The Effect And Its Significance Of Interventional Therapy On The Serum Levels Of Endothelin And Nitric Oxide In Patients With Type2Diabetic Peripheral Arterial Disease

Objective:By observing the levels of endothelin(ET) and nitricoxide(NO) in type2diabetic patients with peripheral arterial disease(PAD)and its change before and after the operation of arterial angiography, balloondilation and stent implantation, aims to study the relationship betweenendothelial dysfunction and type2diabetic peripheral lesions. In addition, tofurther explore the effect of interventional therapy on endothelial function andthe correlativity between the change of endothelial function and the vascularrestenosis and thrombosis after intervention.Methods:25type2diabetic patients with peripheral arterial disease(Fontaine degreeⅡ b—Ⅳ) in endocrinology department of our hospital whounderwent sussessful operation of arterial angiography, balloon dilation andstent implantation from December2012to December2013were enrolled toparticipate in the study (PTA group). Over the same period, another25type2diabetic patients (clinical and auxiliary examination were used to exclude theacute and chronic complications of diabetes mellitus and other comorbidity) inour hospital were chosen as diabetes mellitus group (T2DM group).Furthermore,25healthy individuals were chosen as reference objects (Controlgroup). Four millilitre elbow venous blood of PTA group and T2DM groupwere taken at6:00am the next morning after a10-hour of fasting (PTA group:pe-interventional venous blood). The levels of fasting blood-glucose (FBG),glycosylated hemoglobin (HbA1c), cholesterol (TC), triglyceride (TG),high-density lipoprotein (HDL), low-density lipoprotein (LDL), endothelin(ET) and nitric oxide (NO) were tested. The venous blood specimens ofcontrol group were taken under the same conditions and the levels of aboveindexes were tested too. During percutaneous lower extremity arteries intervention of PTA group,4ml of the arterial blood specimens were collectedrespectively from the arterial sheath after the successful placement of thearterial sheath (pre-interventional arterial blood), or from distal artery ofstenosis or occlusion site respectively after the guide wire and catheter passingthrough the arterial segment of stenosis or occlusion (ischemic areaprior-interventional arterial blood) and after balloon dilatation or stentimplantation (ischemic area post-interventional arterial blood). The venousblood specimens were collected at24h after intervention (post-interventionalvenous blood). Their levels of ET and NO were tested. SPSS13.0softwarewas used for statistical analysis. The measurement data was shown bymeans±standard deviation. T-test was used for the comparision between thetwo groups. The comparision between multiple groups was performed by OneWay analysis of variance (ANOVA). Linear correlation analysis was used forthe comparision among parameters. P＜0.05was considered statisticallysignificant.Results:1The levels of FBG and HbA1c among three groups: In control groupwere respectively5.09±0.68mmol/L,4.88±0.83%; in T2DM group wererespectively6.71±0.74mmol/L,7.00±1.34%; in PTA group were respectively8.09±1.03mmol/L,8.56±1.27%. Comparing with control group, the levels ofFBG and HbA1c of T2DM group and PTA group were significantly higher(T2DM group and control group: t=8.053, P<0.01; t=6.731, P<0.01. PTAgroup and control group: t=12.187, P<0.01; t=12.112, P<0.01). The levels ofFBG and HbA1c of PTA group were much higher than that of T2DM group(t=5.461, P<0.01; t=4.222, P<0.01). The difference between groups weresignificant.2The levels of blood lipid among three groups: The levels of TC, TG,HDL and LDL: In control group were respectively3.85±0.77mmol/L,1.18±0.31mmol/L,1.54±0.27mmol/L,2.88±0.68mmol/L; in T2DM groupwere respectively4.33±0.89mmol/L,1.71±0.36mmol/L,1.31±0.23mmol/L,3.35±0.66mmol/L; in PTA group were respectively5.00±0.95mmol/L, 