The relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot_West China Medical Journal

Authors：

CHEN Heming ¹ , ZHANG Xiaojun ¹ , CHEN Hao ¹ , HU Lin ¹ , TANG Guojun ¹ , CHEN Xiaoxi ¹ ,  YU Yuan ²

1. Department of Endocrinology, Ankang Central Hospital, Ankang, Shaanxi 725000, P. R. China;
2. Department of Orthopaedics and Microsurgery, Ankang Central Hospital, Ankang, Shaanxi 725000, P. R. China;

Corresponding author：

YU Yuan, Email: yuyuan61800@163.com

Keywords：

Diabetes; Diabetic foot; Inflammation; Nutrition; Prognosis

DOI：

10.7507/1002-0179.201906154

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Objective To explore the relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot.Methods A total of 70 patients with refractory diabetic foot between August 2015 and August 2017 were randomly selected as the observation group. Another 70 patients with diabetes mellitus (without foot ulcer) who visited the hospital in the same period were set as the control group. The observation group was subgrouped into the non-amputation group and the amputation group according to the follow-up endpoint events, and into the grade Ⅲ, Ⅳ, and Ⅴ groups according to Wagner classification method. The blood levels of inflammatory markers and nutritional markers between groups were compared.Results In the observation group, vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 2 (FGF2), fibrinogen (FIB), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-18, lipoprotein phospholipase A2 (LP-PLA2), C-reactive protein (CRP) levels were significantly higher than those in the control group, and albumin (ALB), prealbumin (PA), and transferrin (TRF) levels were significantly lower than those in the control group, with statistically significant differences (P<0.01). The blood levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, and CRP in the amputation group were significantly higher than those in the non-amputation group, and the levels of TRF, ALB, and PA were significantly lower than those in the non-amputation group (P<0.01). There were statistically significant differences in the levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, CRP, TRF, ALB, and PA in patients with diabetic foot with different Wagner grades (P<0.05). The result of multiple logistic regression analysis showed that IL-6 [odds ratio (OR)=1.487, 95% confidence interval (CI) (1.023, 2.120), P<0.001], IL-18 [OR=1.274, 95%CI (1.052, 1.665), P<0.001], LP-PLA2 [OR=1.478, 95%CI (1.126, 1.789), P<0.001], and CRP [OR=2.085, 95%CI (1.574, 2.782), P<0.001] were independent risk factors for the occurrence of refractory diabetic foot, and TRF [OR=0.645, 95%CI (0.002, 0.898), P<0.001], ALB [OR=0.838, 95%CI (0.429, 0.923), P<0.001], and PA [OR=0.478, 95%CI (0.201, 0.984), P<0.001] were independent protective factors for the occurrence of refractory diabetic foot.Conclusion In the clinical treatment of diabetic foot, we should pay attention to the monitoring of the level of inflammatory factors and nutritional status, and it is necessary to timely carry out anti-inflammatory treatment and appropriate nutritional support treatment.

Citation： CHEN Heming, ZHANG Xiaojun, CHEN Hao, HU Lin, TANG Guojun, CHEN Xiaoxi, YU Yuan. The relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot. West China Medical Journal, 2019, 34(12): 1401-1406. doi: 10.7507/1002-0179.201906154 Copy

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13.	陈静, 程庆丰, 陈悦, 等. 糖尿病足患者截肢及生存预后影响因素分析. 中国糖尿病杂志, 2018, 26(2): 123-127.
14.	吕晓玉, 王中京. 糖尿病足创面内miR-29b表达水平与氧化应激介质、炎症细胞因子的相关性研究. 海南医学院学报, 2019, 25(4): 302-304, 309.
15.	马朋朋, 董聪慧, 李伟, 等. 前列地尔注射液联合二甲双胍片治疗糖尿病足周围神经病变的临床研究. 中国临床药理学杂志, 2018, 34(16): 1942-1944, 1948.
16.	吴炎, 张睿, 黄冰, 等. 糖尿病足患者血浆脂蛋白相关磷脂酶A2、D-二聚体和纤维蛋白原水平变化及临床意义. 检验医学与临床, 2018, 15(14): 2175-2177.
17.	万瑛. 糖尿病足患者血清IL-18和IL-6浓度监测的临床意义. 江苏大学学报(医学版), 2018, 28(5): 447-449.
18.	钱超, 余建华, 谷费菲, 等. 糖尿病足患者脂蛋白相关磷脂酶A2、D-二聚体及纤维蛋白原水平分析. 国际检验医学杂志, 2015, 10(22): 3303-3304.
19.	Mohammad NA, Khresheh RM. Evaluate the effect of education interventions in the prevention of diabetic foot ulcers through knowledge of the disease and self-care practices in Saudi Arabia. Open Access Maced J Med Sci, 2018, 6(11): 2206-2213.
20.	王艳红, 岳宗相, 黄荣利, 等. 糖尿病足患者临床特征及危险因素分析. 华西医学, 2017, 32(8): 1199-1202.

