CAJ | 학술논문

目的：探讨血管细胞黏附分子-1（VCAM-1）和成纤维细胞生长因子2（FGF2）等炎症因子与难愈性糖尿病足（DF）发生、发展的关系。方法收集145例难愈性DF患者（DF组）和65例无足部溃疡的2型糖尿病（T2DM）患者（T2DM组）的基本临床资料，采集空腹血检测VCAM-1、FGF2、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、血糖（FBG）、餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c ）、糖化白蛋白（GA）、C反应蛋白（CRP）、纤维蛋白原（FIB）、白细胞计数（WBC）和中性粒细胞比率（Neu％），并对结果进行统计分析。将 DF 组参照Wagner分级方法分为WagnerⅢ级（37例）、WagnerⅣ级（92例）和WagnerⅤ级（16例）。结果 DF组和T2DM组之间性别构成、体重指数（BMI）、FBG、2 hPG、HbA1c和GA差异均无统计学意义（P＞0．05）。DF组VCAM-1、FGF2、TNF-α、IL-6、WBC、Neu％、FIB、CRP、年龄、糖尿病病程和心率均高于 T2DM组（P＜0．01）。TNF-α与VCAM-1呈正相关（r＝0．284，P＝0．000）。单因素Logistic回归分析表明VCAM-1、FGF2、TNF-α、IL-6、年龄、糖尿病病程、心率、WBC、Neu％、FIB和CRP是DF发生的危险因素。多因素Logistic回归分析显示VCAM-1、TNF-α、FIB和Neu％为DF发生的独立风险因素。WagnerⅤ级组年龄低于WagnerⅢ级组和WagnerⅣ级组（P＜0．01），而IL-6、CRP、FIB、WBC、Neu％均高于 Wagner Ⅲ级组和 Wagner Ⅳ级组（P＜0．05、P＜0．01）。WagnerⅤ级组FGF2和HbA1c高于WagnerⅢ级组（P＜0．05）。结论血清VCAM-1、FGF2等炎症因子水平升高在DF发生、发展过程中起到重要作用。DF治疗中应注重抗炎治疗。
목적：탐토혈관세포점부분자-1（VCAM-1）화성섬유세포생장인자2（FGF2）등염증인자여난유성당뇨병족（DF）발생、발전적관계。방법수집145례난유성DF환자（DF조）화65례무족부궤양적2형당뇨병（T2DM）환자（T2DM조）적기본림상자료，채집공복혈검측VCAM-1、FGF2、종류배사인자-α（TNF-α）、백세포개소-6（IL-6）、혈당（FBG）、찬후2 h혈당（2 hPG）、당화혈홍단백（HbA1c ）、당화백단백（GA）、C반응단백（CRP）、섬유단백원（FIB）、백세포계수（WBC）화중성립세포비솔（Neu％），병대결과진행통계분석。장 DF 조삼조Wagner분급방법분위WagnerⅢ급（37례）、WagnerⅣ급（92례）화WagnerⅤ급（16례）。결과 DF조화T2DM조지간성별구성、체중지수（BMI）、FBG、2 hPG、HbA1c화GA차이균무통계학의의（P＞0．05）。DF조VCAM-1、FGF2、TNF-α、IL-6、WBC、Neu％、FIB、CRP、년령、당뇨병병정화심솔균고우 T2DM조（P＜0．01）。TNF-α여VCAM-1정정상관（r＝0．284，P＝0．000）。단인소Logistic회귀분석표명VCAM-1、FGF2、TNF-α、IL-6、년령、당뇨병병정、심솔、WBC、Neu％、FIB화CRP시DF발생적위험인소。다인소Logistic회귀분석현시VCAM-1、TNF-α、FIB화Neu％위DF발생적독립풍험인소。WagnerⅤ급조년령저우WagnerⅢ급조화WagnerⅣ급조（P＜0．01），이IL-6、CRP、FIB、WBC、Neu％균고우 Wagner Ⅲ급조화 Wagner Ⅳ급조（P＜0．05、P＜0．01）。WagnerⅤ급조FGF2화HbA1c고우WagnerⅢ급조（P＜0．05）。결론혈청VCAM-1、FGF2등염증인자수평승고재DF발생、발전과정중기도중요작용。DF치료중응주중항염치료。
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 A1c (HbA1c ),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 WagnerⅢ(37 cases), WagnerⅣ(92 cases)and Wagner Ⅴ(16 cases).Results Between DF and T2DM groups,sex,body mass index (BMI),FBG,2 hPG,HbA1c 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 T2DMgroup(P<0.01).TNF-αwas 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 WagnerⅤgroup was significantly lower than those of WagnerⅢ and Ⅳ groups(P<0.01 ),and serum IL-6,CRP,FIB,WBC and Neu% were significantly higher than those of WagnerⅢand Ⅳgroups(P<0.05,P<0.01 ).The levels of FGF2 and HbA1c in WagnerⅤgroup were significantly higher than those in WagnerⅢgroup(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.