發(fā)布時(shí)間：2018-04-19 21:52

  本文選題：2型糖尿病 + 糖尿病足　； 參考：《安徽醫(yī)科大學(xué)》2015年碩士論文

【摘要】：2型糖尿病足病患者胰島素生長(zhǎng)因子1的研究目的:研究糖尿病足潰瘍患者血清胰島素樣生長(zhǎng)因子1(IGF-1)水平的變化及不同潰瘍程度的皮膚組織中IGF-1的表達(dá),及其對(duì)糖尿病足潰瘍的影響。方法:選擇2012.01-2014.06在解放軍第306醫(yī)院內(nèi)分泌科住院的74例2型糖尿病足患者(糖尿病足組,年齡59.99歲±11.74歲,病程155.90月±84.44月,其中Wagner1-2級(jí)患者35例,Wagner3級(jí)患者28例,Wagner4級(jí)11例),及年齡/病程匹配的同期住院的81例無(wú)足病的2型糖尿病患者(糖尿病組,年齡63.02歲±9.51歲,病程131.12月±71.82月),檢測(cè)患者血清IGF-1水平及臨床生化指標(biāo),觀察糖尿病足組IGF1水平改變情況,分析血清IGF-1水平對(duì)糖尿病足潰瘍的影響。留取糖尿病足病患者足部難愈性潰瘍的皮膚共15例,其中男性10例,女性5例,年齡60.23歲±5.31歲,糖尿病病程150.14月±54.62月,按wagner分級(jí)分為wagner2級(jí)5例,wagner3級(jí)5例,wagner4級(jí)5例�；颊咔鍎�(chuàng)換藥過(guò)程中,留取病變交界部分的皮膚。用組織學(xué)觀察傷口皮膚成纖維細(xì)胞及新生血管,免疫組織化學(xué)觀察其足部組織的IGF-1的表達(dá)。結(jié)果:糖尿病足組與糖尿病組比較,血清IGF-1水平顯著降低(118.12ng/ml± 49.96ng/ml vs136.51ng/ml± 46.14ng/ml p=0.018)。糖尿病足組按Wagner分級(jí),Wagner4級(jí)較Wagner1-2級(jí)患者的血清IGF-1水平顯著降低(67.88ng/ml± 22.98ng/ml vs 139.23 ng/ml±52.43ng/ml p=0.000)。IGF-1在Wagner1-2級(jí)為139.23ng/ml± 52.43ng/ml,Wagner3級(jí)為109.82ng/ml± 39.06ng/ml,在Wagner4級(jí)為67.88ng/ml± 22.98ng/ml,3組間存在顯著差異。Spearman相關(guān)分析顯示糖尿病足組血清IGF-1水平與ABI呈正相關(guān)(r=0.251,P=0.039),與糖化血紅蛋白(Hb A1c)呈負(fù)相關(guān)(r=-0.233,P=0.046)。回歸分析提示糖尿病足組血清IGF-1與ABI(β=36.805,t=2.165,P=0.034)及糖化血紅蛋白(Hb A1c)(β=-4.439,t=-2.051,P=0.044)之間均存在線性回歸關(guān)系。HE染色結(jié)果顯示,wagner4級(jí)患者潰瘍皮膚中成纖維細(xì)胞及新生血管數(shù)量較wagner3級(jí)患者減少,wagner3級(jí)患者潰瘍皮膚中成纖維細(xì)胞及新生血管數(shù)量較wagner2級(jí)患者減少。免疫組化結(jié)果提示,Wagner4級(jí)較wagner3級(jí)IGF-1積分光密度降低(32.44au±9.88au vs 53.10au±14.49au p=0.017p=0.017),Wagner3級(jí)較wagner2級(jí)IGF-1積分光密度降低(53.10au±14.49au vs86.48au±10.60au p=0.001)。結(jié)論:糖尿病足潰瘍患者血清IGF-1降低,且IGF-1水平越低潰瘍?cè)街?IGF-1水平的降低的同時(shí)Hb A1c的升高及ABI的降低,可能對(duì)糖尿病足潰瘍嚴(yán)重程度產(chǎn)生影響。同時(shí)糖尿病足患者足潰瘍創(chuàng)面IGF-1表達(dá)隨著潰瘍程度加重而減少,提示IGF-1的表達(dá)下調(diào)可能參與了糖尿病足的發(fā)病。趾臂指數(shù)與體脂關(guān)系及其在在2型糖尿病下肢血管病變風(fēng)險(xiǎn)評(píng)估中作用的研究目的:通過(guò)分析2型糖尿病患者趾臂指數(shù)(TBI)與體脂之間的關(guān)系,了解體脂對(duì)2型糖尿病患者TBI的影響,探討TBI及體脂在糖尿病下肢血管病風(fēng)險(xiǎn)評(píng)估中的意義。方法:選擇收集踝肱指數(shù)(ABI)及TBI均正常范圍的2型糖尿病患者123例,收集患者一般資料,臨床生化指標(biāo),應(yīng)用BCA-2A型人體成分分析儀定量測(cè)量身體不同部分的主要成分。將TBI按二分位數(shù)分為2組,TBI較高組:0.82≤TBI1.12,TBI較低組:0.6TBI0.82。將各組間身體成分進(jìn)行比較,分析體脂成分與TBI之間的關(guān)系。結(jié)果:兩組患者的2型糖尿病病程、糖化血紅蛋白(Hb A1c)、空腹及餐后血糖、膽固醇、甘油三酯、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、胰島素抵抗指數(shù)均無(wú)明顯差異,而TBI較低組與TBI較高組比較,臥位收縮壓(133.53±15.35mm Hg vs 123.85±26.95 mm Hg,p=0.007),臥位血壓差(61.40±15.49 mm Hg vs51.80±25.52 mm Hg,p=0.014),體脂百分比(29.09±6.10 vs 26.75±6.28,p=0.038),身體年齡(63.19±14.04歲vs 56.77±13.50歲,p=0.011),內(nèi)臟脂肪/軀干肌肉(0.45±0.13 vs 0.40±0.13,p=0.045),上肢脂肪/上肢肌肉(0.45±0.13 vs 0.40±0.13,p=0.043),下肢脂肪/下肢肌肉(0.45±0.13 vs 0.40±0.13,p=0.038)升高。多元逐步回歸分析提示身體年齡(β=-0.002,p=0.003)、立位壓差(β=-0.002,p=0.013)、體脂百分比(β=-00.004 p=0.014)為T(mén)BI降低的獨(dú)立危險(xiǎn)因素。結(jié)論:我們的研究發(fā)現(xiàn),在ABI正常的2型糖尿病患者中TBI越低,體脂含量越多,身體年齡及脈壓差越大,體脂含量增多與身體年齡及脈壓差增大均為T(mén)BI降低的獨(dú)立風(fēng)險(xiǎn)因素。重視TBI及體脂檢測(cè),對(duì)于2型糖尿病患者下肢血管病變風(fēng)險(xiǎn)早發(fā)現(xiàn)及早干預(yù)有積極的作用。
