Superoxide Dismutase(SOD) Changes And Its Significance In Diabetic Patients With Lower Extremity Vascular Disease Before And After The Intervention

Objective: Through observe the levels of serum Superoxidedismutase（SOD） levels in patients with peripheral arterial disease（PAD） intype2diabetic patients and healthy persons, to investigate the changes ofserum Superoxide dismutase（SOD） levels in patients with type2diabeteslower limb vascular lesions before and after interventional therapy. To discussthe oxidative stress level in diabetic patients with lower extremity vascularlesions and the effects that interventional treatment on serum Superoxidedismutase（SOD）. In order to investigate the pathogenesis of diabetic largevascular disease and the effects of interventional treatment on oxidative stressin local blood vessel. To provide theoretical basis for anti-oxidation and toimprove the long-term effect after intervention in diabetic patients with lowerextremity vascular lesions.Methods:42diabetic patients with lower extremity vascular lesions inour hospital was admitted in our department who accept the interventionaltreatment.16diabetic patients with peripheral arterial disease who accept anoperation method of arteriography has been choosed as group A,24cases whoaccept interventional treatment as group B. Among this cases, balloondilatation was given to16patients（B₁）,8patients have an operation of stentimplantation （B₂）.In addition, the selection of our hospital over the sameperiod20cases of healthy persons as normal control group （group C）.Conditions selected this case （group A and B） are as follows:1. all patientswere selected with the1999WHO diagnostic criteria for diabetes;2. all caseshave clinical manifestation of lower extremity vascular disease: Fontainepoints Grade II_b-IV grade（Fontaine points Grade: grade I: weakness、sense ofcoldness; grade II_a: low-grade intermittent claudication, the walking distanceless than500m; grade II_b: serious intermittent claudication, the walking distance less than200m; grade III: rest pain; grade IV: ulcer or gangrene）, andafter Doppler ultrasonic testing,ABI,lower extremity CT angiography （CTA）confirmed;3.Cases that with diabetic ketoacidosis, hyperglycemichyperosmolar status; acute infections, the moist gangrene with infections offoot which need a debridement, the hematological system disease, and severedisease of liver or kidney were excluded from the observed objects. Before theintervention, patients of group A and B were supine to draw3ml fastingvenous blood（venous blood before intervention）from elbow vein at morning6:00, to test TC,TG,HDL-C,LDL-C,HbA1c,SOD.Patients of group C weredetected for the above-mentioned indexes in the same condition. During theinterventional treatment, after the artery sheath catheter inserted, immediatelydrew3ml arterial blood （arterial blood before intervention）, when threadthrough a narrow area by a catheter, drew3ml blood from the end of artery（arterial blood from the location of ischemia before interventional treatment）,after balloon or stent implantation,took blood from the ischemic artery（arterialblood from the location of ischemia after interventional treatment）,after theintervention, all patients were24hour after intervention supine morning6:00took elbow vein blood（venous blood after intervene）. The blood which weretaked from the vessel was put in vitro,3000rpm centrifuge10min,supernatantswere collected, and saved in-20degree until being tested. SOD were detectedby WST-1,which kit was from nanjing jiancheng Biotech companies,operating in strict accordance with instructions. Measurement data usedmeans±standard deviation, SPSS13.0software was took for statistical analysis.Between the two groups using two sample t-test to compared, multiple groupcomparison by single factor analysis of variance（ANOVA）,enumeration dataused Chi-square test. test=0.05,P＜0.05was considered statistically different.Results:1.16cases who were operated lower artery angiography hade no obviously stenosis（clinical symptoms caused by lumbar spinal stenosis or surrounding nerve pathological changes which caused by diabetes）.In group B,24cases all been operated successfully, among this