糖尿病周围神经病变和血管病变对糖尿病足溃疡的相互作用及相关性探讨

目的 探讨糖尿病足溃疡（DFU）发生的危险因素,分析糖尿病周围神经病变（DPN）和糖尿病血管病变（PAD）与DFU的相互作用.方法 选取T2DM患者278例,按其是否合并DFU分成糖尿病足溃疡组（DFU,102例）和糖尿病非足溃疡组（NDFU,176例）,回顾性分析两组生化特征和并发症情况.采用Logistic回归分析DFU发生的危险因素,并通过相对超额危险度比（RERI）,归因比（AP）和相互作用指数（S）评价DPN与PAD的相加相互作用.结果 与NDFU组比较,DFU组HbA1c和纤维蛋白原（FIB）水平,DR、DPN和PAD发生率均升高,血红蛋白（Hb）、血白蛋白（Alb）、TC和LDL-C降低（P＜0.05）.Logistic回归分析显示,DFU相关影响因素有：HbA1 c、DPN、PAD、Hb、Alb和FIB（OR分别为1.41、3.66、3.00、0.98、0.79和2.51）.DPN和PAD对DFU的相加相互作用指标RERI、AP和S分别为3.45（95％CI：1.22～8.56）、0.29（95％CI：0.02～0.58）和1.45（95％CI：1.03～4.96）.结论 血糖控制欠佳、合并DPN和PAD、营养不良及FIB代谢失衡是DFU发生的主要危险因素.DPN和PAD对DFU存在相加相互作用,同时患有DPN和PAD可增加DFU的患病风险.     

亚临床甲状腺功能减退与2型糖尿病慢性并发症的关系

目的 探讨亚临床甲状腺功能减退 （SCH）与T2DM慢性并发症的关系。 方法 将1294例T2DM患者分为SCH组和甲状腺功能正常组,比较两组间慢性并发症患病率及患者的甲状腺功能,采用Logistic多元回归分析SCH与糖尿病慢性并发症的关系。 结果18.8%的T2DM患者合并SCH。SCH组糖尿病慢性肾脏疾病（CKD）、DR、糖尿病周围神经病变（DPN）和糖尿病足病（DF）患病率均高于甲状腺功能正常组（P〈0.05）;CKD、DR和DPN患者FT3下降,促甲状腺激素（TSH）升高（P〈0.05）。Logistic多元回归分析显示,SCH为CKD的独立危险因素（OR=3.39,P=0.012）。 结论 T2DM合并SCH 患者CKD、DR、DPN和DF患病率升高。SCH是CKD的独立危险因素。     

Predictors of diabetes foot complications among patients with diabetes in Saudi Arabia

AimsTo identify risk factors and clinical biomarkers of prevalent diabetes foot complications, including foot ulcers, gangrene and amputations among patients with diabetes in Jeddah, Saudi Arabia.Methods598 diabetes patients from Jeddah participated in the current study. Patients were considered to have diabetes foot complications if they reported diagnosis of foot ulcers or gangrene or amputations in a questionnaire administered by a physician and confirmed by clinical exams. Information on socio-demographic and lifestyle variables was self-reported by patients, and several clinical markers were assessed following standard procedures.ResultsThe prevalence of diabetes foot complications in this population was 11.4%. In the multivariable model without adjustment for PAD (peripheral artery disease) and DPN (diabetes peripheral neuropathy), non-Saudi nationality, longer diabetes duration and insulin use was significantly associated with higher diabetes foot complications prevalence. Each 1 g/L increase of hemoglobin was associated with 2.8% lower prevalence of diabetes foot complications. In the multivariable model adjusting for PAD and DPN, the previously observed associations except for nationality were no longer significant. Patients with both DPN and PAD had 9.73 times the odds of diabetes foot complications compared to the patients with neither condition.ConclusionIn this population, longer diabetes duration, insulin use, lower hemoglobin levels and non-Saudi nationality were associated with higher prevalence of foot complications. These associations were largely explained by the presence of DPN and PAD except for non-Saudi nationality. Diabetes patients with both DPN and PAD had nearly 10-fold increased risk of foot complications than those with neither condition.     

