| ObjectiveOur research included two main parts. The first part was to investigate the correlation of glucose fluctuation and diabetic lower extremity arterial disease (DLEAD) in type 2 diabetes mellitus (T2DM) and explore the mechanism of glucose fluctuation on DLEAD and provide possible clues for clinically rational hypoglycemic and theoretical basis for protection DLEAD, DLEAD patients were chosen as the main research object, and were compared with T2DM patients without lower extremity arterial disease and normal healthy person who had the general clinical data matching.2. The second part was to investigate the correlation of xidative stress inflammatory response and diabetic lower extremity vascular disease in type 2 diabetes mellitus and explore the possible mechanism of lipoic acid injection on DLEAD and provide clinically theoretical basis for protection DLEAD. DLEAD patients were chosen as the main research object, and the changes of ankle-brachial index (ABI) and clinical symptoms score were observed before and after lipoic acid injection for treatment of DLEAD, as well as the influence of lipoic acid injection on high sensitivity C reactive protein (hs-CRP) and 8-iso-prostaglandin 2a (8-iso-PGF2a) levels.Methods1. The T2DM subjects were chosen from endocrinologist in our hospital and were divided into two groups, type 2 diabetic patients with lower extremity arterial disease (Group DLEAD, n=50) and without lower extremity arterial disease (Group T2DM, n=30), which had the general clinical data matching.20 normal healthy person were selected in the our medical center at the same period for control group (group NC, n=20), who had the general clinical data matching and were confirmed without diabetes through OGTT trial. Based on ABI value, Group DLEAD were divided into moderate or severe group (Group DLEAD 1, ABI<0.7) and mild lesion group (Group DLEAD2, 0.7≤ABI<0.9). Lower extremity vascular lesions were scored in group DLEAD. All subjects were lined 72 hours glucose monitoring by wearing a continuous glucose monitoring system, and then blood glucose fluctuations are calculated and recorded parameters, such as mean amplitude of glycemic excursions (MAGE), maximum days of blood sugar fluctuations (LAGE), standard deviation of blood glucose (SDBG), absolute means of daily differences (MODD) and mean of blood glucose (MBG). At the same time, the clinical data were recorded and hs-CRP and 8-iso-PGF2a levels were determined, and then they were compared between group DLEAD, group T2DM and group NC, so did they between group DLEAD 1 and group DLEAD2. Pearson correlation analysis and multiple linear regression analysis were used for correlation analysis.2. DLEAD patients were divided randomly two groups, treatment group (group A, n=25) and conventional treatment group (group B, n=25). The conventional treatment group was treated with conventional antihypertensive, antidiabetic and lipid-lowering therapy. The treatment group was given lipoic acid injection dissolved in in 250ml 0.9% sodium chloride solution by instillation once per day for two weeks, in addition to the conventional therapy. The indexes before and after the treatment were compared between the two groups, including clinical symptom score, ABI, hs-CRP and 8-iso-PGF2a value.Results1.1 There were no statistical differences of age, systolic blood pressure (SBP), body mass index (BMI), ratio of gender, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), total cholesterol (TC), glycated hemoglobin (HbAlc), fasting plasma glucose (FPG) level and course of diabetes (CD) between DLEAD and T2DM group.1.2 In DLEAD, T2DM and NC groups, the hs-CRP,8-iso-PGF2α, LAGE, MAGE, MODD, SDBG, MBG level showed a decreasing trend, while the ABI level showed an increasing trend, and the differences were statistically significant (P<0.05).1.3 Pearson correlation analysis showed that MAGE was positively correlated with CD, HbA1c, MODD, SDBG, LAGE, hs-CRP and 8-iso-PGF2a in DLEAD group (P<0.05).1.4 The clinical symptom scores and ABI was positively and negatively correlated with CD, MAGE, hs-CRP,8-iso-PGF2α in group DLAED respectively, which was statistically significant (P<0.05). Multiple linear regression analysis showed finally equation:clinical symptom scores =0.592 *MAGE+0.210*hs-CRP+0.163*CD+0.044*8-iso-PGF2a-2.359, ABI=-0.019*MAGE-0.007*hs-CRP-0.005*CD-0.001*8-iso-PGF2a+1.116.1.5 There were no differences of ratio of gender, age, BMI, SBP, DBP, TC, TG, HDL-C, LDL-C, FPG, LAGE level and CD between DLEAD1 group and DLEAD2 group (P>0.05). The group DLEAD1 had greater CD,8-iso-PGF2α, hs-CRP, HbA1c, MAGE, SDBG, MODD, MBG and clinical symptom scores than group DLEAD2, the differences were statistically significant (P<0.05).2.1 There were no differences of ratio of gender, age, SBP, BMI, HDL-C, low-density LDL-C, FPG, TG, TC, hs-CRP and 8-iso-PGF2α level and CD before treatment in both groups (P>0.05). ABI and the clinical symptom scores showed no statistical differences before treatment in both groups (P>0.05).2.2 After 14 days of treatment, clinical symptom scores, hs-CRP and 8-iso-PGF2α decreased in A group, the differences were statistically significant (P<0.05), whereas the results did not found in B group. Compared with B group, the clinical symptom scores, hs-CRP and 8-iso-PGF2α after treatment also had statistically significant differences(P<0.05). The changes of clinical symptom scores, hs-CRP and 8-iso-PGF2a of group A before and after lipoic acid injection for treatment was higher than that of group B, the differences were also statistically significant(P<0.05).Conclusions1.1 Glucose fluctuation in DLEAD patients is greater than that without lower extremity arterial disease. The lower extremity arterial disease is severer, the glucose fluctuation is greater.1.2 The level of oxidative stress and inflammatory factor in DLEAD is greater than that without lower extremity arterial disease. The lower extremity arterial disease is severer, the level of oxidative stress and inflammatory factor is greater.1.3 DLEAD is significant related to glucose fluctuations. Glucose fluctuation possibly participate in the onset and process of DLEAD through oxidative stress and inflammatory response mechanism.2.1 Lipoic acid injection can significantly improve clinical symptom and decrease hs-CRP and 8-iso-PGF2a level in T2DM patients with lower extremity arterial disease.2.2 Lipoic acid injection possibly treates DLEAD through anti-oxidant and anti-inflammatory mechanism. |
PDF Full Text Request