2型糖尿病并糖尿病足患者中血栓素A2、前列环素的变化及临床意义

目的探讨2型糖尿病(T2DM)合并糖尿病足(DF)患者血栓素A2(TXA2)和前列环素(PGI2)的变化情况及其与糖尿病足病情的关系。方法 60例T2DM并DF患者分为DF非坏疽组38例和DF坏疽组22例,30例健康体检者为对照组,应用放免法测定血浆TXA2和PGI2的稳定代谢产物血栓素B2(TXB2)和6-酮-前列环素(6-keto-PGF1α)含量,同时观察DF患者的病程、体质指数、血压、血糖、胰岛素、糖化血红蛋白、血脂、胰岛素抵抗指数(HOMA-IR)和踝肱动脉指数(ABI)的变化,并分析其与TXB2和6-keto-PGF1α的关系。结果糖尿病患者存在明显的TXA2和PGI2平衡异常。糖尿病足患者的血浆TXB2明显高于对照组(P<0.01),而血浆6-keto-PGF1α水平明显低于对照组(P<0.01),糖尿病足患者的TXB2/6-keto-PGF1α(T/P)明显高于对照组,DF坏疽组比DF非坏疽组更为严重(P<0.01)。糖尿病足组患者的T/P值与病程、总胆固醇、低密度胆固醇、空腹血糖、餐后2小时血糖和HOMA-IR呈正相关关系(P<0.05,P<0.01),与ABI呈负相关关系(P<0.01)。结论检测血浆TBA2与6-keto-PGF1α水平可提示血管内皮细胞的损伤,早期判断糖尿病足患者血管病变的程度,及早采取治疗措施。

The Change and Clinical Significance of Thromboxane A2 and Prostacycline in Patients with Diabetic Foot of Type 2 Diabetes Mellitus

Objective To explore the change of thromboxane A2 (TXA2) and prostacyclin (PGI2) in patients with type 2 diabetes mellitus (T2DM) and diabetic foot (DF), and the relationship with diabetes foot condition. Methods 60 T2DM patients with and DF were divided into DF gangrene group (22 cases) and non- gangrenous DF (38 cases), while 30 healthy persons were selected as control group. The plasma thromboxane B2 (TXB2) and 6-keto-prostacyclin (6-keto-PGF1α) were measured by radioimmunoassay. The patients’ disease course of DF, body mass index, blood pressure, blood glucose, insulin, glycosylated hemoglobin, blood lipid, the change of insulin resistance index (HOMA-IR) and ankle-brachial artery index (ABI) were observed and analyzed the relationship with TXB2 and 6-keto-PGF1α. Results Diabetic patients had significant abnormal balance of TXA2 and PGI2. Plasma TXB2 in patients with diabetic foot were significantly higher (P<0.01), while plasma 6-keto-PGF1α levels were significantly lower than the control group (P<0.01); the TXB2 / 6-keto-PGF1α (T/P) value were significantly higher in diabetic foot patients, and DF gangrene group was more serious than non-gangrene group (P<0.01). The T/P in diabetic foot group were positively correlated with duration of disease, total cholesterol, LDL, fasting glucose, 2-hour postprandial blood glucose and HOMA-IR (P<0.05, P<0.01), and negatively correlated with ABI (P<0.01). Conclusions The detection of plasma TXB2 and 6-keto-PGF1α levels can prompt the injury of vascular endothelial cell and early judgment of the vascular lesions level in patients with diabetic foot to take treatment measures early.