| Objective : In 2011, there were 366 million people with diabetes worldwide, and it has been estimated that the number may surpass 552 million by 2030. Lower limbs’ angiopathy, as one of the most common type 2 diabetic complications, impairs quality of life, increases mortality and results in high economic burden for the family and the society. The mechanism of type 2 diabetic lower limbs’ angiopathy mechanism has not yet been clarified completely. Several studies have confirmed that oxidative stress(OS) is correlated with type 2 diabetic lower limbs’ angiopathy. Further studies about the association will’help preventing and treating the type 2 diabetic lower limbs’ angiopathy. 8-iso-prostaglandin f2α(8-iso-PGF2α),which is an isomer of prostaglandin F2 a, is considered as one of the best markers of oxidative stress. Lipoicacid(LA), as a kind of natural antioxidants, is widely used for the treatment of diabetic peripheral neuropathy. In this study,we tested the serum 8-iso-PGF2α level in patients with type 2 diabetes, and clarified the role of oxidative stress in the occurrence and development of type 2 diabetic lower limbs’ angiopathy. By the curative effect of LA,the role of anti-oxidative stress in type 2 diabetic lower limbs’ angiopathy and the possible mechanism was further studied.Methods:176 patients with type 2 diabetes, recruited from the First Department of Endocrinology, Third Hospital of Hebei Medical University, from March, 2014 to February, 2015, were included in this study. All the patients were diagnosed with diabetes bythe standard proposedby the WHO in 1999. The patients were randomlydivided into two groups: simple type 2 diabetes mellitus(SDM) group and lower limbs’ angiopathy combine the peripheral neuropathy(DMA) group. SDM group included 42 cases(25 male and 17 female), with a mean age 56.4±10.2 yearsand a mean course of 5.7±2.3 years. DMA group included 134 cases(82 male and 52 female), with amean age 62.4±13.9 years and a mean course of 8.5±2.6 years. The 50 healthy individuals of normal control(NC) group were collected from the physical examination center of the Third Hospital of Hebei Medical University during the same period. NC group included 32 male and 18 female, with a mean age of 52.8±11.4 years. DMA group were randomly divided into conventional drugs(DMA-C) group, including 78 cases(52 male and 26 female) with a mean age of 60.9±10.4 yearsand a mean course of 7.7±2.1 years, and lipoic acid(DMA-LA) group, including 56 cases(30 male and 26 female) with amean age of 63.9±12.4 yearsand a mean course of 9.3±3.2 years. DMA-C groupwas given routine hypoglycemic, anti-hypertensive, lipid-lowering, anti-platelet and vasodilator therapy, treatment for 2 weeks and the DMA- LA groupwas given the conventional treatment and alpha-lipoic acid(0.9% Na Cl 250 ml + lipoic acid 0.15 * 4, ntravenous infusion, once a day every day for 2 weeks). A fasting blood sample(4ml) was obtained to testthe serum biochemical and 8-iso-PGF2α level. The later one needed an environment of-20 ℃. 2 weekslater, the 8-iso-PGF2α level was tested once again.1) collect data on the demographics: record height, weight, calculate body mass index(BMI) = weight(kg)/height2(m2).2) collect data on the clinical indicators: Circulating fasting blood glucose(FPG),triglycerides(TG), total cholesterol(TC), low-density lipoprotein Cholesterol(LDL-C) and high density lipoprotein Cholesterol(HDL-C) were measured by automatic.biochemical analyzer; Glycated hemoglobin(Hb A1c) was measured by SIEMENS DCA2000+,Fasting insulin(FINS) was evaluatedwith a radioimmunoassay counter,Diagnostic Ultrasound System was used to detect the blood vessels of the lower limbs, including the lumen, inwall, intima-media membrane and plaques. Ankle-brachial index(ABI, ankle arterial pressure/brachial arterial pressure) was measured using a portable continuous-wave doppler, 0.7≦ ABI < 0.9 means mild angiopathy; 0.5 ≦ABI < 0.7 means moderate angiopathy; 0.3 ≦ABI < 0.5 means severe angiopathy.3) The serum 8-iso-PGF2αlevel wasmeasuered with enzyme linked immunosorbent assay(ELISA)SPSS16.0 statistical software was used for data analysis. Measurement data were expressed by mean ± standard deviation(`c± s). t-test was applied in the comparison between groups, paired t test was used between before and after treatment. The single factor analysis of variance was used for the comparison among three groups; Count data were expressed by rateχ2 test was applied in the comparison between two groups. P<0.05 was considered to be statistically significant.Results1 There was no significant difference in the age, gender between T2 DM group and NC group. The BMI, TG, TC, LDL- C, FBG, Hb A1 c levels of SDM group were significantly higher than those of NC group(respectively t=3.514,P<0.05;t=3.997,P<0.05;t=2.385,P<0.05;t=12.214,P<0.05;t=64.846,P<0.05;t=27.065,P<0.05). The levels of HDL- C, ABI of SDM group were lower than those of the NC group(t=4. 041,P<0.05;t=5.657,P<0.05). The BMI, TG, TC, LDL- C, FBG and Hb A1 c levels of DMA group of were significantly higher than those of SDM group(t= 5.355,P<0.05;t= 5.185,P<0.05;t= 3.908,P<0.05;t= 2.348,P<0.05;t= 4.114,P<0.05;t= 5.192,P<0.05). The HDL – C level andthe ABI was lower than that of SDM group(t=6.481,P<0.05;t=52.928,P<0.05).2 The serum 8-iso-PGF2α level in SDM group(34.17±11.36 pg/ml) was significantly higher than that in NC group(27.95±12.69 pg/ml)(t=3.548, P < 0.05). The serum 8-iso-PGF2α level in DMA group(49.13 ± 15.65 pg/ml) was higher than that in SDM and NC group(t=11.069,P<0.05;t=11.712,P<0.05).3 2 weeks later, the serum 8-iso-PGF2α level in DMA- C group(41.25±13.67 pg/ml) was lower than that before treatment(48.67±15.58 pg/ml)(t=4.793, P<0.05). The serum 8-iso-PGF2α level in DMA-LA group(32.65±10.69 pg/ml)waslower than thatthat before treatment(50.22±16.41 pg/ml)(t=12.294, P<0.05). The serum 8-iso-PGF2α level in DMA-LA group 32.65±10.69 pg/ml was lower than that in DMA-C group 41.25±13.67 pg/ml(t=6.020, P<0.05).4 2 weeks later,the Patients with intermittent claudication disappear or walking distance increases, the ABI of DMA-C group(0.65±0.08) was, higher than thatbefore treatment(0.51±0.06)(t=48.565, P<0.05). The ABI of DMA-LA group(0.66±0.09) was higher than that before treatment(0.48±0.05)(t=14.96, P<0.05). Comparison of ABI DMA-LA group 0.66±0.09 and DMA- C group 0.65±0.08 between groups,There was no statistically significantdifference,(t=0.935, P>0.05).Conclusions:1 the serum 8-iso-PGF2α level in the patients with type 2 diabetes washigher than NC group. The serum 8-iso-PGF2α level in patients with type 2 diabetic lower limbs’ angiopathy was more significantly higher. It could be seen that oxidative stressplay a role in the aoccurence and developmentof type 2 diabetic diabetes lower limbs’ angiopathy.2 LA could obviously reduced the oxidative stress level in the patients with type 2 diabetic lower limbs’ angiopathy by lowering the serum 8-iso-PGF2α level and heighting ABI,give play to the role of blood vessels to protect. |
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