中国部分省市糖尿病足调查及医学经济学分析

目的调查和分析2型糖尿病患者糖尿病足的分类分期和医疗费用。方法以统一的调查方法对全国11个省市、14家三级甲等医院2004年全年门诊和住院糖尿病足患者进行调查,包括病史回顾、体格检查、生化检查及医疗费用等,对足溃疡进行分类、分期和病因分析,以及采用踝肱动脉压比值确定下肢血管病变程度。结果共调查糖尿病足与周围血管病变患者634例。足病高发在年龄71~80岁、病程11~20年、文化程度初小及初中、月收入501~1500元的糖尿病患者。足病患者合并糖尿病并发症或相关病变依次为神经病变(68.0%)、高血压(57.4%)、视网膜病变(42.8%)、肾病(40.4%)、血脂异常(30.0%)、下肢动脉病变(28.7%)、冠心病(28.5%)、脑血管病(24.3%),吸烟率为38.8%。足溃疡诱因以物理因素(77.7%)为主。足溃疡和(或)坏疽患者中,溃疡以单发(57.3%)、Wagner1级和2级溃疡(63.2%)为主,合并坏疽者28.8%,部位多在足趾(88.0%),干性坏疽居多(49.1%)。足溃疡以混合型溃疡为主(60.4%),67.9%的溃疡合并感染。糖尿病足溃疡患者平均住院日数为26天,住院总费用为14906元。206例糖尿病足患者的主要费用的分布为药品费7661元、检查费2567元、治疗费1548元、处置-换药费771元。结论糖尿病足患者多为高龄、文化程度低、收入低者;多已合并大血管及微血管病并发症。足溃疡中单发、表浅及缺血溃疡多见,合并感染率高;医疗花费大,以药品花费最多。     

Albuminuric diabetic kidney disease predicts foot ulcers in type 2 diabetes

Diabetic Foot Ulcers (DFU) are feared among individuals with diabetic kidney disease (DKD), but it is unclear whether they are more frequent, especially in normoalbuminuric DKD.Five hundred and twenty patients admitted in our diabetology ward from 2007 to 2017 were followed up during 54 ± 26 months. New DFUs were registered, and their relationship with the initial renal status was analyzed by LogRank and multivariate Cox regression analysis.The 520 subjects were mainly men (57.9 %), 62 ± 9 years old, with a duration of diabetes of 14 ± 10 years, HbA1c: 8.7 ± 1.8 % (72 ± 19 mmol/mol), and complications: 33.7 % macroangiopathies, 22.1 % previous foot ulcers, 44.8 % DKD, 26.9 % retinopathies. Fifty-seven new DFU occurred, mainly in subjects with DKD. DKD was related to later DFU (HR: 1.79; 95%CI: 1.05–3.07), this relationship stayed significant adjusted for age, gender, and a history of previous DFU (HR: 3.61; 95%CI: 2.11–6.18), and further adjusted for the duration of diabetes, HbA1c, BMI, arterial hypertension, and dyslipidemia. Among the 233 subjects with DKD, 129 (55.3 %) had an isolated AER > 30 mg/24H, 41 (17.6 %) had an isolated eGFR<60 mL/min/1.73 m², and 63 (27.0 %) cumulated both abnormalities. By Cox regression analysis adjusted for age and gender, albuminuric DKDs were related to later DFU: with eGFR≥60: HR: 1.91; 95%CI: 1.02–3.59, with eGFR<60: HR: 2.53; 95%CI: 1.25–5.10, whereas normoalbuminuric DKD was not: HR: 1.04; 95%CI: 0.35–3.07, despite similar rates of neuropathies, peripheral arterial diseases, and retinopathies.In people with type 2 diabetes, albuminuric DKD was associated with two to three folds increased risk of DFUs, whereas normoalbuminuric DKD was not.     

