Study on the correlationship of serum VCAM-1, FGF 2 and other inflammatory cytokines with refractory diabetic foot

doi:10.3969/j.issn.1673-8640.2014.05.010

Abstract

Abstract: Objective To investigate the relationship of vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 2 (FGF2) and other inflammatory cytokines with the occurrence and development of refractory diabetic foot(DF). Methods A total of 145 patients with refractory DF (DF group) and 65 patients with type 2 diabetes mellitus(T2DM) and non-foot ulcers (T2DM group) were enrolled for the basic clinical data, and fasting blood were collected for the determinations of VCAM-1, FGF2, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), fasting blood glucose (FBG), 2 h postprandial blood glucose (2 hPG), glycosylated hemoglobin A_1c(HbA_1c), glycated albumin (GA), C-reactive protein (CRP), fibrinogen (FIB), white blood cell count (WBC) and neutrophil ratio (Neu%). The results were analyzed statistically. According to Wagner grade, DF group was classified into Wagner Ⅲ(37 cases), Wagner Ⅳ(92 cases) and Wagner Ⅴ(16 cases). Results Between DF and T2DM groups, sex, body mass index (BMI), FBG, 2 hPG, HbA_1c and GA had no statistical significance (P> 0.05). The levels of VCAM-1, FGF2, TNF-α, IL-6, WBC, Neu%, FIB, CRP, age, duration of diabetes and heart rate in DF group were significantly higher than those in T2DM group(P<0.01).TNF-α was significantly correlated with VCAM-1(r=0.284, P=0.000).Univariate Logistic regression analysis showed that VCAM-1, FGF2, TNF-α, IL-6, age, duration of diabetes, heart rate, WBC, Neu%, FIB and CRP were risk factors for DF occurrence. Multivariate Logistic regression analysis showed that only VCAM-1, TNF-α, FIB and Neu% were the independent risk factors of DF occurrence. The age of Wagner Ⅴ group was significantly lower than those of Wagner Ⅲ and Ⅳ groups(P<0.01), and serum IL-6, CRP, FIB, WBC and Neu% were significantly higher than those of Wagner Ⅲ and Ⅳ groups(P<0.05, P<0.01 ). The levels of FGF2 and HbA_1c in Wagner Ⅴ group were significantly higher than those in Wagner Ⅲ group(P<0.05). Conclusions The elevated levels of serum VCAM-1, FGF2 and other inflammatory cytokines play important roles in the occurrence and development of DF, and we should pay more attention to anti-inflammatory therapy when treating DF.

Key words: Vascular cell adhesion molecule-1, Fibroblast growth factor 2, Tumor necrosis factor-alpha, Interleukin-6, Inflammatory cytokine, Diabetic foot

CLC Number:

R446.1

ZHANG Ying, WANG Weiling, YANG Qintong, ZHAO Jingjing, ZHOU Lixia, XING Jiayi, ZHAO Yanrong.. Study on the correlationship of serum VCAM-1, FGF 2 and other inflammatory cytokines with refractory diabetic foot[J]. , 2014, 29(5): 472-476.

References

[1] Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes[J]. JAMA, 2005, 293(2): 217-228.
[2] 张妲, 关小宏.糖尿病足溃疡与炎症[J].中国老年学杂志, 2013, 33(2):493-495.
[3] Bakker K, Apelqvist J, Schaper NC, et al. Practical guidelines on the management and prevention of the diabetic foot 2011[J]. Diabetes Metab Res Rev, 2012, 28(Suppl 1):225-231.
[4] Wagner FW Jr. The dysvascular foot:a system of diagnosis and treatment[J]. Foot Ankle, 1981, 2(2):64-122.
[5] 李秀钧, 邬云红.糖尿病是一种炎症性疾病[J].中华内分泌代谢杂志, 2003, 19(4):251-253.
[6] Weigelt C, Rose B, Poschen U, et al.Immune mediators in patients with acute diabetic foot syndrome[J]. Diabetes Care, 2009, 32(8):1491-1496.
[7] Dinh T, Tecilazich F, Kafanas A, et al. Mechanisms involved in the development and healing of diabetic foot ulceration[J]. Diabetes, 2012, 61(11):2937-2947.
[8] 唐可京, 谢灿茂, 李幼姬.细胞间粘附分子-1和血管细胞间粘附分子-1的结构与功能[J].细胞与分子免疫学杂志, 2002, 18(2):193-195.
[9] 徐茂锦, 邹大进, 叶江洪.高糖、晚期糖化终产物对微血管内皮细胞VCAM-1表达的影响[J].解放军医学杂志, 2002, 27(7):618-619.
[10] 吴煜, 熊瑛, 崔驰.FGF-2的非酶糖基化修饰及对糖尿病血管病变的影响[J].中外医疗, 2009, 28(23):14-15.
[11] Xu J, Wu HF, Ang ES, et al. NF-kappa B modulators in osteolytic bone diseases[J].Cytokine Growth Factor Rev, 2009, 20(1):7-17.
[12] Uccioli L, Sinistro A, Almerighi C, et al. Proinflammatory modulation of the surface and cytokine phenotype of monocytes in patients with acute Charcot foot[J].Diabetes Care, 2010, 33(2):350-355.
[13] 陈立立, 胡仁明.2型糖尿病发病的炎症机制[J].中华糖尿病杂志, 2012, 4(4):248-251.
[14] 王伟灵, 赵延荣, 周丽霞, 等.糖尿病足坏疽患者血脂、凝血功能与踝肱指数的相关性分析[J].检验医学, 2010, 25(11):897-900.
[15] Rattan R, Nayak D. High levels of plasma malondialdehyde, protein carbonyl, and fibrinogen have prognostic potential to predict poor outcomes in patient with diabetic foot wounds: a preliminary communication[J].Int J Low Extrem Wounds, 2008, 7(4):198-203.
[16] 孙好杰, 王鹏华, 丁敏, 等.糖尿病足截趾患者的转归——5年的随访研究[J].中华内分泌代谢杂志, 2012, 28(3):201-206.