糖尿病足截肢患者血清Nε-羧甲基赖氨酸与胫前动脉斑块内钙化的关系  

Association between serum N^-carboxymethyl-lysine level and anterior tibial arterial plaque calcification in patients with diabetic foot post foot amputation

作　　者：李丽华[1] 叶斐[2] 付先利[1] 徐绥宁 包正阳 孙振 严金川[2] 吴建农[1] 王中群[2] 

机构地区：[1]江苏大学附属医院病理科,镇江212001 [2]江苏大学附属医院心内科,镇江212001

出　　处：《中华心血管病杂志》2017年第11期958-962,共5页Chinese Journal of Cardiology

基　　金：国家自然基金（81370408,81770450）;江苏省青年医学人才项目（QNRC2016836）;镇江市社会发展项目（SH2015038,SH2015023）;江苏大学临床专项（JDLCZX001）

摘　　要：目的探索糖基化终产物主要成分Nε－羧甲基赖氨酸（CML）水平与糖尿病足截肢患者胫前动脉斑块钙化之间的相关性。方法前瞻性入选2012年6月至2016年6月在江苏大学附属医院骨科因糖尿病足行大截肢治疗的患者共60例。根据下肢胫前动脉狭窄程度的彩色多普勒超声检测结果，将截肢患者分为轻度狭窄组（n＝20）、中度狭窄组（n＝20）及重度狭窄组（n＝20）。采集各组患者临床基线资料，分离胫前动脉行苏木素－伊红（HE）染色明确动脉壁病变情况，邻甲－酚酞络合酮法测定动脉壁钙含量，酶法检测明确各组动脉组织碱性磷酸酶（ALP）活性，ELISA法检测各组血清CML水平。结果截肢前糖尿病足患者胫前动脉彩色超声检查与截肢后动脉HE染色显示，随着糖尿病足患者胫前动脉狭窄程度的加重，斑块的回声强度明显增加，斑块内点灶状分布的蓝染钙颗粒也不断增多甚至破坏动脉壁内弹力板。轻度、中度和重度狭窄组动脉壁钙含量[分别为（2.3±0.9）、（3.9±1.3）和（6.6±1.7） μmol/mg]、ALP活性[分别为（102.4±39.4）、（202.3±73.4）和（483.7±117.9） U/mg]、血清CML水平[分别为（28.9±4.4）、（37.9±5.3）和（57.3±7.1） μg/L]差异均有统计学意义（P均〈0.001）。Pearson相关性分析显示血清CML水平与糖尿病足胫前动脉钙含量（r＝0.749, P〈0.001）及ALP活性（r＝0.923，P〈0.001）均呈正相关。结论血清CML水平与糖尿病足截肢患者胫前动脉斑块内钙化具有一定的相关性。ObjectiveTo observe the correlation between Nε-carboxymethyl-Lysine （CML）, the main component of advanced glycation end products and the calcification of the anterior tibial artery plaque in patients with diabetic foot post foot amputation. MethodsSixty patients hospitalized for foot amputation operation due to diabetic foot from June 2012 to June 2016 in the Department of Orthopedics, Affiliated Hospital of Jiangsu University were prospectively recruited.The patients were categorized into mild stenosis （0〈stenosis〈50%, n=20）, moderate stenosis （50%≤stenosis〈70%, n=20） and severe stenosis （70%≤stenosis≤100%, n=20） based on the color Doppler ultrasound assessed severity of anterior tibial artery stenosis.The baseline clinical data of patients were collected and anterior tibial artery was isolated.Then, HE staining, O-Cresolphthalein Complexone method, enzymic method and ELASA analysis were then performed to detect the evolution of calcification, arterial calcium content, alkaline phosphatase activity and serum CML concentration, respectively. ResultsThe results from both color Doppler ultrasound scan before amputation and HE staining after amputation showed that echo intensity as well as spotty blue calcium particles of anterior tibial artery plaque increased significantly in proportion to degree of stenosis and destructed elastic plate of the arterial wall was evidenced in patients with severest stenosis.The content of calcium （（2.3±0.9）, （3.9±1.3）, （6.6±1.7） μmol/mg, respectively, P〈0.001）, ALP activity （（102.4±39.4）, （202.3±73.4）, （483.7±117.9） U/mg, respectively, P〈0.001） and serum CML level （（28.9±4.4）, （37.9±5.3）, （57.3±7.1）μg/L, respectively, P〈0.001） increased significantly in proportion to stenosis severity.Pearson correlation analysis showed that serum CML level was positively correlated with the content of calcium （r=0.749, P〈0.001） and ALP activity （r=0.923, P〈0.001）, respectively.ConclusionsSeru

关 键 词：糖尿病足 截肢者 动脉硬化 糖基化终产物 高级 

分 类 号：R587.2[医药卫生—内分泌]