血清Metrnl、GDF11表达水平与糖尿病足感染患者下肢血管病变及预后的关系  

The relationship between serum Metrnl and GDF11 expression levels with lower extremity vascular disease and prognosis in patients with diabetic foot infection

作　　者：王晨鸽 王晓东[1] 骆玉明 柴倩 杨姣 Wang Chenge;Wang Xiaodong;Luo Yuming;Chai Qian;Yang Jiao(Department of Endocrinology,Shangluo Central Hospital,Shaanxi,Shangluo 726000,China;不详)

机构地区：[1]陕西省商洛市中心医院内分泌科,726000 [2]陕西省商洛市中心医院手足外科,726000

出　　处：《疑难病杂志》2025年第4期412-417,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省科技计划项目(2021SF-437)。

摘　　要：目的探讨血清镍纹样蛋白(Metrnl)、生长分化因子11(GDF11)表达水平与糖尿病足(DF)感染患者下肢血管病变(LEVD)及预后的关系。方法选取2022年1月—2023年12月商洛市中心医院内分泌科收治的DF感染患者97例为DF组,单纯2型糖尿病(T2DM)患者97例为T2DM组。根据是否发生LEVD将DF感染患者分为LEVD亚组73例和非LEVD亚组24例;随访6个月,根据预后情况将DF感染患者(失访2例)分为预后不良亚组30例和预后良好亚组65例。另选取同期医院健康体检者97例为健康对照组。采用酶联免疫吸附试验检测血清Metrnl、GDF11水平;多因素Logistic回归分析DF感染患者预后不良的影响因素;受试者工作特征(ROC)曲线分析血清Metrnl、GDF11水平对DF感染患者预后不良的预测价值。结果血清Metrnl、GDF11水平比较,DF组<T2DM组<健康对照组(F/P=2058.898/<0.001、139.757/<0.001);LEVD亚组DF患者血清Metrnl、GDF11水平低于非LEVD亚组(t/P=4.165/<0.001、6.469/<0.001);随访6个月,97例DF感染患者随访期间失访2例,预后不良发生率为31.58%(30/95)。预后不良亚组T2DM病程、DF病程、合并LEVD比例、HbA1c水平高于预后良好亚组,血清Metrnl、GDF11水平低于预后良好亚组(t/P=6.603/<0.001、11.567/<0.001、5.410/0.020、7.832/<0.001,3.891/<0.001、4.983/<0.001);多因素Logistic回归分析显示,合并LEVD、HbA1c水平高是DF感染患者预后不良的独立危险因素[OR(95%CI)=2.297(1.145~4.599)、1.881(1.043~3.394)],血清Metrnl、GDF11水平高是其独立保护因素[OR(95%CI)=0.656(0.488~0.882)、0.680(0.519~0.892)];血清Metrnl、GDF11水平及二者联合预测DF感染患者预后不良的曲线下面积(AUC)分别为0.774、0.737、0.902,二者联合的AUC大于单独预测(Z/P=2.239/0.002、2.836/<0.001)。结论DF感染患者血清Metrnl、GDF11水平降低,且与LEVD发生有关,联合检测血清Metrnl、GDF11水平对DF感染患者不良预后具有较高的预测价值。Objective To investigate the relationship between serum Meteorin-like protein(Metrnl)and growth differentiation factor 11(GDF11)expression levels with lower extremity vascular disease(LEVD)and prognosis in patients with diabetic foot(DF)infection.Methods A total of 97 DF infection patients admitted to the Department of Endocrinology,Shangluo Central Hospital,from January 2022 to December 2023 were selected as the DF group,and 97 patients with type 2 diabetes mellitus(T2DM)alone were selected as the T2DM group.DF infection patients were further divided into the LEVD subgroup(n=73)and the non-LEVD subgroup(n=24)based on the presence of LEVD.After a 6-month follow-up(with 2 lost to follow-up),DF infection patients were categorized into the poor prognosis subgroup(n=30)and the good prognosis subgroup(n=65).Additionally,97 healthy individuals undergoing physical examinations during the same period were included as the healthy control group.Serum Metrnl and GDF11 levels were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate logistic regression analysis was performed to identify factors influencing poor prognosis in DF infection patients.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of serum Metrnl and GDF11 levels for poor prognosis in DF infection patients.Results Serum Metrnl and GDF11 levels followed the order:DF group<T2DM group<healthy control group(F/P=2058.898/<0.001,139.757/<0.001).The LEVD subgroup exhibited lower serum Metrnl and GDF11 levels compared to the non-LEVD subgroup(t/P=4.165/<0.001,6.469/<0.001).After 6 months of follow-up(with 2 lost),the incidence of poor prognosis was 31.58%(30/95).The poor prognosis subgroup had longer T2DM and DF duration,higher proportions of LEVD,higher HbA 1c levels,and lower serum Metrnl and GDF11 levels compared to the good prognosis subgroup(t/P=6.603/<0.001,11.567/<0.001,5.410/0.020,7.832/<0.001,3.891/<0.001,4.983/<0.001).Multivariate logistic regression analysis showed that LEVD and high HbA1c levels w

关 键 词：糖尿病足 下肢血管病变 镍纹样蛋白 生长分化因子11 预后 相关性 

分 类 号：R587.2[医药卫生—内分泌]