血清NLRP3、ANGPTL4水平与2型糖尿病下肢动脉病变的关系

目的探讨血清核苷酸结合寡聚化结构域样受体蛋白3（NLRP3）、血管生成素样蛋白4（ANGPTL4）与2型糖尿病（T2DM）下肢动脉病变（LEAD）的关系。 方法选择2019年1月至2021年1月安徽医科大学附属宿州医院内分泌科收治的89例T2DM合并LEAD患者（LEAD组），55例单纯T2DM患者（T2DM组）和50例健康志愿者（健康对照组）。检测血清NLRP3和ANGPTL4水平，收集临床资料，Pearson相关性分析NLRP3、ANGPTL4与静息ABI指数之间相关性。Logistic逐步回归分析NLRP3、ANGPTL4与T2DM合并LEAD的关系。绘制受试者工作特征曲线（ROC）分析NLRP3、ANGPTL4诊断T2DM合并LEAD的价值。 结果LEAD组血清NLRP3水平高于T2DM组和健康对照组（P＜0.05），血清ANGPTL4水平低于T2DM组和健康对照组（P＜0.05）。Fontaine's Ⅳ期患者静息踝肱指数（ABI）、ANGPTL4水平低于Ⅲ期和Ⅱa~Ⅱb期患者（P＜0.05），NLRP3高于Ⅲ期和Ⅱa~Ⅱb期患者（P＜0.05）。NLRP3与静息ABI指数呈负相关（r=-0.893，P＜0.05），ANGPTL4与静息ABI指数呈正相关（r=0.805，P＜0.05）。T2DM病程≥5年、高胰岛素抵抗指数（HOMA-IR）和高NLRP3是T2DM合并LEAD的危险因素（P＜0.05），高ANGPTL4是T2DM合并LEAD的保护因素（P＜0.05）。联合NLRP3、ANGPTL4检测诊断T2DM合并LEAD的曲线下面积为0.902，高于单独NLRP3、ANGPTL4的0.698、0.705（P＜0.05）。 结论T2DM合并LEAD患者血清NLRP3水平增高，ANGPTL4降低，且与T2DM合并LEAD的发生以及病情严重程度有关，联合NLRP3和ANGPTL4可为LEAD诊断提供有效信息。

Relationship between serum NLRP3 and ANGPTL4 levels and lower extremity arterial disease in type 2 diabetes mellitus

ObjectiveTo investigate the relationship between serum nucleotide binding oligomerization domain-like receptor protein 3 (NLRP3) and angiopoietin-like 4 (ANGPTL4) levels and lower extremity arterial disease (LEAD) in type 2 diabetes mellitus (T2DM). MethodsFrom January 2019 to January 2021, 89 T2DM patients with LEAD (LEAD group) treated at the Department of Endocrinology, Suzhou Hospital Affiliated to Anhui Medical University, 55 simple T2DM patients (T2DM group), and 50 healthy volunteers (healthy control group) were selected. Serum NLRP3 and ANGPTL4 levels were detected and clinical data were collected, and the correlation between NLRP3 and ANGPTL4 and resting ankle-brachial index (ABI) was analyzed by Pearson correlation analysis. Logistic regression was used to analyze the relation between NLRP3 and ANGPTL4 and T2DM combined with LEAD. Receiver operating characteristic curve (ROC) was drawn to assess the value of NLRP3 and ANGPTL4 in diagnosing T2DM combined with LEAD. ResultsSerum NLRP3 level in the LEAD group was higher than those in the NLEAD group and healthy control group (P＜0.05), and serum ANGPTL4 level was lower than those in the NLEAD group and healthy control group (P＜0.05). The levels of resting ABI and ANGPTL4 in Fontaine's stage Ⅳ patients were lower than those in stage Ⅲ and stage Ⅱa~Ⅱb patients (P＜0.05), and NLRP3 was higher than that in stage Ⅲ and stage Ⅱa~Ⅱb patients (P＜0.05). NLRP3 was negatively correlated with resting ABI (r=-0.893, P＜0.05), while ANGPTL4 was positively correlated with resting ABI (r=0.805, P＜0.05). T2DM duration ≥5 years, high insulin resistance index, and high NLRP3 were risk factors for T2DM complicated with LEAD (P＜0.05), and high ANGPTL4 was a protective factor for T2DM complicated with LEAD (P＜0.05). The area under the curve of NLRP3 plus ANGPTL4 was 0.902, which was higher than either of them alone (NLRP3: 0.698; ANGPTL4: 0.705; P＜0.05). ConclusionSerum NLRP3 level increases and ANGPTL4 level decreases in T2DM patients with LEAD, which is related to the occurrence and severity of T2DM patients with LEAD. The combination of NLRP3 and ANGPTL4 can provide effective information for the diagnosis of LEAD.