The Study Of Ratio Of Monocyte To High Density Lipoprotein Cholesterol And Diabetic Foot Osteomyelitis

Objectives:1.The analysis for the trend of Monocyte(M)count,High density lipoprotein cholesterol(HDL-C),and the Ratio of Monocyte to HDL-C(MHR)in non-Diabetes mellitus(NDM)patients,type 2 diabetes mellitus(T2DM)patients,type 2 diabetes mellitusc with diabetic foot(T2DM-DF)patients,and further explore the risk factors of T2DM and T2DM-DF.2.In Type 2 diabetes mellitus with diabetic foot osteomyelitis(T2DM-DFO),the difference of M-count,HDL-C and MHR between positive foot X-ray group(X-ray of foot supported osteomyelitis diagnosis)and negative foot X-ray group(X-ray of foot did not support osteomyelitis diagnosis)was compared,and the ROC curve was used to find out whether there was the best diagnostic cut point of osteomyelitis patients who missed because X-ray did not support osteomyelitis diagnosis.Methods:1.From January 2014 to December 2018,127 T2DM patients and 141 T2DM-DF patients were collected from the Department of endocrinology of The second people's Hospital of Yunnan Province.From January 2016 to December 2018,64 T2DM-DF patients were collected from the Department of bone and trauma surgery of The second people's Hospital of Yunnan Province.From March 2019 to May 2019,130 cases of NDM were collected from the physical examination center of the second people's Hospital of Yunnan Province?2.Basic informations of the enrolled patients,including gender,age,systolic pressure(SP),diastolic pressure(DP),body mass index(BMI),smoking history,hypertension(HT)history,diabetic nephropathy(DN)history,diabetic retinopathy(DR)history,lower extremity arterial disease(LEAD)history were recorded;The laboratory data of white blood cell(WBC),neutrophils(N),lymphocyte(L),monocyte(M),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),albumin(ALB),serum uric acid(SUA),serum creatine(Scr),procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),glycosylated hemoglobin A1c(HbA1c)were recorded.3.The measurement data conforming to normal distribution is expressed as mean±SD.One way ANOVA analysis was carried out in NDM group,T2DM group and T2DM-DF group,and LSD multiple comparison was used in group comparison.T test was used for comparison between the two groups;median(minimum,maximum)was used for measurement data of non normal distribution,and rank sum test was used for comparison between the two groups;frequency was used for counting data,and chi square test was used for comparison between groups.The risk factors of T2DM and T2DM-DF were investigated by binary logistic regression analysis,and the indexes related to wagner grading of T2DM-DF were explored by Spearman correlation analysis.In T2DM-DF group,the index difference between positive foot X-ray group and negative foot X-ray group was compared.The ROC curve was used to analyze the predictive value of M-count,HDL-C and MHR level on negative foot X-ray group of DFO patients.Results:1.SP,BMI,WBC count,M count,TG,HDL-C,LDL-C,ALB,MHR were statistically different in the NDM group,T2DM group and T2DM-DF group(P<0.05),and no significant difference was found in other indicators.2.Compared with NDM group,T2DM group had higher BMI,TG and MHR,but lower HDL-C and ALB levels.Further binary logistic regression analysis showed that BMI,TG,HDL-C and MHR were the risk factors of suffering from T2DM for NDM group(P<0.05)3.Compared with T2DM group,T2DM-DF group had higher SP,WBC count and MHR,but lower HDL-C and ALB levels.Spearman correlation coefficient analysis showed that there was no correlation between HDL-C and ALB levels and DF' levels,while SP,WBC count,MHR and DF' levels were positively correlated(r=0.334,P=0.031),(r=0.237,P=0.005),(r=0.221,P=0.031).Further binary logistic regression analysis showed that SP,WBC,HDL-C and ALB were the risk factors of suffering from DF in T2DM patients(P<0.05).4.In T2DM-DFO patients,the M count,HDL-C and MHR of foot X-ray negative group were lower than those of foot X-ray positive group;draw the ROC of subjects,and calculate the M,HDL-C,MHR under the ROC.The results showed that the AUC of HDL-C was less than 0.5,which indicates that HDL-C had no predictive ability to T2DM-DFO patients with negative foot X-ray,the AUC of MHR was 0.719,and the detection efficiency was the highest.When MHR was more than 1.3,it was statistically significant to predict the presence of myeloitis in DF patients with negative foot x-ray(P<0.05).Conclusion:1.The lower the HDL-C lever and or the higher the MHR lever in NDM patients,the possiblity of suffering fromT2DM is greater,the lower the HDL-C lever in T2DM patients,the possiblity of suffering from DF is greater.2.The level of M and MHR have certain predictive value for patients with DFO,but whose X-ray of foot does not support osteomyelitis,the detection efficiency of MHR is the highest.When MHR is more than 1.3,it has predictive significance for the diagnosis of osteomyelitis,suggesting that clinicians should further perform Magnetic resonance imaging(MRI)and/or biopsy to determine whether or not be associated with osteomyelitis,so as to determine DFO treatment strategy.