[Abstract]:The study of insulin growth factor 1 in patients with type 2 diabetic foot disease: To study the changes of serum insulin like growth factor 1 (IGF-1) level and the expression of IGF-1 in the skin tissues of different levels of ulceration and its effect on diabetic foot ulcers in patients with diabetic foot ulcers. Methods: to select 2012.01-2014.06 in the endocrinology of PLA 306th hospital. 74 cases of type 2 diabetic foot patients (diabetic foot group, age 59.99 years old + 11.74 years old, 155.90 months of age 155.90 + 84.44 months, 35 cases of Wagner1-2, 28 cases, 11 Wagner4), and 81 patients with non foot disease in the same period of age / course of illness (diabetes group, age 63.02 years old, 9.51 years, course of illness) .12 month + 71.82 months), the level of serum IGF-1 and clinical biochemical indexes were detected and the changes of IGF1 level in diabetic foot group were observed and the effects of serum IGF-1 level on diabetic foot ulcers were analyzed. There were 15 cases of foot refractory ulcer in diabetic foot disease patients, including 10 cases of male, 5 women, 60.23 years old and 5.31 years of diabetes. From 150.14 months to 54.62 months, 5 cases of wagner2 grade, 5 cases of wagner3 grade and 5 cases of wagner4 grade were divided according to the grade of Wagner. The skin of the junctional part of the lesion was retained during the debridement and change of the debridement. The expression of IGF-1 in the foot tissue was observed by histology and immunohistochemistry. Results: diabetic foot group and sugar In the urine sickness group, the serum IGF-1 level was significantly lower (118.12ng/ml 49.96ng/ml vs136.51ng/ml + 46.14ng/ml p=0.018). The serum IGF-1 level of the diabetic foot group was significantly lower than that of the Wagner1-2 patients (67.88ng/ml + 22.98ng/ml 139.23). 52.43ng/ml, 109.82ng/ml + 39.06ng/ml and 67.88ng/ml + 22.98ng/ml at Wagner4 level, there were significant differences in.Spearman correlation between the 3 groups. The serum IGF-1 level in the diabetic foot group was positively correlated with ABI (r=0.251, P=0.039), and the regression analysis suggested diabetes. There was a linear regression relationship between IGF-1 and ABI (beta =36.805, t=2.165, P=0.034) and glycosylated hemoglobin (Hb A1c) (beta =-4.439, t=-2.051, P=0.044) in the foot group, which showed that the number of fibroblasts and neovascularization in the ulcer skin of the patients with wagner4 grade was less than that of those in the patients, and the fibroblasts in the ulcer skin were thinner. The number of cell and neovascularization was lower than that of wagner2. The results of immunohistochemistry showed that the light density of Wagner4 level was lower than that of wagner3 IGF-1 integral (32.44au 9.88au vs 53.10au + 14.49au p=0.017p=0.017), and Wagner3 level was lower than that of wagner2 class. Conclusion: diabetic foot ulcer The patients' serum IGF-1 decreased, and the lower the IGF-1 level, the heavier the ulcers, the increase of Hb A1c and the decrease of