2型糖尿病伴骨关节炎患者血清VEGF、FGF2、CTGF、TGF-β水平变化意义及临床实用价值

发布时间：2018-05-03 06:24

本文选题：糖尿病 + 骨关节炎　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探究一般资料及生化指标在2型糖尿病伴骨关节炎(膝关节)发生、发展的作用及相关性,为糖尿病骨关节炎的临床诊断与治疗提供理论依据。[方法]收集2014年10月至2016年12月在昆明医科大学内分泌二科、运动医学科就诊及体检中心体检的580例病例,其中2型糖尿病200例(DM组),骨关节炎97例(OA组),2型糖尿病合并骨关节炎83例(DM合并OA组)及正常对照组(Normal control group,NC组)200例的一般临床资料(年龄、性别、BMI、SBP、DBP)并检测其生化指标(FPG、空腹C肽、空腹胰岛素(Fasting insulin,FINS)、HbA1c、TC、TG、LDL-C、HDL-C、Ca2+),计算 HOMA-IR、HOMA-β。采用SPSS22.0统计软件对上述研究对象相关指标的数据进行统计学分析,比较四组间各指标差异性,并分析上述指标在不同疾病患者血清中的差异及意义。[结果](1)NC组、DM组、OA组、DM合并OA组四组间两两比较年龄、性别均无统计学差异(P值0.05)。(2)DM组和NC组在BMI、SBP、DBP、FPG、空腹C肽、空腹胰岛素、糖化血红蛋白、Ca2+、HOMA-IR、HOMA-β均有统计学差异(P值0.05),在TC、HDL-C无统计学意义(P值0.05)。(3)OA组与NC组在BMI、Ca2+、HOMA-β均有统计学差异(P值0.05),在SBP、DBP、空腹胰岛素、TC、TG、LDL-C、HDL-C、HOMA-IR 无统计学差异(P 值0.05)。(4)DM合并OA组与NC组在BMI、SBP、DBP、FPG、空腹C肽、空腹胰岛素、糖化血红蛋白、TG、LDL-C、HDL-C、Ca2+、HOMA-IR、HOMA-β均有统计学差异(P值0.05),在TC无统计学差异(P值0.05)。(5)DM组与OA组在BMI、FPG、空腹C肽、糖化血红蛋白、TC、TG、LDL-C、Ca2+、HOMA-IR、HOMA-β均有统计学差异(P值0.05),在SBP、DBP无统计学差异(P值0.05)。(6)DM合并OA组与DM组在BMI、空腹胰岛素、糖化血红蛋白、LDL-C、Ca2+、HOMA-IR、HOMA-β均有统计学差异(P值0.05),在DBP、SBP、FPG、空腹C肽、TC、TG、HDL-C无统计学差异(P值0.05)。(7)DM合并OA组与OA组在BMI、FPG、空腹C肽、空腹胰岛素、糖化血红蛋白、TC、TG、LDL-C、Ca2+、HOMA-IR、HOMA-β均有统计学差异(P值0.05),在SBP、DBP、HDL-C无统计学差异(P值0.05)。(8)Logistic回归分析结果提示:糖化血红蛋白、BMI、HOMA-IR可能是糖尿病患者OA发生的危险易感因素;空腹C肽、Ca2+则可能是糖尿病患者OA发生的保护性因素。[结论]DM合并OA组糖、脂、Ca2+代谢紊乱及胰岛素抵抗水平最严重,血压及BMI升高水平也最明显;糖化血红蛋白、BMI、HOMA-IR可能为糖尿病患者发生0A的危险因素;空腹C肽、Ca2+则可能为保护性因素,提示血糖控制达标、减轻体重及补充钙剂可能延缓或阻止DM患者OA发生,可为糖尿病骨关节炎的预防和治疗提供新的思路。[目的]探究血管内皮生长因子(Vascular endothelial growth factor,VEGF)、成纤维细胞生长因子2(Fibroblast growth factor 2,FGF2)、结缔组织生长因子(Connective tissue growth factor,CTGF)、转化生长因子-β(Transforming growth factor-beta,TGF-β)在2型糖尿病伴骨关节炎发生、发展中的作用及相关性,为糖尿病骨关节炎的临床诊断与治疗提供理论依据。[方法](1)收集2014年10月至2016年12月在昆明医科大学内分泌二科、运动医学科就诊的380例病例,其中200例2型糖尿病(DM组),97例骨关节炎(OA组),83例2型糖尿病合并骨关节炎(DM合并OA组)及体检中心体检的200例正常健康对照组(Normal control group,NC组)的空腹血2-3ml。(2)采用ELISA方法检测血清中血管生成因子(VEGF、FGF2、CTGF、TGF-β)水平。(3)应用SPSS22.0统计软件对上述研究对象相关指标进行统计学分析,比较四组间各指标差异性及血管生成因子(VEGF、FGF2、CTGF、TGF-β)浓度,分析上述因子在不同疾病患者血清中浓度的差异。[结果](1)2型糖尿病组、骨关节炎组、2型糖尿病合并骨关节炎组血清VEGF、FGF2、CTGF、TGF-β检测水平均较正常对照组升高,且2型糖尿病合并骨关节炎组比2型糖尿病组和骨关节炎组升高更明显(P0.01)。(2)Pearson相关性分析结果提示:VEGF、FGF2、CTGF、TGF-β均与年龄、空腹血糖及糖化血红蛋白呈正相关关系(P0.05),其余指标与4种血管生成因子则均无相关性。(3)Logistic 回归分析示:VEGF(OR=1.263)、FGF2(OR=1.105)、CTGF(OR=1.327)、TGF-β(OR=1.212)为糖尿病患者OA发生的危险因素。(4)VEGF、FGF2、CTGF、TGF-β的ROC曲线面积分别为为0.811、0.865、0.736、0.795,对糖尿病合并骨关节炎诊断准确性均属中等。[结论]2型糖尿病合并骨关节炎组血清VEGF、FGF2、CTGF、TGF-β 4种血管生成因子高表达共同参与糖尿病骨关节炎的发生、发展,有望通过阻断或抑制其生成预防或治疗糖尿病骨关节炎。单纯通过检测某一种因子的浓度作为OA早期诊断的指标其灵敏度和特异度还有待进一步研究。
