ABSTRACT
Objective:To investigate the correlation between the secreted frizzled related protein 5 (SFRP5), 25-hydroxy vitamin D [25(OH)D], retinol binding protein 4 (RBP4) and the degree of illness in elderly patients with type 2 diabetes mellitus (T2DM) and the evaluation value of curative effect.Methods:One hundred and thirteen elderly patients with T2DM who treatment in Taihu Hospital of Wuxi City from January 2018 to October 2019 were selected as the study group, and 113 healthy patients during the same period were selected as the control group. The serum levels of RBP4, SFRP5, and 25(OH)D were compared between the two groups, patients with different disease levels, and patients with or without vascular complications. Spearman was used to analyze the correlation between each index and the degree of illness, and Pearson was used to analyze the correlation between each index and the insulin resistance index (HOMA-IR). The receiver operating characteristic (ROC) curve and area under ROC (AUC) were used to analyze the value of SFRP5, 25(OH)D, RBP4 and the combination of the three to predict vascular disease in T2DM patients.Results:The levels of RBP4 , HOMA-IR in study group were higher than those in control group: (22.96 ± 2.26) μg/L vs.(11.28 ± 1.69) μg/L, 3.83 ± 0.70 vs.1.65 ± 0.59, the levels of SFRP5, 25(OH)D in study group were lower than those in control group: (9.28 ± 3.14) μg/L vs. (14.65 ± 3.38) μg/L, (32.65 ± 5.12) nmol/L vs. (51.29 ± 6.33) nmol/L, and the differences were statistically significant ( P<0.05). The level of RBP4 in severe group was higher than that in mild group:(26.91 ± 2.51) μg/L vs. (19.35 ± 2.23) μg/L, the levels of SFRP5, 25(OH)D in severe group were lower than those in mild group: (7.13 ± 2.98) μg/L vs. (11.25 ± 3.30) μg/L, (27.97 ± 4.56) nmol/L vs. (36.93 ± 5.50) nmol/L, and the differences were statistically significant ( P<0.05). The levels of SFRP5, 25(OH)D in patients with macrovascular disease were the lowest, followed by those with microvascular and those without vascular disease; the level of RBP4 in patients with macrovascular disease was the lowest, followed by those with microvascular and those without vascular disease, and the differences were statistically significant ( P<0.05). There was a positive correlation between RBP4 and the degree of illness and HOMA-IR ( P<0.05), and there was a negative correlation between 25(OH)D and SFRP5 and the degree of illness and HOMA-IR ( P<0.05). The AUC of SFRP5 for predicting vascular disease was 0.721, and the cut-off value was ≤11.14 μg/L , with a sensitivity of 78.21%, and a specificity of 60.00%.The AUC of 25(OH)D for predicting vascular disease was 0.786, and the cut-off value was ≤ 36.56 nmol/L, with a sensitivity of 87.18%, and a specificity of 65.71%. The AUC of RBP4 for predicting vascular disease was 0.816, and the cut-off value was greater than 21.45 μg/L , with a sensitivity of 57.69% and a specificity of 94.29%. The AUC of SFRP5 + 25(OH)D + RBP4 for predicting vascular disease was 0.847, with a sensitivity of 70.51% and a specificity of 85.71% ( P<0.05). Conclusions:In severe T2DM elderly patients with vascular complications, the levels of blood SFRP5, 25(OH)D and RBP4 are increased and significantly related to the patient′s condition and insulin resistance, and they can predict the occurrence of vascular disease.
ABSTRACT
ObjectiveTo evaluate the diagnosis and treatment of postoperative pulmonary embolism(PE). MethodsWe retrospectively analyzed clinical manifestations,diagnosis,treatment and prognosis of 51 postoperative PE. Results36 PE (70.59％ ) developed after orthopaedic surgery or with malignant tumors within 1 week after surgery.Dyspnea or chest distress was the most common symptoms.Sudden death was common in patients with PE.Problems in diagnosis of PE included:poor assessment of deep vein thrombosis(DVT) before operation,and the value of beside echocardiography in the diagnosis of patients with suspected high-risk PE was not fully recognized. Twenty-three PE cases received only anticogulant treatment.Intravenous thrombolysis or percutaneous interventional techniques were undertaken in 3 each cases.Cardiopulmonary resuscitation(CPR) simply after sudden death due to postoperative PE was often unsuccessful.ConclusionsPostoperative PE is a common cause of death,currently available measures are often ineffective.The key lies in prevention especially in those of high-risk PE or suspected non-high-risk PE.