1. Malta DC, Andrade S, Oliveira TP, et al. Probability of premature death for chronic non-communicable diseases, Brazil and Regions, projections to 2025. Rev Bras Epidemiol, 2019, 22: e190030.
2. de Gaetano M, McEvoy C, Andrews D, et al. Specialized pro-resolving lipid mediators: modulation of diabetes-associated cardio-, reno-, and retino-vascular complications. Front Pharmacol, 2018, 19(9): 1488.
3. 许樟荣. 2017年糖尿病足病防治进展. 中华糖尿病杂志, 2018, 10(1): 68-71.
4. 王婧薷, 杨荣华, 陈晓东. 自体富血小板血浆在糖尿病足治疗中的应用进展. 中华损伤与修复杂志(电子版), 2018, 13(2): 139-141.
5. Mishra SC, Chhatbar KC, Kashikar A, et al. Diabetic foot. BMJ, 2017, 16(359): 5064.
6. 葛均波, 徐永健. 内科学. 8版. 北京: 人民卫生出版社, 2013: 175.
7. American Diabetes Association. American Diabetes Association Standards of Medical Care in Diabetes—2019. Diabetes Care, 2019, 42: S1-S186.
8. 唐黎之, 童南伟. 美国糖尿病学会2018年版糖尿病医学诊疗标准更新内容解读. 华西医学, 2018, 33(5): 513-519.
9. Bakker K, Apelqvist J, Schaper NC. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev, 2012, 28(Suppl 1): 225-231.
10. Wagner FW Jr. The dysvascular foot: a system of diagnosis and treatment. Foot Ankle, 198l, 2(2): 64-122.
11. Wang T, Li X, Fan LH, et al. Negative pressure wound therapy promoted wound healing by suppressing inflammation via down-regulating MAPK-JNK signaling pathway in diabetic foot patients. Diabetes Res Clin Pract, 2019, 150(15): 81-89.
12. Atic R, Deveci E. Endothelin 1, NF-kappa B, and ADAM-15 expression in diabetic foot wounds. Bratisl Lek Listy, 2019, 120(1): 58-64.
13. 陈静, 程庆丰, 陈悦, 等. 糖尿病足患者截肢及生存预后影响因素分析. 中国糖尿病杂志, 2018, 26(2): 123-127.
14. 吕晓玉, 王中京. 糖尿病足创面内miR-29b表达水平与氧化应激介质、炎症细胞因子的相关性研究. 海南医学院学报, 2019, 25(4): 302-304, 309.
15. 马朋朋, 董聪慧, 李伟, 等. 前列地尔注射液联合二甲双胍片治疗糖尿病足周围神经病变的临床研究. 中国临床药理学杂志, 2018, 34(16): 1942-1944, 1948.
16. 吴炎, 张睿, 黄冰, 等. 糖尿病足患者血浆脂蛋白相关磷脂酶A2、D-二聚体和纤维蛋白原水平变化及临床意义. 检验医学与临床, 2018, 15(14): 2175-2177.
17. 万瑛. 糖尿病足患者血清IL-18和IL-6浓度监测的临床意义. 江苏大学学报(医学版), 2018, 28(5): 447-449.
18. 钱超, 余建华, 谷费菲, 等. 糖尿病足患者脂蛋白相关磷脂酶A2、D-二聚体及纤维蛋白原水平分析. 国际检验医学杂志, 2015, 10(22): 3303-3304.
19. Mohammad NA, Khresheh RM. Evaluate the effect of education interventions in the prevention of diabetic foot ulcers through knowledge of the disease and self-care practices in Saudi Arabia. Open Access Maced J Med Sci, 2018, 6(11): 2206-2213.
20. 王艳红, 岳宗相, 黄荣利, 等. 糖尿病足患者临床特征及危险因素分析. 华西医学, 2017, 32(8): 1199-1202.

West China Medical Journal

The relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot

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