ABI, which may affect the severity of diabetic foot ulcers, and the IGF-1 expression in the foot ulcer of diabetic foot patients decreased with the aggravation of the ulcer degree, suggesting that the down regulation of IGF-1 expression may be involved in the sugar expression. The relationship between the toe arm index and body fat and its role in the risk assessment of lower extremity vascular lesions in type 2 diabetes. Objective: To investigate the relationship between the toe arm index (TBI) and body fat in type 2 diabetic patients, to understand the effect of body fat on TBI in type 2 diabetic patients and to explore the risk of TBI and body fat in diabetic lower extremity vascular disease. Methods: 123 cases of type 2 diabetic patients who collected the ankle brachial index (ABI) and the normal range of TBI were selected to collect the general data of the patients, the clinical biochemical indexes and the quantitative measurement of the main components of different parts of the body by using the BCA-2A body component analyzer. The TBI was divided into 2 groups according to the two digits, and the higher TBI group: 0.82 < TBI1.12, TBI compared. Low group: 0.6TBI0.82. compared body composition in each group and analyzed the relationship between body fat composition and TBI. Results: two groups of patients with type 2 diabetes, glycosylated hemoglobin (Hb A1c), fasting and postprandial blood glucose, cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and insulin resistance index were not obvious The difference was found in the lower TBI group and the higher TBI group, and the supine systolic pressure (133.53 + 15.35mm Hg vs 123.85 + 26.95 mm Hg, p=0.007), the poor blood pressure (61.40 + 15.49 mm Hg vs51.80 25.52 mm), the percentage of body fat (29.09 + 6.10 26.75 + 6.28,), body age (63.19 + 14.04 years, 56.77 + 26.95), visceral fat / Trunk muscles (0.45 + 0.13 vs 0.40 + 0.13, p=0.045), upper limb fat / upper limb muscles (0.45 + 0.13 vs 0.40 + 0.13, p=0.043), lower limbs fat / lower limb muscles (0.45 + 0.13 vs 0.40 + 0.13, p=0.038). Multivariate stepwise regression analysis suggested that the body age (beta =-0.002, p= 0.003), orthostatic pressure (beta =-0.002, p=0.013), body fat percentage (beta =-00.004 p=0.0) 14) independent risk factors for TBI reduction. Conclusion: our study found that the lower the TBI in patients with type 2 diabetes, the lower the TBI, the more the body fat content, the greater the body age and pulse pressure, the increase of body fat and the increase of the body age and pulse pressure are the independent risk factors for the decrease of TBI. The value of TBI and body fat detection, for type 2 diabetes patients, is emphasized. Early detection and early intervention have a positive effect on the risk of lower limb vascular disease.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R587.2

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相關(guān)期刊論文 前1條

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本文編號(hào)：1774885