严重下肢动脉病变与糖尿病足的相关性研究

目的 调查住院病人糖尿病足(DF)和下肢动脉病变(PAD)的发病情,分析两者之间的相关性.方法 测定523例住院糖尿病病人空腹及餐后血糖、HbA_(1C)血脂分析和尿微量白蛋白浓度等.应用多普勒超声技术评估所有糖尿病住院病人PAD病情,检查股动脉、股浅动脉、胭动脉、胫前动脉、胫后动脉和腓动脉.根据检查结果分为3组:无病变组、轻度病变组(血管狭窄<50%)和重度病变组(血管狭窄≥50%).糖尿病足诊断按照Wagner标准.结果 在凶糖尿病住院523例病人中,DF 95例(18.2%).PAD 311例(59.5%),其中重度PAD 131例(25.0%).95例DF病人中重度PAD 55例(57.9%).Log9istic回归分析显示,严重PAD(OR=5.00)是DF的独立危险因素.其他危险因素包括吸烟、高血压和糖尿病神经病变.结论 严重PAD是DF最主要的危险因素.     

Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study

Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. Methods Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). Results After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. Conclusions/interpretation Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.     

The potential of transdermal nitric oxide treatment for diabetic peripheral neuropathy and diabetic foot ulcers

The Center for Disease Control (CDC) estimates that 29 million Americans have diabetes, and 70% of diabetic patients develop diabetic peripheral neuropathy [1,2]. Up to 27% of the direct medical cost of diabetes may be attributed to DPN [3]. A 2013 article from the American Diabetes Association reported a $176 billion direct medical cost of diabetes in 2012 [4]. DPN patients often suffer from shooting and burning pain in their distal limbs and a severe loss of sensation. Diabetic foot ulcers, infections, and amputations may follow. Currently available treatments: tricyclic antidepressants, anticonvulsants such as gabapentin and pregabalin, serotonin and norepinephrine reuptake inhibitor, duloxetine, topical 5% lidocaine (applied to the most painful area) can manage painful symptoms but do not address the underlying pathologies of DPN and diabetic wound ulcers. A combination of pain-reducing medications can provide relief when individual medications fail, and opioids such as tramadol and oxycodone may be administered with these medications to reduce pain [5]. Due to the prevalence of diabetes, DPN, and diabetic foot ulcers, and because of the lack of available effective treatments to directly address the pathology contributing to these conditions, novel treatments are being sought. Our hypothesis is that a deficiency of nitric oxide synthase in diabetic patients leads to a lack of vascularization of the peripheral nerves, which causes DPN; and this could be treated with vasodilators such as nitric oxide. In this paper, the mechanisms of DPN are reviewed and analyzed to elucidate the potential of a transdermal nitric oxide application for the treatment of DPN and diabetic wound ulcers by increasing vasodilation.     

The association of diabetic microvascular and macrovascular disease with cutaneous circulation in patients with type 2 diabetes mellitus

Aims

To study the impact of diabetic neuropathy, both peripheral sensorimotor (DPN) and cardiac autonomic neuropathy (CAN), on transcutaneous oxygen tension (TcPO₂) in patients with type 2 diabetes mellitus (T2DM).

Analysis of factors associated with extremity ulceration in diabetic subjects with peripheral neuropathy

Peripheral neuropathy is the main risk factor for foot ulceration in diabetic subjects. This study examined the association of peripheral arterial disease (PAD) with foot ulceration in a sample of diabetic subjects with peripheral neuropathy, and also if inflammatory markers would be associated with this event. We evaluated 32 type 2 diabetic individuals with abnormal 10-g monofilament exam, who were stratified in 2 groups according to history or presence of lower extremities ulcer. The group "with ulcer" (n = 18) included the ones that had active or cicatrized ulcer, or some lower-extremity amputation due to ulcer complications. In addition to the neurological examination and monofilament test, they were submitted to biothesiometry, lower extremity vascular assessment with Doppler, and laboratory determinations. No difference between the groups was found concerning sex distribution, mean age, and duration of diabetes diagnosis. The group with ulcer showed higher mean values of height (1.70 +/- 0.06 vs. 1.63 +/- 0.11 m, p = 0.044), vibration perception threshold measured in medial malleolli (40.9 +/- 13.0 vs. 30.6 +/-12.3 V, p = 0.040) than the group without ulcer. The groups did not differ regarding the mean values of the inflammatory markers. Response to patellae reflex was worse in the group with ulcer (p = 0.047), in which a higher proportion of individuals with abnormal toe-brachial index (p = 0.030) was observed as compared to those without ulcer. We concluded that PAD is associated with the presence of ulcer in neuropathic subjects. The assessment of digital arteries flow in lower limbs (in great toe) contributed to detect such association. Association of diabetic foot ulcers and inflammatory markers was not observed, but cannot be excluded due to limitations of sample size. Prospective studies should examine the sensitivity of the toe-brachial index to identify PAD in diabetic individual at risk of ulceration.     