cases,balloon dilatation was given to16patients,8patients have an operation of stent implantation. The lipid variation among groups of A, B and C:the level of TC, TG, LDL-C in group A （venous blood before intervention） respectively was（4.23±0.83）mmol/L,（1.84±0.34）mmol/L,（1.28±0.45）mmol/L,（2.42±0.86）mmol/L. the level of TC, TG, LDL-C in group B （venous blood before intervention） respectively was （4.26±0.57）mmol/L,（1.96±0.49）mmol/L,（1.33±0.33）mmol/L,（2.78±0.79） mmol/L; the level of TC,TG,LDL-C in group C （venous blood before intervention） respectively was （3.47±0.41）mmol/L,（1.24±0.27）mmol/L,（1.64±0.38）mmol/L,（1.48±0.36）mmol/L. The level of TC,TG,LDL-C in group A was higher than group C（t=3.574,P＜0.05; t=6.251,P＜0.01; t=2.774,P＜0.05）. The level of TC,TG,LDL-C in group B was higher than group C（t=4.736,P＜0.05;t=5.484,P＜0.01; t=4.470,P＜0.01）. The lipid variation in group A haveno significant difference with group B（P＞0.05）.The level of HDL-cin group A and C、group B and C had no significance（P＞0.05）.2.Thelevel of HbA1c,SOD,ABI in group A and B （venous blood before intervention）respectively compared with group C: the level of HbA1c in threegroups respectively was （7.68±1.60）%,（8.86±1.96）%,（4.56±0.67）%, the level of HbA1c in group A and B is higher than group C（t=7.787, P＜0.01; t=9.219, P＜0.01）; the level of HbA1c in group A was lower thangroup B（t=2.048,P＜0.05）.The level of SOD in three groups respectivelywas（46.1±3.13） U/ml,（35.37±3.58）U/ml,（60.50±6.99）U/ml, the level of SOD in group A and B was lower than group C（t=8.420, P＜0.01; t=14.324, P＜0.01）; the level of SOD in group A was higher than group B（t=10.092,P＜0.01）. The level of ABI in three groups respectively was0.70±0.12,0.58±0.13,1.15±0.07. the level of ABI in group A and B waslower than group C（t=14.324, P＜0.01; t=17.392, P＜0.01）, the level ofABI in group B was lower than group A（t=3.027,P＜0.01）. HbA1c and SOD have negative correlation（r=-0.541,P＜0.01）.3. The level of SODcompared between in vein and artery respectively group A and B: in group A, The level of SOD in vein is（46.10±3.13）U/ml, in artery beforeintervention was （44.00±3.51）U/ml. The level of SOD in vein and in art ery had no significant（P＞0.05）. in group B, The level of SOD in veinwas35.37±3.58U/ml, in artery before intervention was34.81±3.22U/ml;in group B, The level of SOD in vein and in artery also had no significant（P＞0.05）.4.The level of SOD in group B: In groupB₁and B₂, the level of SOD in arterial blood before intervention respectively was（35.70±3.04） U/ml,（36.07±2.14）U/ml. These two case had no significant（P＞0.05）. The level of SOD in arterial blood from the location of ischemia before interventional treatment respectively was （32.95±3.52）U/ml,（33.59±2.64）U/ml, these two case had no significant（P＞0.05）.The SOD level of these two cases in arterial blood from the location of ischemia before interventional treatment was lower than the level of SOD in arterial blood before intervention（t=2.741,P＜0.05; t=2.704,P＜0.05）.In arterialblood after intervention, the level of SOD respectively was （29.40±5.49）U/ml,（26.68±2.31）U/ml. These two case had no significant（P＞0.05）. TheSOD level of these two cases in arterial blood from the location of ischemia after interventional treatment was lower than the level of SOD in arterial blood from the location of ischemia before interventional treatment （t=2.536,P＜0.05; t=5.005,P＜0.01）.Conclusion:1. The level of serum SOD have no difference between invein and artery;2.serum SOD and HbA1c have negative correlation;3. TheSOD level in arterial blood from the location of ischemia is lower than thelevel of SOD in arterial blood before intervention. After interventionaltreatment, serum SOD is more lower, which enhanced oxidative stress. Thisphenomenon indicated that the oxidative stress play a important role inrestenosis.4.The artery which have pathological changes itself exists theoxidative stress, it has the mechanical damages of the vessel andischemia-reperfusion injury after balloon dilatation or stent implantation thatincreased the level of free radical, and improve the oxidative stress in localblood vessel. This reaction process increase the risk of restenosis afterinterventional treatment.