2.06±0.37mmol/L,1.11±0.23mmol/L,4.10±0.80mmol/L. Compared withcontrol group, the levels of TC, TG and LDL of T2DM group and PTA groupwere significantly higher (T2DM group and PTA group: t=2.048, P<0.05;t=5.502, P<0.01; t=2.470, P<0.05. PTA group and control group: t=4.721,P<0.01; t=9.042, P<0.01; t=5.820, P<0.01); but the levels of HDL weresignificantly lower (T2DM group and PTA group: t=-3.212, P<0.01. PTAgroup and control group: t=-6.080, P<0.01). The levels of TC, TG and LDLof PTA group were significantly higher than that of T2DM group (t=2.593,P<0.05; t=3.359, P<0.01; t=3.641, P<0.01); however, the levels of HDL weresignificantly lower than that of T2DM group (t=-3.065, P<0.01). All of thedifferences were statistically significant.3The serum levels of ET: The ET levels of venous blood: Control groupwere2.96±0.83pg/mL; T2DM group were5.48±1.13pg/mL, which weresignificantly higher than that of control group (t=8.989, P<0.01). The levels ofpre-interventional venous blood in PTA group were7.63±1.00pg/mL, whichwere higher than that in control group and T2DM group (t=17.912, P<0.01;t=7.116, P<0.01). The levels of post-interventional venous blood were9.22±1.13pg/mL, which were significantly higher than that ofpre-interventional venous blood (t=5.257, P<0.01). The ET levels in arterialblood of PTA group: pre-interventional arterial blood were7.64±1.01pg/mLand there was no significant difference comparing with that in venous blood(P>0.05); ischemic area prior-interventional arterial blood were10.45±1.33pg/mL, which were higher than that of pre-interventional arterialblood (t=8.422, P<0.01); ischemic area post-interventional arterial blood were13.18±1.05pg/mL, which were significantly higher than that ofpre-interventional arterial blood and ischemic area prior-interventional arterialblood (t=19.035, P<0.01; t=8.092, P<0.01).4The serum levels of NO: The NO levels of venous blood: Control groupwere49.61±3.48μmol/L, T2DM group were44.62±3.56μmol/L, which werelower than that of control group (t=-5.014, P<0.01). The levels ofpre-interventional venous blood in PTA group were40.14±3.02μmol/L, which were lower comparing with that of control group and T2DM group (t=-10.283,P<0.01; t=-4.796, P<0.01). The levels of post-interventional venous bloodwere30.60±3.63μmol/L, which were lower than that of pre-interventionalvenous blood (t=-10.095, P<0.01). The NO levels in arterial blood of PTAgroup: pre-interventional arterial blood were40.11±3.01μmol/L and there wasno significant difference comparing with that in venous blood (P>0.05);ischemic area prior-interventional arterial blood were22.35±3.48μmol/L,which were significantly lower than that of pre-interventional arterial blood(t=-19.323, P<0.01); ischemic area post-interventional arterial blood were26.06±3.45μmol/L,which were lower than that of pre-interventional arterialblood (t=-15.358, P<0.01) and were higher than that of ischemic areaprior-interventional arterial blood (t=3.790, P<0.01).5The correlation between ET and NO: Liner correlation analysis wasused to explore the correlation between ET and NO in venous blood of T2DMgroup and pre-intervention of PTA group. Negative correlation existedbetween the levels of ET and NO (r=-0.942, P<0.01).Conclusions:1Comparing with the diabetic patients, the levels of serum ET in type2diabetic patients with PAD are significantly higher, while the levels of NO aresignificantly lower. There is a close relationship between endothelialdysfunction and lower extremity arterial disease.2The interventional treatment can further aggravate the impairment ofvascular endothelial function, enhance inflammatory reaction and disturb thebalance between ET and NO, which can increase the risk of arterial restenosisand thrombosis after the interventional therapy. Therefore, early protection ofendothelial function and anti-inflammatory treatment are necessary forpatients after interventional operation.