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

Aims/hypothesis Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries. Methods The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD −, infection −; B: PAD −, infection +; C: PAD +, infection −; D: PAD +, infection +. Results PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity. Conclusions/interpretation According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.     

A health needs assessment of adults with diabetic foot disease in the US

IntroductionDiabetic foot disease has been considered as an important complication of diabetes mellitus. The main risk factor to cause diabetic foot disease is peripheral neuropathy. Diabetic foot disease usually started from diabetic foot ulceration, it would develop to diabetic foot infection and amputation even death when conducting the poor prognosis and management of diabetic foot ulceration. Despite this, incidence of diabetic foot disease is still increasing and is therefore potentially under-recognized, under-diagnosed and under-treated all over the word, especially in the US. The aim of this study is to clarify the needs of the adults at risk and health care providers in diagnosis and treatment of diabetic foot disease in the US.MethodsCochrane library, bibliographic databases, American Diabetes Association website and DFS questionnaire website have been used to search the relevant literature of diabetic foot disease among adults in the US. Additionally, conducting subgroup analysis to review the relevant literature.ResultsThe findings of this health needs assessment described that diabetic foot disease in the adults is higher in men than women in the US. American Indian achieved the highest prevalence of diabetic foot disease, in comparison to other ethnic groups. Meanwhile, age has been defined as an important factor to influence the diabetic foot disease rate. Diagnosing properly is important, in accordance with understanding the etiopathogenesis of diabetic foot disease for health professionals. A comprehensive Foot Examination has been established and developed by the American Diabetes Association (ADA). It has been used widely with the characters of easy conducting and rapid performance. Moreover, treatment of DFUs with becaplermin gel obtained the lower cost and the larger clinical benefit when comparing the traditional wound care.     

糖尿病足危险因素分析

目的探讨糖尿病（DM）患者发生糖尿病足（DF）的危险因素。方法利用病案查询系统检索1996年1月至2009年12月四川大学华西医院DF患者的总出院人数为662例,男371例,291例,平均年龄（664-11）岁;同期入院无DF的DM患者353例,男205例,女148例,平均年龄（66±9）岁。根据是否合并DF将所有患者分为DF患者组（DFP组）和非DF患者组（non．DFP组）。用卡方检验和单、多因素logistic回归分析方法对常见危险因素进行分析。结果与non—DFP组相比,DFP组糖尿病慢性并发症糖尿病肾病（DN）、糖尿病视网膜病变（DR）、周围动脉病变（PAD）、糖尿病周围神经病变（DPN）、糖尿病自主神经病变（DAN）的发生率均明显高于non—DFP组,组间差异均有统计学意义（X。=34．133、11．694、165．727、85．852、72．021,均P〈0．05）;且其肺部感染、骨质疏松的发生率更高,差异亦均有统计学意义（X2=32．619,23．932,均P〈0．05）。单因素分析显示吸烟、DN、DR、PAD、DPN、DAN是DF的危险因素（Wald=4．874、33．516、11．581、146．356、82．446、67,686,均P〈0．05）;高密度脂蛋白胆固醇（HDL—C）（Wald=25．532,P=0．000）是DF的保护性因素。多因素非条件logistic回归分析显示DN、DPN、DAN、PAD是DF的危险因素（Wald=11．007、21．484、11．963、87．427,均P〈0．05）;而HDL—C（Wald=14．971,P=0．000）是DF的保护性因素。结论DN、DPN、DAN、PAD是DF的危险因素,而HDL—C是DF的保护因素。     

Combined exercise and visual gaze training improves stepping accuracy in people with diabetic peripheral neuropathy

