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

Video：

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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

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.	許樟榮. 2017年糖尿病足病防治進展. 中華糖尿病雜志, 2018, 10(1): 68-71.
4.	王婧薷, 楊榮華, 陳曉東. 自體富血小板血漿在糖尿病足治療中的應用進展. 中華損傷與修復雜志(電子版), 2018, 13(2): 139-141.
5.	Mishra SC, Chhatbar KC, Kashikar A, et al. Diabetic foot. BMJ, 2017, 16(359): 5064.
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8.	唐黎之, 童南偉. 美國糖尿病學會2018年版糖尿病醫學診療標準更新內容解讀. 華西醫學, 2018, 33(5): 513-519.
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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.	陳靜, 程慶豐, 陳悅, 等. 糖尿病足患者截肢及生存預后影響因素分析. 中國糖尿病雜志, 2018, 26(2): 123-127.
14.	呂曉玉, 王中京. 糖尿病足創面內miR-29b表達水平與氧化應激介質、炎癥細胞因子的相關性研究. 海南醫學院學報, 2019, 25(4): 302-304, 309.
15.	馬朋朋, 董聰慧, 李偉, 等. 前列地爾注射液聯合二甲雙胍片治療糖尿病足周圍神經病變的臨床研究. 中國臨床藥理學雜志, 2018, 34(16): 1942-1944, 1948.
16.	吳炎, 張睿, 黃冰, 等. 糖尿病足患者血漿脂蛋白相關磷脂酶A2、D-二聚體和纖維蛋白原水平變化及臨床意義. 檢驗醫學與臨床, 2018, 15(14): 2175-2177.
17.	萬瑛. 糖尿病足患者血清IL-18和IL-6濃度監測的臨床意義. 江蘇大學學報(醫學版), 2018, 28(5): 447-449.
18.	錢超, 余建華, 谷費菲, 等. 糖尿病足患者脂蛋白相關磷脂酶A2、D-二聚體及纖維蛋白原水平分析. 國際檢驗醫學雜志, 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.	王艷紅, 岳宗相, 黃榮利, 等. 糖尿病足患者臨床特征及危險因素分析. 華西醫學, 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. 許樟榮. 2017年糖尿病足病防治進展. 中華糖尿病雜志, 2018, 10(1): 68-71.
4. 王婧薷, 楊榮華, 陳曉東. 自體富血小板血漿在糖尿病足治療中的應用進展. 中華損傷與修復雜志(電子版), 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. 內科學. 8版. 北京: 人民衛生出版社, 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, 童南偉. 美國糖尿病學會2018年版糖尿病醫學診療標準更新內容解讀. 華西醫學, 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. 陳靜, 程慶豐, 陳悅, 等. 糖尿病足患者截肢及生存預后影響因素分析. 中國糖尿病雜志, 2018, 26(2): 123-127.
14. 呂曉玉, 王中京. 糖尿病足創面內miR-29b表達水平與氧化應激介質、炎癥細胞因子的相關性研究. 海南醫學院學報, 2019, 25(4): 302-304, 309.
15. 馬朋朋, 董聰慧, 李偉, 等. 前列地爾注射液聯合二甲雙胍片治療糖尿病足周圍神經病變的臨床研究. 中國臨床藥理學雜志, 2018, 34(16): 1942-1944, 1948.
16. 吳炎, 張睿, 黃冰, 等. 糖尿病足患者血漿脂蛋白相關磷脂酶A2、D-二聚體和纖維蛋白原水平變化及臨床意義. 檢驗醫學與臨床, 2018, 15(14): 2175-2177.
17. 萬瑛. 糖尿病足患者血清IL-18和IL-6濃度監測的臨床意義. 江蘇大學學報(醫學版), 2018, 28(5): 447-449.
18. 錢超, 余建華, 谷費菲, 等. 糖尿病足患者脂蛋白相關磷脂酶A2、D-二聚體及纖維蛋白原水平分析. 國際檢驗醫學雜志, 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. 王艷紅, 岳宗相, 黃榮利, 等. 糖尿病足患者臨床特征及危險因素分析. 華西醫學, 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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