本文關(guān)鍵詞： 糖尿病 下肢動脈病變 chemerin 可溶性選擇素P　出處：《川北醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討2型糖尿病下肢動脈病變與可溶性選擇素p及chemerin的相關(guān)性,為2型糖尿病下肢動脈病變發(fā)表機(jī)制提供一定依據(jù)。以血管彩超作為診斷下肢動脈病變的參考標(biāo)準(zhǔn),初步探討踝肱指數(shù)診斷2型糖尿病下肢動脈病變的截點(diǎn)值。方法：1.選擇川北醫(yī)學(xué)院附屬醫(yī)院2013年1月-2014年11月住院的2型糖尿病患者(診斷符合1999年WHO診斷標(biāo)準(zhǔn))共90例,以多普勒超聲結(jié)果為依據(jù),將2型糖尿病組分為2型糖尿病無下肢血管病變組(NPAD組)30例和2型糖尿病伴下肢血管病變組(PAD組)60例,并對伴有下肢血管病變的糖尿病組按病變嚴(yán)重程度分為輕度、中度和重度三個亞組。同期選取我院體檢中心健康體檢者為健康對照組(健康組)共30例。2.所有受檢者采空腹12小時后晨起靜脈血,采用酶聯(lián)免疫吸附法測定可溶性選擇素P、chemerin含量,同時對研究對象進(jìn)行一般資料得采集,測定踝肱指數(shù)及相關(guān)生化資料。結(jié)果：1.PAD、NPAD和健康組之間chemerin比較,健康組NPAD組PAD組,呈逐漸增加的趨勢(P0.05)；PAD、NPAD和健康組之間選擇素P比較,兩兩比較有統(tǒng)計(jì)差異NPAD組健康組(P0.05),PAD組NPAD組(P0.05)。PAD組和NPAD組的ABI比較分析結(jié)果提示PAD組ABI水平低于NPAD組,具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.PAD組、NPAD組、健康組三組間兩兩比較,FPG、HbAlc、hs-CRP指標(biāo)存在顯著性差異,具有統(tǒng)計(jì)學(xué)差異(P0.05)。與健康組比較,PAD組和NPAD組總膽固醇水平顯著升高,有統(tǒng)計(jì)意義(P0.05)。3.糖尿病下肢動脈病變各亞組之間HbAlc、年齡之間無統(tǒng)計(jì)學(xué)差異(P0.05)；組間可溶性選擇素P比較： P3明顯高于P2。和于P1,且具有統(tǒng)計(jì)學(xué)差異(P0.05),P1小于P2組間比較有統(tǒng)計(jì)學(xué)差異。組間| chemerin水平比較： P3明顯高于P1,具有統(tǒng)計(jì)學(xué)差異；P3高于P2,但無統(tǒng)計(jì)學(xué)差異。4.以血管超聲診斷PAD為參考標(biāo)準(zhǔn),ROC分布曲線提示ABI用于糖尿病下肢動脈血管病變的截點(diǎn)值為0.95, ABI診斷PAD的特異性為90%,靈敏性為86.7%,ABI與chemerin、可溶性選擇素P水平成負(fù)相關(guān)。5.直線相關(guān)分析顯示,chemerin水平與TC、hs-CRP、病程、HbAlc成正相關(guān)；可溶性選擇素P與病程、HbAlc、hs-CRP成正相關(guān),Chemerin與可溶性選擇素P成正相關(guān)。Logistic分析顯示,糖尿病下肢動脈血管病變的獨(dú)立危險因素有病程、hs-CRP、TC、可溶性選擇素P、FPG。結(jié)論：1.chemerin與糖尿病下肢動脈病變可能有關(guān),可能參與2型糖尿病下肢動脈病變發(fā)生發(fā)展。chemerin與可溶性選擇素P在2型糖尿病下肢動脈病變中可能存在協(xié)同作用。2.本研究認(rèn)為可溶性選擇素P可能是2型糖尿病下肢動脈病變危險因素,并且可溶性選擇素P可能與PAD嚴(yán)重程度密切相關(guān)。3.本研究得出ABI0.95為診斷下肢血管病變的截點(diǎn)值,該研究結(jié)果考慮可能受樣本量太小因素影響。
[Abstract]:Objective: to investigate the correlation between lower extremity arterial lesions and soluble selectin p and chemerin in type 2 diabetes mellitus, and to provide a basis for the publication of lower extremity arterial lesions in type 2 diabetes mellitus. Methods 1. 90 patients with type 2 diabetes mellitus who were hospitalized in the affiliated Hospital of North Sichuan Medical College from January 2013 to November 2014 were selected. The diagnosis met the diagnostic criteria of 1999 WHO. Based on the results of Doppler ultrasound, type 2 diabetes mellitus group was divided into two groups: type 2 diabetes without lower extremity vascular lesion group (n = 30) and type 2 diabetes with lower extremity vascular disease group (n = 60). The diabetic patients with vascular disease of lower extremity were divided into mild and mild according to the severity of the lesion. Three subgroups of moderate and severe. 