[Abstract]:[Objective] to explore the role and correlation of general data and biochemical indexes in the development of type 2 diabetes with osteoarthritis (knee joint), and to provide a theoretical basis for the clinical diagnosis and treatment of diabetic osteoarthritis. [Methods] to collect the two Department of Endocrinology and the medical examination center of the sports medicine department from October 2014 to December 2016 in Kunming Medical University. 580 cases of physical examination, including 200 cases of type 2 diabetes (group DM), 97 cases of osteoarthritis (group OA), 83 cases of type 2 diabetes with osteoarthritis (DM combined with OA group) and 200 cases of normal control group (Normal control group, NC) and 200 cases of general clinical data (age, sex, BMI, SBP, DBP) and their biochemical indexes (FPG, fasting peptide, fasting insulin) Lin, FINS), HbA1c, TC, TG, LDL-C, HDL-C, Ca2+), calculate HOMA-IR, HOMA- beta. Use SPSS22.0 statistical software to analyze the data related to the above objects, compare the differences between the four groups, and analyze the difference and significance of the above indexes in the sera of the patients with different diseases. There was no statistical difference in sex between the four groups (P value 0.05). (2) there were statistical differences between group DM and NC in BMI, SBP, DBP, FPG, fasting C peptide, fasting insulin, glycosylated hemoglobin, Ca2+, HOMA-IR, HOMA- beta (P value 0.05). (3) there were statistical differences (3) Value 0.05), there were no statistical differences in SBP, DBP, fasting insulin, TC, TG, LDL-C, HDL-C, HOMA-IR (P value 0.05). (4) DM combined OA group and NC group in BMI, fasting insulin, glycosylated hemoglobin, there were no statistical differences (0.05). (5) (5) group and group In BMI, FPG, fasting C peptide, glycosylated hemoglobin, TC, TG, LDL-C, Ca2+, HOMA-IR, HOMA- beta, there were statistical differences (P value 0.05), and there were no statistical differences in SBP (6). There was no statistical difference in HDL-C (P value 0.05). (7) there were statistical differences between OA group and OA group in BMI, FPG, fasting C peptide, fasting insulin, glycosylated hemoglobin, TC, TG, LDL-C, Ca2+, and there was no statistical difference (8). (8) regression analysis suggested that glycosylated hemoglobin It is a risk factor for the occurrence of OA in diabetic patients; fasting C peptide and Ca2+ may be a protective factor for the occurrence of OA in diabetic patients. [conclusion]DM combined with group OA, glucose, lipid, Ca2+ metabolism and insulin resistance is the most serious, and the level of blood pressure and BMI increase is also most obvious; glycosylated hemoglobin, BMI, HOMA-IR may be the 0A of diabetic patients. Risk factors, fasting C peptide and Ca2+ may be protective factors, suggesting that blood glucose control is reached, weight loss and calcium supplement may delay or prevent the occurrence of OA in DM patients, which can provide new ideas for the prevention and treatment of diabetic