A Study On The Relationship Between Cystatin C,Fibrinogen And Type 2 Diabetic Foot Ulcer

Objective: Through the analysis of serum cystatin C（CysC）levels,fibrinogen（FIB）levels in diabetic patients and Type 2 Diabetic Foot Ulcer（DFU）,we aim to explore the influence of CysC,FIB in occurrence and development of DFU.Methods: 184 patients with type 2 diabetes admitted to the department of endocrinology,affiliated medical college of guilin medical college from January 2017 to May 2018 were selected as the study subjects,and general information of the study subjects including age,gender,body mass index（BMI）and course of disease were collected.And serum biochemical indexes including triglyceride（TG）,cholesterol（CHOL）,high density cholesterol（HDL）,low density cholesterol（LDL）,urinary inhibition C（CysC）,fibrinogen（FIB）,plasma D-Dimer（D-Dimer）,glomerular filtration rate（GRF）,albumin（propagated）,white blood cells（WBC）,neutrophil ratio（NEUT）,fasting plasma glucose（FPG）,blood sugar 2 hours after meal（2 h PG）,uric acid（UA）,glycosylated hemoglobin（Hb A1c）,fructosamine（FA）.Among them,92 patients with type 2 diabetic foot ulcer（DFU）were treated as the experimental group（group A）,and 92 patients without type 2 diabetic foot ulcer（group B）were treated as the control group.There were 99 males and 85 females.The average age was（60.70±10.93）years old.The experimental group was further divided into 5 groups according to the Wagner grade of diabetic foot ulcer（DFU）: Wagner grade 1（n = 16）,Wagner grade 2（n =39）,Wagner grade 3（n = 23）,Wagner grade 4（n=13）,and Wagner grade 5（n =1）.The general clinical data and serum biochemical indexes of the experimental group and control group were analyzed retrospectively.Through Pearson correlation analysis,the correlation between Wagner grading level of DFU patients and serum CysC and FIB level was studied.Logistic univariate and multivariate regression were used to analyze the risk factors of DFU.By plotting the ROC curve of DFU related influencing factors and calculating the area under the curve,the predictive value of meaningful serum biochemical indexes for DFU patients was analyzed and evaluated.Results: The results of general clinical data analysis showed that the age and disease course of the DFU group were significantly higher than that of the non-dfu group,while the BMI was lower than that of the non-dfu group.There were statistically significant differences in age,disease course and BMI between the two groups（P<0.05）,while there was no statistically significant difference in gender between the two groups（P>0.05）.Among the serum biochemical indexes,TG,CHOL,HDL,CysC,FIB,D-Dimer,GFR,WBC and NEUT showed statistically significant differences between the experimental group and the control group（P<0.05）.However,there was no significant difference in LDL,FPG,2h PG,UA,Hb A1 c or FA between the two groups（P>0.05）.In the correlation analysis,the correlation between DFU severity and CysC and FIB levels in patients with type 2 diabetic foot ulcer was statistically significant（P<0.05）,and the CysC and FIB levels were positively correlated with Wagner grading（r=0.209;r=0.436）.Logistic univariate regression analysis showed that Age,course of disease,BMI,TG,CHOL,HDL,CysC,FIB,D-Dimer,GFR,WBC and NEUT were risk factors for the occurrence and development of type 2 diabetic foot ulcer（P<0.05）.ROC curve analysis shows that CysC,FIB and NEUT have predictive value for DFU.Conclusion: CysC and FIB are independent risk factors for DFU progression in patients with T2 DM,and changes in CysC and FIB levels are of guiding significance for the exploration of the pathogenesis and development mechanism of DFU,risk prediction,and the innovation of diagnosis and treatment methods.