胱抑素C、高迁移率族蛋白1和生长分化因子-15水平对糖尿病足溃疡皮瓣修复术后早期感染的预测价值  

Predictive value of Cys C,HMGB1,GDF-15 levels for early infection after flap reconstruction for diabetic foot ulcer

作　　者：冯洪涛 焦小平 尚文煊 李红普 FENG Hongtao;JIAO Xiaoping;SHANG Wenxuan;LI Hongpu(Deptartment of Vascular Surgery,People′s Hospital of He′nan University of Traditional Chinese Medicine,Zhengzhou 450000,He′nan,China)

机构地区：[1]河南中医药大学人民医院(郑州人民医院)血管外科,河南郑州450000

出　　处：《实用医学杂志》2024年第23期3331-3336,共6页The Journal of Practical Medicine

基　　金：河南医学科技攻关计划联合共建项目(编号:LHGJ20220782)。

摘　　要：目的探究胱抑素C(Cys C)、高迁移率族蛋白1(HMGB1)、生长分化因子-15(GDF-15)水平对糖尿病足溃疡(DFU)皮瓣修复术后早期感染的预测价值。方法选择2021年7月至2024年3月在河南中医药大学人民医院治疗的DFU患者155例纳入DFU组,根据皮瓣修复术后1周内手术部位是否发生感染将DFU患者分为非感染组(104例)、感染组(51例),另选取同期糖尿病但未发生足溃疡的患者85例纳入对照组。采用乳胶免疫比浊法检测血清Cys C水平,酶联免疫吸附法检测血清HMGB1、GDF-15水平;利用多因素logistic回归分析影响DFU皮瓣修复术后早期感染的因素;ROC曲线分析血清Cys C、HMGB1、GDF-15水平对DFU皮瓣修复术后早期感染的预测价值。结果与对照组相比,DFU组血清Cys C、HMGB1、GDF-15表达水平显著升高(P<0.05);与非感染组相比,感染组FPG、CRP、Cys C、HMGB1、GDF-15表达水平显著升高(P<0.05);Cys C、HMGB1、GDF-15、FPG和CRP均是影响DFU皮瓣修复术后早期感染的独立危险因素(P<0.05);血清Cys C、HMGB1、GDF-15单独预测皮瓣修复术后早期感染的AUC分别为0.810、0.850、0.828,三者联合预测的AUC为0.930,优于三者单独预测(Z_(Cys C-三者联合)=3.381、Z_(HMGB1-三者联合)=2.588、Z_(GDF-15-三者联合)=2.857,均P<0.05)。结论Cys C、HMGB1、GDF-15在DFU患者血清中表达上调,三者均是影响DFU皮瓣修复术后早期感染的因素,三者联合对DFU皮瓣修复术后早期感染有着较高的预测价值。Objective To explore the predictive value of cystatin C(Cys C),high mobility group box 1(HMGB1),and growth differentiation factor⁃15(GDF⁃15)levels for early infection after flap reconstruction for diabetic foot ulcer(DFU).Methods From July 2021 to March 2024,155 DFU patients treated in our hospital were included in DFU group.DFU patients were assigned into non⁃infection group(104 cases)and infection group(51 cases)according to whether there was infection at the operation site within one week after flap reconstruction.Control group included 85 patients with diabetes but without foot ulcer.Latex immunoturbidimetry was applied to detect serum Cys C level;enzyme linked immunosorbent assay to detect serum levels of HMGB1 and GDF⁃15;multivariate logistic regression to analyze the factors affecting early infection after flap reconstructionfor DFU,and receiver operating characteristic(ROC)curve to analyze the predictive value of serum Cys C,HMGB1,and GDF⁃15 levels for early infection after flap reconstruction for DFU.Results The expression levels of serum Cys C,HMGB1,and GDF⁃15 were obviously higher in the DFU group(P<0.05)when compared with those in the control group.The expression levels of FPG,CRP,Cys C,HMGB1,and GDF⁃15 were obviously higher in the infection group(P<0.05)when compared with those in the non⁃infection group.Cys C,HMGB1,GDF⁃15,FPG,and CRP were all inde⁃pendent risk factors for early infection after flap reconstruction for DFU(P<0.05).The AUC predicted by serum Cys C,HMGB1,and GDF⁃15 alone for early infection after flap reconstruction for DFU was 0.810,0.850,and 0.828,respectively.The AUC predicted by the combination of these three markers was 0.930,which was better than that predicted by the three markers alone(Z_(Cys C⁃three combination)=3.381,Z_(HMGB1⁃three combination)=2.588,Z_(GDF⁃15⁃three combination)=2.857,all P<0.05).Conclusions Cys C,HMGB1,and GDF-15 are upregulated in the serum of DFU patients,and all the three are factors affecting early infection after flap recons

关 键 词：糖尿病足溃疡 皮瓣修复 胱抑素C 高迁移率族蛋白1 生长分化因子-15 

分 类 号：R587.1[医药卫生—内分泌]