Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
Department of Medical Biochemistry, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
Int J Clin Pract. 2021 Sep;75(9):e14589. doi: 10.1111/ijcp.14589. Epub 2021 Jul 12.
This study investigated the status of serum ischaemia-modified albumin (IMA) levels in the development of diabetic foot ulcer (DFU) in patients with diabetes mellitus (DM) and in predicting ulcer formation and ulcer grading.
Thirty patients with DM, 30 with DFU and 30 healthy controls were included in the study. All participants' demographic characteristics and serum IMA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) levels and DFU infection grades were recorded.
Nine (30%) patients with DFU were grade 2 according to the grading of International Working Group of the Diabetic Foot, 14 (46.7%) were grade 3 and seven (23.3%) were grade 4. Significant, powerful and positive correlation was determined between serum IMA and albumin-adjusted IMA levels and degrees of DFU (r = 0.878 and r = 0.846, P < .001 for both). Serum IMA levels in the DFU group were significantly higher than in the DM and control groups (P < .001). The optimal cut-off values for IMA in predicting DFU was 23.5 ng/mL (sensitivity 96%, specificity 87% and AUC = 0.97, P < .001). Additionally, at a cut-off value of 20.6 ng/mL, serum albumin-adjusted IMA differentiated cases of DFU from healthy individuals with 90% sensitivity and 83% specificity (AUC = 0.95, P < .001) Serum IMA levels exhibited significant, positive correlation with CRP, ESR, WBC, fasting plasma glucose and HbA1c (r = 0.575, r = 0.592, r = 0.597, r = 0.68 and r = 0.74, respectively, P < .001). Serum albumin levels were significantly negatively correlated with IMA, CRP, ESR and WBC values (r = -0.49, r = -0.56, r = -0.62 and r = -0.53, respectively, P < .001).
Our study findings indicate that together with CRP, ESH, WBC and albumin, increased IMA levels in patients with DM can be useful in the early prevention of DFU development and in predicting the severity of DFU infection.
本研究旨在探讨糖尿病患者中血清缺血修饰白蛋白（IMA）水平在糖尿病足溃疡（DFU）发展中的状况，以及其对溃疡形成和分级的预测价值。
本研究纳入了 30 例糖尿病患者、30 例 DFU 患者和 30 例健康对照者。记录所有参与者的人口统计学特征以及血清 IMA、C 反应蛋白（CRP）、红细胞沉降率（ESR）和白细胞（WBC）水平和 DFU 感染分级。
根据国际糖尿病足工作组的分级，9 例（30%）DFU 患者为 2 级，14 例（46.7%）为 3 级，7 例（23.3%）为 4 级。IMA 与白蛋白校正后 IMA 水平与 DFU 严重程度之间存在显著、强正相关（r=0.878 和 r=0.846，均 P<0.001）。DFU 组的血清 IMA 水平显著高于糖尿病组和对照组（P<0.001）。IMA 预测 DFU 的最佳截断值为 23.5ng/mL（灵敏度 96%，特异性 87%，AUC=0.97，P<0.001）。此外，在截断值为 20.6ng/mL 时，血清白蛋白校正 IMA 可将 DFU 病例与健康个体区分开来，灵敏度为 90%，特异性为 83%（AUC=0.95，P<0.001）。血清 IMA 水平与 CRP、ESR、WBC、空腹血糖和 HbA1c 呈显著正相关（r=0.575、r=0.592、r=0.597、r=0.68 和 r=0.74，均 P<0.001）。血清白蛋白水平与 IMA、CRP、ESR 和 WBC 值呈显著负相关（r=-0.49、r=-0.56、r=-0.62 和 r=-0.53，均 P<0.001）。
本研究结果表明，在糖尿病患者中，与 CRP、ESR、WBC 和白蛋白一起，升高的 IMA 水平可用于早期预防 DFU 的发生，并预测 DFU 感染的严重程度。
