Analysis Of Predisposing Factors Of Diabetic Foot Disease And Clinical Research Of Cardiac Function Changes

Part 1.Analysis of Predisposing Factors for Diabetic Foot Disease Objective:To investigate the predisposing factors of diabetic foot disease in patients with type 2 diabetes occurrence and development.It is of great significance to prevent cardiovascular and cerebrovascular adverse events.Methods:This study was carried out on 103 type 2 diabetic foot patients and randomly selected 120 type 2 diabetes mellitus a non-foot disease during the same period in the department of Endocrinology of China-Japan Union Hospital of Jilin University from January 2012 to November 2017.The clinical data of the DF and NDF groups were compared,such as age,gender,the duration of diabetes,smoking,height,weight,body mass index(BMI),the days of hospitalization,systolic blood pressure(SBP),diastolic blood pressure(DBP),diabetic kidney disease(DKD),diabetic retinopathy(DR),diabetic peripheral neuropathy(DPN),diabetic peripheral arterial disease(DPAD),hypertension,coronary heart disease(CHD),cerebral infarction,hemoglobin(Hb),platelet(PLT),fasting plasma glucose(FPG),Postprandial 2h Plasma Glucose(P2h G),total protein(TP),albumin(Alb),glycosylated hemoglobin A1c(Hb A1c),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),Cystatin C(Cys C),Urea(UREA),Serum Creatinine(Scr),Uric Acid(UA),estimating glomerular filtration rate(e GFR),fibrinogen(FIB),ankle-brachial index(ABI),left ventricular ejection fraction(LVEF),short left ventricular fraction(LVFS),Left ventricular diastolic early E peak(E),late diastolic A peak(A),calculated E/A ratio;left ventricular diastolic early e peak(e),late diastolic a peak(a),calculation e/a ratio,stroke volume(SV),left ventricular end-diastolic volume(LVEVD),cardiac output(CO),heart rate(HR),aortic diameter(AOD),left atrial diameter(LAD),right ventricular diameter(RVD),interventricular septum thickness(IVST),left ventricular end-diastolic diameter(LVEDD),left ventricular posterior wall thickness(LVPWT),and pulmonary artery diameter(PAD).Application SPSS22.0 for statistical analysis.Results:Compared with the NDF group,the proportion of males,age,the course of disease,days of hospitalization,DKD,DR,DPN,DPAD positive rate,smoking rate,coronary heart disease,cerebral infarction prevalence,FIB,PLT,Cys C,IVST in the DF groupwere all significant increased(P<0.05).The ABI,Hb,TP,Alb,TG,LDL-C,HDL-C,E/A,e,a,e/a in DF patients were significantly lower than those in the NDF group(P<0.05).BMI,SBP,DBP,prevalence of hypertension,TC,FPG,P2 h G,Hb A1 c,UREA,Scr,e GFR,LVEF,LVFS,SV,LVEDV,CO,HR,E,A,AOD,LVEDD,RVD,LVD,LVPWT,PAD were not statistically significant between the two groups(P>0.05).When applying sex,age,smoking,medical history,DPAD,DPN,HB,PLT,FIB,TP,Alb,TG,LDL-C,HDL-C,CREA,e GFR,ABI(left,right),E/A and IVS into binary logistic regression analysis,we found smoking,DPAD,DPN,SBP,TP,FIB,and ABI(left)were independent risk factors for the development of diabetic foot disease.Conclusion:Smoking,DPAD,DPN,SBP,TP,FIB and ABI(left)are independent risk factors for the development of diabetic foot disease.Part 2.Clinical Research of Cardiac Function Changes in Diabetic Foot Disease Objective:To investigate the changes of cardiac function in patients with diabetic foot disease(Wagner grade 0-5)and to improve the evaluation of cardiac function in patients with diabetic foot disease.Methods:A retrospective analysis of 103 patients with T2 DM combined with DF and 120 patients with NDF who were hospitalized during the same period in the department of Endocrinology of China-Japan Union Hospital of Jilin University from January 2012 to November 2017 were analyzed.There were 14 patients who were amputated due to diabetic foot disease in department of vascular surgery of China-Japan Union Hospital of Jilin University.According to the Wagner grading standard,DF patients were divided into 6 groups,which were Wagner 0-5 group,24 people in group 0,14 people in group 1,23 people in group 2,14 people in group 3,20 people in group 4,8 people in group 5.Patients with diabetic foot disease were divided into amputation group and non-amputation group according to whether they were amputated or not.Patients with diabetic foot disease were divided into amputation group,simple extended injury group and no operation group according to whether amputation or decompression surgery was performed.The same patient underwent amputation and Invasive surgery was classified as amputation group,and 14 patients with diabetic foot disease were included in the amputation group.The indexes of cardiac ultrasound were analyzed between groups.Application SPSS22.0 for statistical analysis.Results:1.The E/A and e/a values of Wagner 0,1,2,3,and 4 in non-diabetic foot and diabetic foot were significantly higher than those of Wagner 5(P<0.05).The E/A and e/a values of Wagner 0,1,2,and 3 in non-diabetic foot and diabetic foot were significantly higher than Wagner 4(P<0.05).There was no significant difference in E/A and e/a values between Wagner grade 4 and grade 5(P>0.05).The e peaks of Wagner 0,1,2,and 3 in non-diabetic foot and diabetic foot were all significantly higher than those of Wagner 5 and 4(P<0.05).There was no significant difference in LVEF value,LVFS value and cardiac structure index between non-diabetic foot group and diabetic foot group(P>0.05).2.Compared with NDF,LVEF values,E/A and e/a in DF amputation group were significantly lower(P<0.05).The HR values of the DF amputation group were higher than those of the NDF and DF non amputation group(P<0.05).There was no significant difference in cardiac structural parameters between the three groups(P>0.05).3.The HR value of the amputation group was higher than that of the non-operation group and the simple expansion group(P<0.05).The values of E/A and e/a in the amputation group were lower than those in the no-operation group and the simple-invasive group(P<0.05).The LVEDV value and LVEDD value of the amputation group were significantly different from that of the simple excision group(P<0.05).Conclusion:Left ventricular function in patients with diabetic foot disease is mainly diastolic dysfunction.With the increase of Wagner grade,the degree of diastolic dysfunction is more serious.The degree of diastolic function decline in the amputation group is also more serious,and earlier than the decline of systolic function.Left ventricular cardiac function changes earlier than changes in heart structure.Routine echocardiography and cardiac function assessment are necessary to prevent sudden cardiac death.