30 healthy persons were selected as healthy control group (healthy group). All the subjects were collected venous blood 12 hours after fasting. The content of soluble selectin was determined by enzyme-linked immunosorbent assay (Elisa). At the same time, the general data were collected, and the ankle brachial index and related biochemical data were measured. Results: 1. Chemerin was compared between NPAD group and healthy group, PAD group in healthy group. There was a statistical difference between P0.05 P0.05 pad and healthy group. The results of ABI comparison between NPAD group and NPAD group in NPAD group showed that ABI level in PAD group was lower than that in NPAD group, which had statistical significance P0.05. 2. Pad group was significantly lower than that of NPAD group, and there was no significant difference in ABI level between PAD group and healthy group (P 0.05. 2. Pad group), and the results showed that the ABI level in PAD group was significantly lower than that in NPAD group, and there was a significant difference between two groups (P 0.05, P 0.05, P 0.05, P 0.05, P < 0.05). There was significant difference in HbAlcs-CRP between the three groups in healthy group (P 0.05). The total cholesterol level in pad group and NPAD group was significantly higher than that in healthy group. There was no significant difference in HbAlc among the subgroups of diabetic lower extremity arterial lesion (P 0.05), but there was no significant difference in age (P 0.05). The soluble selectin P ratio between groups was significantly higher than that in P 2 and P 1, and there was statistical difference between P 0.05 P 1 and P 0 05 P 1 in P 0 05 P 1 and P 0 05 P 1 in P 0 05 P < P 0 05 P 1 in P 2 group. Statistical differences. Comparison of chemerin levels between groups: P3 was significantly higher than P1, P 3 was higher than P 2, but there was no statistical difference. 4. Using vascular ultrasound diagnosis of PAD as reference standard, ABI distribution curve suggested that ABI could be used in diabetic lower extremity artery. The cut-off point of vascular lesion was 0.95.The specificity of ABI in the diagnosis of PAD was 90, the sensitivity was 86.7 and the level of soluble selectin P was negatively correlated .5.The linear correlation analysis showed that the level of chemerin was positively correlated with PAD and HbAlc. There was a positive correlation between soluble selectin P and HbAlccs-CRP. Logistic analysis showed that Chemerin had positive correlation with soluble selectin P. The independent risk factors of diabetic lower extremity arteriopathy were the course of disease and the soluble selectin PfFPG.Conclusion 1. Chemerin may be associated with diabetic lower extremity arterial lesion. There may be synergistic effect between chemerin and soluble selectin P in type 2 diabetes mellitus. 2. This study suggests that soluble selectin P may be a type 2 diabetes mellitus. Risk factors for arterial lesions in lower extremities, And soluble selectin P may be closely related to the severity of PAD. In this study, we obtained that ABI0.95 is the cut-off point for the diagnosis of lower extremity vascular diseases. The results of this study may be affected by too small sample size.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2

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