Abstract
ObjectiveTo investigate the serum level of cystatin C (CysC), ischemia-modified albumin (IMA), and lipoprotein-associated phospholipase A2 (LP-PLA2) in patients with type 2 diabetes mellitus (T2DM) and with lower extremity atherosclerotic occlusive disease (LEASOD) and their correlation.MethodsFrom March 2017 to December 2019, 110 patients with T2DM with LEASOD, who were treated in our hospital, were selected as the observation group. One hundred ten healthy persons who received medical examination in our hospital during the same period were selected as the control group. Serum CysC, IMA, LP-PLA2, and ankle-brachial index (ABI) were detected in each group. According to the ABI index, the observation group was divided into three subgroups, namely, the mild group (n = 45), the moderate group (n = 42), and the severe group (n = 23). Pearson correlation analysis was used to analyze the relationship between serum CysC, IMA, and LP-PLA2 levels in patients with T2DM with LEASOD and their condition. The receiver operator characteristic (ROC) curve was used to analyze the diagnostic value of serum CysC, IMA, and LP-PLA2 levels in patients with T2DM with LEASOD.ResultsThe serum levels of CysC, IMA, and LP-PLA2 in the observation group were higher than those in the control group (p < 0.05). The serum levels of CysC, IMA, and LP-PLA2 in the severe and the moderate group were higher than those in the mild group, and the serum levels of CysC, IMA, and LP-PLA2 in the severe group were higher than those in the moderate group (p < 0.05). Pearson correlation analysis showed that CysC, IMA, and LP-PLA2 levels were all negatively correlated with ABI (r = −0.802, r = −0.757, r = −0.764, p < 0.001). The ROC curve results showed that the area under the curve (AUC) of serum CysC in the diagnosis of T2DM with LEASOD was 0.806, and the best cut-off value was 1.74 mg/L. The AUC of serum IMA for diagnosis of T2DM with LEASOD was 0.772, and the best cut-off value was 92.58 g/L. The AUC of serum LP-PLA2 in the diagnosis of T2DM with LEASOD was 0.781, and the best cut-off value was 544.86 ng/L. The AUC of the three combined diagnoses of T2DM with LEASOD was 0.863.ConclusionSerum levels of CysC, IMA, and LP-PLA2 were increased in patients with T2DM with LEASOD. Serum CysC, IMA, and LP-PLA2 are closely related to the severity of the disease. The higher the serum levels of CysC, IMA, and LP-PLA2, the more serious the degree of lower extremity arteriosclerosis occlusion, which can be used as an important serum marker to monitor the severity of T2DM with LEASOD. The combined detection of serum CysC, IMA, and LP-PLA2 has good diagnostic value for patients with T2DM with LEASOD.
Highlights
Diabetes is a group of metabolic diseases caused by decreased insulin secretion, insensitivity to insulin action of the body, or both, with a chronic increase of blood glucose level and multiple chronic complications as the main clinical features [1, 2]
The inclusion criteria were as follows: all patients met the diagnostic guidelines for Type 2 diabetes mellitus (T2DM) and lower extremity arteriosclerosis obliterans [13, 14]; all patients had a medical history of T2DM with symptoms such as limb pain, intermittent claudication or ischemic ulcer, and gangrene in the lower limbs, and lower extremity atherosclerotic occlusive disease (LEASOD) was confirmed through color Doppler ultrasound, CT angiography, and other imageological tests to detect the corresponding artery stenosis or occlusion; and all patients should have complete clinical data
Pearson correlation analysis showed that serum Cystatin C (CysC), Ischemia modified albumin (IMA), and LP-PLA2 levels were negatively correlated with the Ankle brachial index (ABI) index (r = −0.802, r = −0.757, r = −0.764, p < 0.001)
Summary
Diabetes is a group of metabolic diseases caused by decreased insulin secretion, insensitivity to insulin action of the body, or both, with a chronic increase of blood glucose level and multiple chronic complications as the main clinical features [1, 2]. The T2DM can cause microvascular and peripheral vascular lesions, leading to lower extremity atherosclerotic occlusive disease (LEASOD), limb ischemia and intermittent claudication, and even lower extremity ulcer, gangrene, or amputation in the severe cases. The incidence of LEASOD is increasing year by year, and 70–80% of patients have no clinical symptoms. Some early manifestations, such as fatigue after exercise and soreness of the lower limbs, are often mistaken by people as a presentation of old age and/or fatigue. Some patients are insensitive to pain due to neuropathy caused by diabetes, and most patients have intermittent claudication, resting pain, ischemic gangrene, and other symptoms when it is difficult to treat, seriously affecting the physical and mental health and quality of life of patients [5, 6]
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