osteoarthritis. [Objective] explore the vascular endothelial growth factor (Vascular endothelial growth factor, VEGF) and fibroblast Cell growth factor 2 (Fibroblast growth factor 2, FGF2), connective tissue growth factor (Connective tissue growth factor, CTGF), transforming growth factor - beta (Transforming growth factor-beta) in type 2 diabetes with osteoarthritis, development and relevance, for the clinical diagnosis and treatment of osteoarthritis of diabetes For the theoretical basis. [method] (1) to collect 380 cases of medical treatment in the Endocrinology Department of Kunming Medical University from October 2014 to December 2016, including 200 cases of type 2 diabetes (group DM), 97 cases of osteoarthritis (group OA), 83 cases of type 2 diabetes combined with osteoarthritis (DM combined with OA) and 200 normal healthy controls (Norm Al control group, NC group) 2-3ml. (2) using ELISA to detect the levels of serum angiogenic factors (VEGF, FGF2, CTGF, TGF- beta) in serum. (3) use SPSS22.0 statistical software to carry out statistical analysis on the related indexes of the above subjects, and compare the concentrations of angiogenic factors and angiogenic factors between the four groups. The difference in serum concentrations of these factors in patients with different diseases. [results] (1) the levels of VEGF, FGF2, CTGF and TGF- beta in the serum of type 2 diabetic group, type 2 diabetes and osteoarthritis group were higher than those in the normal control group, and the increase of type 2 diabetes combined with osteoarthritis was more obvious than that of the type 2 diabetes group and the osteoarthritis group (P0.01). (2) Pearson correlation analysis showed that VEGF, FGF2, CTGF, and TGF- beta were all positively related to age, fasting blood glucose and glycosylated hemoglobin (P0.05), and the other indexes were not correlated with the 4 kinds of angiogenic factors. (3) Logistic regression analysis showed that VEGF (OR= 1.263), FGF2 (OR=1.105), CTGF (CTGF) were diabetic patients. (4) the ROC curve area of VEGF, FGF2, CTGF, TGF- beta was 0.811,0.865,0.736,0.795, and the diagnostic accuracy of diabetes combined with osteoarthritis was moderate. [conclusion the high expression of serum VEGF, FGF2, CTGF, TGF- beta of the serum of type]2 diabetes combined with osteoarthritis group was involved in the onset of osteoarthritis of diabetes. It is expected that it is expected to prevent or treat diabetic osteoarthritis by blocking or inhibiting its formation. The sensitivity and specificity of a single factor only by detecting the concentration of a certain factor as an early diagnostic indicator of OA remains to be further studied.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R684.3

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