血清IMA、Gremlin-1、镍纹样蛋白在不同临床分级糖尿病足患者中的水平及其对预后不良的预测价值OA

Objective To investigate the levels of serum ischemia-modified albumin(IMA),Gremlin-1 and meteorin-like protein in patients with different clinical grades of diabetic foot(DF)and their predictive value for poor prognosis.Methods A total of 198 patients with DF admitted to Qinhuangdao Hospital of Peking U-niversity Third Hospital from May 2022 to October 2024 were selected as the DF group,and 152 patients with simple type 2 diabetes mellitus(T2DM)without diabetes-related complications who visited Qinhuangdao Hospital of Peking University Third Hospital during the same period were selected as the control group.The patients were followed up for 6 months,and the 198 DF patients were divided into the poor prognosis group and the good prognosis group according to the prognosis.The levels of serum IMA,Gremlin-1 and meteorin-like protein in the patients were detected by enzyme-linked immunosorbent assay.Multivariate Logistic re-gression analysis was used to analyze the influencing factors of poor prognosis in DF patients.The receiver op-erating characteristic(ROC)curve was drawn to analyze the predictive value of serum IMA,Gremlin-1 and meteorin-like protein for poor prognosis in DF patients.Results The levels of glycated hemoglobin and serum IMA,Gremlin-1 in the DF group were higher than those in the control group,while the level of serum meteor-in-like protein was lower than that in the control group,and the differences were statistically significant(P＜0.05).The levels of serum IMA and Gremlin-1 in DF patients with Wagner grade 4 were higher than those in patients with Wagner grades 1,2 and 3,and the levels of serum IMA and Gremlin-1 in DF patients with Wag-ner grade 3 were higher than those in patients with Wagner grades 1 and 2,and the levels of serum IMA and Gremlin-1 in DF patients with Wagner grade 2 were higher than those in patients with Wagner grade 1,all with statistically significant differences(P＜0.05).The level of serum meteorin-like protein in DF patients with Wagner grade 4 was lower than that in patients with Wagner grades 1,2 and 3,and the level of serum meteorin-like protein in DF patients with Wagner grade 3 was lower than that in patients with Wagner grades 1 and 2,and the level of serum meteorin-like protein in DF patients with Wagner grade 2 was lower than that in patients with Wagner grade 1,all with statistically significant differences(P＜0.05).The levels of serum IMA and Gremlin-1 in the poor prognosis group were higher than those in the good prognosis group,and the level of serum meteorin-like protein was lower than that in the good prognosis group,all with statistically sig-nificant differences(P＜0.05).The proportions of patients with Wagner grades 3-4,vascular lesions,periph-eral neuropathy and the level of procalcitonin in the poor prognosis group were higher than those in the good prognosis group,all with statistically significant differences(P＜0.05).The results of multivariate Logistic regression analysis showed that elevated procalcitonin,IMA,Gremlin-1 levels and Wagner grade 3-4 were risk factors for poor prognosis in DF patients(P＜0.05),and elevated meteorin-like protein level was a pro-tective factor for poor prognosis in DF patients(P＜0.05).The result of ROC curve analysis showed that the area under the curve(AUC)for the combined prediction of poor prognosis in DF patients by serum IMA,Gremlin-1 and meteorin-like protein was 0.925,which was greater than the AUC of each of these three indi-cators when used alone(P＜0.05).Conclusion The levels of serum IMA,Gremlin-1 and meteorin-like pro-tein are closely related to the disease grade of DF patients,and the combined detection of these three indicators has a high predictive value for poor prognosis in DF patients.