IntroductionPatients with diabetes and diabetic peripheral neuropathy (DPN) place their feet with less accuracy whilst walking, which may contribute to the increased falls-risk. This study examines the effects of a multi-faceted intervention on stepping accuracy, in patients with diabetes and DPN.MethodsForty participants began the study, of which 29 completed both the pre and post-intervention tests, 8 patients with DPN, 11 patients with diabetes but no neuropathy (D) and 10 healthy controls (C). Accuracy of stepping was measured pre- and post-intervention as participants walked along an irregularly arranged stepping walkway. Participants attended a one-hour session, once a week, for sixteen weeks, involving high-load resistance exercise and visual-motor training.ResultsPatients who took part in the intervention improved stepping accuracy (DPN: +45%; D: +36%) (p < 0.05). The diabetic non-intervention (D-NI) group did not display any significant differences in stepping accuracy pre- to post- the intervention period (?7%).DiscussionThe improved stepping accuracy observed in patients with diabetes and DPN as a result of this novel intervention, may contribute towards reducing falls-risk. This multi-faceted intervention presents promise for improving the general mobility and safety of patients during walking and could be considered for inclusion as part of clinical treatment programmes.     

Dual CCR2/CCR5 antagonist treatment attenuates adipose inflammation,but not microvascular complications in ob/ob mice

Diabetic peripheral neuropathy (DPN) and diabetic kidney disease (DKD) are common diabetic complications with limited treatment options. Experimental studies show that targeting inflammation using chemokine receptor (CCR) antagonists ameliorates DKD, presumably by reducing macrophage accumulation or activation. As inflammation is implicated in DPN development, we assessed whether CCR2 and CCR5 antagonism could also benefit DPN. Five‐week‐old ob/ob mice were fed a diet containing MK‐0812, a dual CCR2‐CCR5 receptor antagonist, for 8 weeks; DPN, DKD and metabolic phenotyping were then performed to determine the effect of CCR inhibition. Although MK‐0812 reduced macrophage accumulation in adipose tissue, the treatment had largely no effect on metabolic parameters, nerve function or kidney disease in ob/ob mice. These results conflict with published data that demonstrate a benefit of CCR antagonists for DKD and hyperglycaemia. We conclude that CCR signaling blockade is ineffective in ob/ob mice and suspect that this is explained by the severe hyperglycaemia found in this model. It remains to be determined whether MK‐0812 treatment, alone or in combination with improved glycaemic control, is useful in preventing diabetic complications in alternate animal models.     

Depression and Incident Diabetic Foot Ulcers: A Prospective Cohort Study

Objective

To test whether depression is associated with an increased risk of incident diabetic foot ulcers.

Methods

The Pathways Epidemiologic Study is a population-based prospective cohort study of 4839 patients with diabetes in 2000-2007. The present analysis included 3474 adults with type 2 diabetes and no prior diabetic foot ulcers or amputations. Mean follow-up was 4.1 years. Major and minor depression assessed by the Patient Health Questionnaire-9 were the exposures of interest. The outcome of interest was incident diabetic foot ulcers. We computed the hazard ratio and 95% confidence interval (CI) for incident diabetic foot ulcers, comparing patients with major and minor depression with those without depression and adjusting for sociodemographic characteristics, medical comorbidity, glycosylated hemoglobin, diabetes duration, insulin use, number of diabetes complications, body mass index, smoking status, and foot self-care. Sensitivity analyses also adjusted for peripheral neuropathy and peripheral arterial disease as defined by diagnosis codes.

Results

Compared with patients without depression, patients with major depression by Patient Health Questionnaire-9 had a 2-fold increase in the risk of incident diabetic foot ulcers (adjusted hazard ratio 2.00; 95% CI, 1.24-3.25). There was no statistically significant association between minor depression by Patient Health Questionnaire-9 and incident diabetic foot ulcers (adjusted hazard ratio 1.37; 95% CI, 0.77-2.44).

Conclusion

Major depression by Patient Health Questionnaire-9 is associated with a 2-fold higher risk of incident diabetic foot ulcers. Future studies of this association should include better measures of peripheral neuropathy and peripheral arterial disease, which are possible confounders or mediators.     

Mechanisms of diabetic foot ulceration: A review

Diabetic foot ulcers (DFUs) are associated with complex pathogenic factors and are considered a serious complication of diabetes. The potential mechanisms underlying DFUs have been increasingly investigated. Previous studies have focused on the three aspects of diabetic peripheral vascular disease, neuropathy, and wound infections. With advances in technology, researchers have been gradually conducting studies using immune cells, endothelial cells, keratinocytes, and fibroblasts, as they are involved in wound healing. It has been reported that the upregulation or downregulation of molecular signaling pathways is essential for the healing of DFUs. With a recent increase in the awareness of epigenetics, its regulatory role in wound healing has become a much sought-after trend in the treatment of DFUs. This review focuses on four aspects involved in the pathogenesis of DFUs: physiological and pathological mechanisms, cellular mechanisms, molecular signaling pathway mechanisms, and epigenetics. Given the challenge in the treatment of DFUs, we are hopeful that our review will provide new ideas for peers.     

