摘要
目的探讨血清沉默信息调节因子1(Sirt1)、甲基转移酶样蛋白3(METTL3)水平与糖尿病足患者临床分级及预后的关系。方法前瞻性选取2023年1月—2025年1月宁夏回族自治区人民医院烧伤整形科收治的糖尿病足患者206例作为糖尿病足组,糖尿病足患者根据临床Wagner分级分为0级(39例)、1级(36例)、2级(42例)、3级(51例)、4级(38例),根据6个月预后分为不良亚组(72例)和良好亚组(134例),另按照2∶1比例选取同期健康体检者103例为健康对照组。采用酶联免疫吸附法检测血清Sirt1、METTL3水平;Spearman相关分析糖尿病足患者血清Sirt1、METTL3水平与临床分级的相关性;多因素Logistic回归分析糖尿病足患者预后不良的影响因素;受试者工作特征(ROC)曲线评价血清Sirt1、METTL3水平对糖尿病足患者预后不良的预测效能。结果糖尿病足组血清Sirt1、METTL3水平均低于健康对照组(t/P=12.188/<0.001、14.765/<0.001);不同临床分级糖尿病足患者血清Sirt1、METTL3水平比较,4级<3级<2级<1级<0级(F/P=377.595/<0.001、440.059/<0.001);糖尿病足患者血清Sirt1与METTL3水平呈正相关(r/P=0.719/<0.001),两者与临床分级呈负相关(r/P=-0.774/<0.001、-0.723/<0.001);多因素Logistic回归分析显示,糖尿病病程长、临床分级4级、HbA 1c高为糖尿病足患者预后不良的独立危险因素[OR(95%CI)=1.259(1.062~1.492)、8.413(2.230~31.746)、2.549(1.443~4.502)],Sirt1高、METTL3高为独立保护因素[OR(95%CI)=0.598(0.472~0.757)、0.757(0.677~0.848)];血清Sirt1、METTL3水平单独及二者联合预测糖尿病足患者预后不良的曲线下面积(AUC)分别为0.805、0.796、0.892,二者联合优于各自单独预测效能(Z/P=3.594/<0.001、3.580/<0.001)。结论血清Sirt1、METTL3水平下降与糖尿病足患者病情加重及预后不良相关,二者联合检测对糖尿病足患者预后的预测效能较高。
Objective To investigate the relationship between serum sirtuin 1(Sirt1)and methyltransferase-like 3(METTL3)levels and the clinical staging and prognosis of patients with diabetic foot(DF).Methods A total of 206 DF patients admitted to the Department of Burns and Plastic Surgery of Ningxia Hui Autonomous Region People's Hospital from January 2023 to January 2025 were prospectively selected as the DF group.Additionally,103 healthy individuals during the same period were selected as the healthy control group in a 2:1 ratio.Serum levels of Sirt1 and METTL3 were measured using enzyme-linked immunosorbent assay.DF patients were classified into grades 0(n=39),1(n=36),2(n=42),3(n=51),and 4(n=38)based on clinical grading.Spearman correlation analysis was used to assess the correlation between serum Sirt1,METTL3 levels and clinical grade in DF patients.Based on 6-month prognosis,DF patients were divided into poor and good prognosis subgroups.Factors influencing prognosis and the predictive value of serum Sirt1 and METTL3 levels were analyzed.Results Compared with the control group,serum Sirt1 and METTL3 levels were significantly lower in the DF group(t=12.188,14.765,both P<0.001).Serum Sirt1 and METTL3 levels progressively decreased from grade 0 to grade 4(F=1607.455,2264.970,both P<0.001).In DF patients,serum Sirt1 was positively correlated with METTL3,while both were negatively correlated with clinical grade(r=0.719,-0.774,-0.723,all P<0.001).The poor prognosis rate among the 206 DF patients was 34.95%(72/206).Prolonged duration of diabetes,clinical grade 4,and elevated glycated hemoglobin(HbA 1c)were identified as independent risk factors for poor prognosis in DF patients,while higher Sirt1 and higher METTL3 levels were independent protective factors[OR(95%CI)=1.259(1.062-1.492),8.413(2.230-31.746),2.549(1.443-4.502),0.598(0.472-0.757),0.757(0.677-0.848)].The area under the ROC curve(AUC)for predicting poor prognosis in DF patients using serum Sirt1 level,METTL3 level,and their combination were 0.805,0.796,and 0.892,respectively.The combined prediction of Sirt1 and METTL3 showed greater value for predicting poor prognosis in DF patients than either biomarker alone(Z=3.594,3.580,both P<0.001).Conclusion Decreased serum levels of Sirt1 and METTL3 are associated with increased clinical grade and poor prognosis in DF patients.The combination of serum Sirt1 and METTL3 levels demonstrates high efficacy in predicting prognosis.
作者
丁杨
张晓莉
孙国斌
巩晶晶
刘金毅
李俊
李沛玲
Ding Yang;Zhang Xiaoli;Sun Guobin;Gong Jingjing;Liu Jinyi;Li Jun;Li Peiling(Department of Burns and Plastic Surgery,The People's Hospital of Ningxia Hui Autonomous Region,Ningxia,Yinchuan 750004,China)
出处
《疑难病杂志》
2026年第3期268-273,共6页
Chinese Journal of Difficult and Complicated Cases
基金
宁夏回族自治区医疗卫生科技计划项目(2021-NW-111)。
