糖尿病下肢血管病变与足溃疡患者血清铁调素水平及相关因素的分析  

Analysis of serum hepcidin levels and related factors in patients with diabetic lower extremity vascular disease and foot ulcer

作　　者：李倩如 袁晶晶[1] 罗寓方 陈子莹 莫朝晖[1] Li Qianru;Yuan Jingjing;Luo Yufang;Chen Ziying;Mo Zhaohui(Department of Endocrinology,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院内分泌科,长沙410013

出　　处：《中国医师杂志》2021年第5期674-678,共5页Journal of Chinese Physician

基　　金：湖南省自然科学基金(2019JJ40454)。

摘　　要：目的探讨糖尿病下肢血管病变与足溃疡患者的血清铁调素水平,分析其相关因素。方法选取2019年1月至6月湘雅三医院内分泌科收治的70例2型糖尿病患者,其中初诊2型糖尿病患者(DM组)21例,合并下肢血管病变患者23例(PAD组),合并足溃疡患者26例(DF组)。ELISA法测定各组血清铁调素。比较不同组别患者血清铁调素水平,并采用相关性分析糖尿病下肢血管病变与足溃疡患者血清铁调素水平的相关性。结果⑴DF组血红蛋白、白蛋白、甘油三酯、总胆固醇、高密度脂蛋白明显低于DM组、PAD组(P<0.05);DF组炎症指标[WBC,中性粒细胞比值(NEUT%),hs-CRP]较DM组明显增高,且WBC数、hs-CRP高于PAD组及DM组(P<0.05),而PAD组与DM组比较,炎症指标(WBC,hs-CRP,NEUT%)差异无统计学意义(P>0.05);⑵DF组和PAD组铁调素水平均较DM组升高,而DF组高于PAD组;铁调素与收缩压、白细胞计数、NEUT%、铁蛋白水平呈正相关(P<0.05),与血红蛋白、糖化血红蛋白、白蛋白、25-羟维生素D水平呈负相关(P<0.05);⑶二分类多因素logistic回归分析结果表明铁调素水平升高为糖尿病患者足溃疡发生的独立危险因素(OR:1.755,95%CI:1.063~2.897,P=0.028)。结论糖尿病患者血清铁调素水平变化与炎症刺激、贫血程度及营养状态等相关,可能是糖尿病下肢血管病变较早改变的炎症指标,铁调素升高为糖尿病足溃疡发生的独立危险因素。Objective To investigate the serum hepcidin level and risk factors associated with peripheral arterial disease(PAD)and foot ulcer in type 2 diabetic patients.Methods From January 2019 to June 2019,70 patients with type 2 diabetes in Department of Endocrinology of Xiangya Third Hospital were selected,including 21 newly diagnosed patients with type 2 diabetes(DM group),23 patients with lower extremity vascular disease(PAD group)and 26 patients with foot ulcer(DF group).Serum hepcidin was determined by enzyme linked immunosorbent assay(ELISA).The serum levels of hepcidin in different groups were compared,and the correlation between diabetic lower extremity vascular disease and foot ulcer was analyzed.Results⑴The hemoglobin,albumin,triglycerides and total cholesterol were significantly lower in DF group compared with PAD and DM groups(P<0.05),while the DF group patients were with higher white blood cell(WBC)count and high sensitivity C reactive protein(hs-CRP)than patients in PAD and DM groups(P<0.05).DF group also showed significantly higher WBC,hs-CRP and neutrophil ratio level(NEUT%)than DM group(P<0.05).The inflammatory indicators of WBC,hs-CRP and NEUT%showed no significant difference between DM group and PAD group(P>0.05).⑵The levels of hepcidin in DF and PAD groups were higher than those in DM group,while that in DF group were higher than those in PAD group(P<0.05);Hepcidin was positively correlated with systolic blood pressure,WBC count,NEUT%and ferritin(P<0.05),and negatively correlated with hemoglobin,glycosylated hemoglobin,albumin and 25-hydroxyvitamin D(P<0.05).⑶Binary multivariate logistic regression analysis showed that elevated hepcidin level was an independent risk factor for diabetic foot ulcer[OR=1.755,95%CI:1.063-2.897,P=0.028].Conclusions The fluctuation of serum hepcidin level in diabetic patients is related to the stimulation of inflammation,the degree of anemia and the nutritional status,which means it might be an early indicator of inflammation in diabetic patients with peripheral arter

关 键 词：糖尿病 2型 下肢血管病变 足溃疡 铁调素 因素分析 

分 类 号：R587.2[医药卫生—内分泌]