Physiopathology of the diabetic foot

Diabetic foot ulcerations result from different physiopathological mechanisms; a clear understanding of them is crucial to reduce their incidence, provide early care, and finally delay the amputation risk. The three main diabetes complications involved in foot ulcerations are neuropathy, peripheral arterial disease, and infection. The most common pathway to ulceration is peripheral sensorimotor and autonomic neuropathy, leading to loss of sensitivity, foot deformities, high foot pressure, and dry skin. Peripheral arterial disease is more frequent and more serious in the diabetic population. It delays cicatrization and causes gangrene and finally amputation. Infection is also a major complication of ulceration because of its risk of spreading into deep tissue and bone, which increases the risk of amputation. Infection may also generalize and become life-threatening. These complications preferentially affect the foot because it is exposed to hyper pressure, neuropathy, and peripheral arterial disease, which cause distal lesions, and the foot is exposed to a closed atmosphere, a source of soaking and skin frailty. Diabetes itself may enhance the risk of complications stemming from the disease's long-term progression and poor glucose control, thereby affecting ocular and renal functions. Finally, some psychosocial situations such as depression syndrome or poor hygiene possibly enhance diabetic foot occurrence.     

Plasma thrombin-activatable fibrinolysis inhibitor (TAFI) antigen levels in diabetic foot ulcers

Plasma TAFI may participate in arterial thrombosis in cardiovascular diseases (CVD) and may be involved in the mechanism of vascular endothelial damage in diabetic patients. The aim of this study was to investigate the association of plasma TAFI antigen level in the development of diabetic foot ulcer in Type 2 diabetes. The TAFI antigen levels were determined in 50 patients with diabetic foot ulcers and 34 patients without diabetic foot ulcers and 25 healthy individuals. We measured TAFIa/ai antigen in plasma samples with a commercially available ELISA Kit. Diabetic foot ulcer group and diabetic group were similar in terms of mean age and sex distribution. Diabetes duration, retinopathy, neuropathy, macrovascular disease and infection were related to diabetic foot ulcers. HbA1c, HDL-cholesterol and Folic Acid levels were decreased in the diabetic foot ulcer group. TAFI levels were 99.44?±?55.94% in control group, 135.21?±?61.05% in diabetic foot ulcer group, 136.75?±?59.38% in diabetic group and was statistically different (P??0.05). No significant difference in plasma TAFI levels were seen between diabetic foot ulcer stages. TAFI antigen levels are increased in Type 2 diabetic patients, but are not related to diabetic foot ulcer development.     

2型糖尿病患者合并手部病变的相关因素分析

目的探讨T2DM患者合并手部病变(简称糖尿病手)的相关因素,为降低糖尿病手的风险提供理论依据。方法选取2019年2月至2020年2月于重庆医科大学附属第一医院内分泌内科住院部收治的530例T2DM患者,按是否有手部病变分为手部病变组(DH,n=136)和单纯T2DM组(T2DM,n=394),比较两组一般资料及生化指标,多因素Logistic回归分析手部病变的影响因素。结果 DH组年龄、DM病程、DR、糖尿病周围神经病变(DPN)、DKD、颈动脉斑块及下肢动脉斑块阳性率、白细胞计数、中性粒细胞-淋巴细胞比率(NLR)、血清尿素、UAlb水平均高于T2DM组(P<0.05),红细胞计数、血红蛋白、TG、eGFR低于T2DM组(P<0.05)。多因素Logistic回归分析发现,DM病程(OR 1.041,95%CI 1.004,1.066)、DPN(OR 1.899,95%CI 1.007,3.580)和NLR(OR 1.035,95%CI 1.008,1.063)是糖尿病手的独立危险因素。结论 T2DM患者DM病程越长,合并DPN及NLR越高,出现糖尿病手的风险越高。