetes, the lower the TBI, the more the body fat content, the greater the body age and pulse pressure, the increase of body fat and the increase of the body age and pulse pressure are the independent risk factors for the decrease of TBI. The value of TBI and body fat detection, for type 2 diabetes patients, is emphasized. Early detection and early intervention have a positive effect on the risk of lower limb vascular disease.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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