超敏C反应蛋白、内皮抑素在糖尿病肢端坏疽早期病变中的诊断意义

目的  探讨超敏C反应蛋白（hs-CRP）、内皮抑素（ES）在糖尿病肢端坏疽早期病变（DG）中的诊断价值。方法  将106例2型糖尿病患者，按照是否出现糖尿病足分为单纯糖尿病组（DM组）和糖尿病肢端坏疽早期病变组（DG组），采用超敏乳胶增强散射比浊法测定hs-CRP，ELISA法测定ES，检测其在DG中的诊断价值。结果  DG组自主神经病变（DAN）、下肢动脉管病变（LEAD）、微量尿蛋白（MAU）、踝肱指数（ABI）、低密度脂蛋白（LDL-C）、hs-CRP、血管内皮生长因子（VEGF）、ES以及欧米诺变色开始时间、完全变色时间均高于DM组（P <0.05或P <0.01）；Spearman相关性分析发现，hs-CRP与DAN、LEAD、VEGF、ES、LDL-C呈正相关（r = 0.486、0.477、0.505、0.503和0.473，P <0.05），与ABI呈负相关（r =-0.488，P <0.05）；ES与DAN、LEAD、VEGF、hs-CRP呈负相关（r =-0.507，-0.501，-0.492和-0.508，P <0.05），与ABI呈负相关（r =0.497，P <0.05）；ES+hs-CRP诊断在敏感性、特异性、阳性预测值、阴性预测值、诊断准确率及AUC均高于ES、hs-CRP单独诊断。结论  ES、hs-CRP与DG以及合并有自主神经病变具有明显相关性，ES联合hs-CRP对于DG具有较高的诊断价值。

Significance of high-sensitivity C-reactive protein and endostatin in early diagnosis of diabetic gangrene

Objective To investigate the high-sensitivity C-reactive protein (hs-CRP) and endostatin (ES) in early diagnosis of diabetic limb gangrene (DG). Methods A total of 106 T2DM patients were divided into simple diabetic group (DM) and early diabetic gangrene group (DG group). hs-CRP was measured using ultra-sensitive latex-enhanced scattering immunoturbidimetric assay. ES was determined by ELISA. Their value in diagnosis of DG was detected. Results DAN, LEAD, MAU, ABI, LDL-C, hs-CRP, VEGF and ES levels in the DG group were higher than those of the DM group (P < 0.05). The Ou Mino discoloration started earlier and the complete discoloration time was longer in the DG group than in the DM group (P < 0.05). Spearman correlation analysis showed that hs-CRP was positively correlated with DAN, LEAD, VEGF, ES and LDL-C (r = 0.486, 0.477, 0.505, 0.503 and 0.473, respectively; P < 0.05), but was in a negative correlation with ABI (r = -0.488, P < 0.05); ES was negatively correlated with DAN, LEAD, VEGF and hs-CRP (r = -0.507, -0.501, -0.492 and -0.508; P < 0.05), but positively correlated with ABI(r = 0.497, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and AUC of the combination of ES and hs-CRP were higher than those of ES and hs-CRP alone in diagnosis of DG. Conclusions ES and hs-CRP have significant correlations with DG and autonomic neuropathy. ES combined with hs-CRP has high diagnostic value for DG.