Changes And Correlation Of Serum Adropin And 25-(OH)D3 Levels In Patients With Type 2 Diabetic Foot Ulce

Objective:To observe the change of serum Adropin and 25-(OH)D3 in diabetic foot ulcer,and to explore the relationship between Adropin and 25-(OH)D3 with diabetic foot ulcer,to clarify the role of Adropin and 25-(OH)D3 in the occurrence and development of diabetic foot ulcer.Methods:Eighty patients with simple type 2 diabetes mellitus(Group B),eighty patients with diabetic foot ulcer(Group C)and eighty healthy subjects without T2DM(Group A)who were hospitalized in the Department of Endocrinology,Changsha Central Hospital from October 2021 to January 2023 were selected.Patients with diabetic foot ulcers were then divided into non-lower extremity arterial disease(NLEAD)subgroup and lower extremity arterial disease(LEAD)subgroup according to Ankle Brachial Index and the result of lower extremity arterial color ultrasound.General clinical data(gender,age,disease duration,BMI,SBP,DBP)were collected from all study subjects,and relevant biochemical parameters,including HbAlc,TG,TC,LDL-C and HDL-C were measured.Serum 25-(OH)D3 levels were measured by Roche automatic biochemical immunoassay analyzer using chemiluminescence.Serum concentrations of Adropin and IL-6 were measured by ELISA.Insulin resistance index(HOMA-IR)was calculated according to relevant biochemical indexes.Ob serve and analyze the difference of related indexes between three groups and two subgroups,and analyze the level change and correlation of Adropin,25-(OH)D3 and other indexes in diabetic foot ulcer and lower extremity arterial disease by multivariate logistic regression and ROC curve.Results:1.There was no significant difference in gender,age,disease duration,BMI,DBP and LDL-C between the three groups(P>0.05).The levels of HbAlc,TC,IL-6,25-(OH)D3,Adropin,and HOMA-IR were statistically significant among the three groups(P<0.05).2.Spearman correlation analysis showed that serum Adropin was positively correlated with 25-(OH)D3 and HDL-C,and negatively correlated with SBP,DBP,HbAlc,TC,TG,IL-6 and HOMA-IR;serum 25-(OH)D3 was positively correlated with Adropin and HDL-C,and negatively correlated with SBP,HbA1c,TC,TG,IL-6 and HOMA-IR.3.After multivariate logistic regression,Adropin,25-(OH)D3,IL-6 and HOMA-IR were statistically significant in the diabetic foot ulcer model,in which Adropin and 25-(OH)D3 were negatively correlated with the occurrence of diabetic foot ulcers,and IL-6 and HOMA-IR were positively correlated with the occurrence of diabetic foot ulcers.Further ROC curve analysis showed that the areas under the ROC curves of Adropin and 25-(OH)D3 for predicting diabetic foot ulcers were 0.902(9 5%CI:0.850～0.954)and 0.966(95%CI:0.938～0.994),respectively,and the sensitivities and specificities were 85.71%and 92.41%,89.47%and 91.36%,respectively.The area of combined prediction of Adropin and 25-(OH)D3 was 0.975(95%CI:0.955～0.996),and the sensitivity and specificity were 92.31%and 90.24%,respectively.4.The serum levels of Adropin and 25-(OH)D3 in patients with diabetic foot ulcer were related to the degree of Wagner grade.Further correlation analysis showed that the serum levels of Adropin and 25-(OH)D3 were negatively correlated with the degree of Wagner grade.5.Comparison between the two subgroups of diabetic foot ulcers(LEAD and NLEAD):gender,age,disease duration,BMI,SBP,DBP,HbAlc,TG,LDL-C,HDL-C,IL-6 were not statistically significant(P>0.05);HOMA-IR,TC,Adropin,25-(OH)D3 were statistically significant(P<0.05).In the DFU with LEAD model,Adropin and 25-(OH)D3 were negatively correlated with the occurrence of DFU with LEAD.Further ROC curve analysis showed that the areas under the ROC curves of Adropin and 25-(OH)D3 for predicting DFU with LEAD were 0.760(95%CI:0.654～0.867)and 0.947(95%CI:0.905～0.989),respectively,and the sensitivities and specificities were 70.27%and 8 3.33%,67.44%and 86.84%,respectively.The area of combined prediction of Adropin and 25-(OH)D3 was 0.958(95%CI:0.921～0.995),and the sensitivity and specificity were 88.10%and 92.11%,respectively.Conclusion:The Serum Adropin and 25-(OH)D3 levels were negatively correlated with the occurrence of diabetic foot ulcers and lower extremity vascular lesions.They were protective factors for DFU and LEAD,and had certain clinical predictive value for the occurrence of DFU and LEAD,and their combined prediction value was better.In the future,serum Adropin and 25-(OH)D3 may become important indicators for the early diagnosis and prevention of DFU,and bring some help to the diagnosis of the severity of DFU.