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Objective:To explore the changes of coagulation index levels in patients with type 2 diabetic foot and their correlation with pathological changes, in order to provide reference for clinical diagnosis of diabetic foot.Methods:133 patients with type 2 diabetes admitted to the Xiaoshan Hospital of Traditional Chinese Medicine in Hangzhou from Jun. 2018 to Jun. 2020 were selected. The patients were divided into type 2 diabetes group ( n=65) and diabetes foot group ( n=68) according to whether they had diabetes feet. In addition, 60 patients who had health examinations in our hospital during the same period were selected as the control group. Fibrinogen (FIB), thrombin time (TT), activated partial thromboplastin time (APTT) and prothrombin time (PT) were compared in each group, and Spearman method was used to analyze the correlation between each index and the occurrence of diabetes foot. Area under curve (AUC) of working characteristics of subjects (ROC) was used to analyze the diagnostic value of each index in diabetes foot. Results:The average FIB of control group, type 2 diabetes group and diabetes foot group was (2.86±0.50) g/L, (3.30±0.81) g/L, (4.43±1.16) g/L; The FIB level in diabetes foot group was significantly higher than that in type 2 diabetes group and control group, and that in type 2 diabetes group was significantly higher than that in control group ( P<0.05) ; The mean TT of control group, type 2 diabetes group and diabetes foot group was (17.60±2.01) s, (15.39±2.39) s, (13.49±2.84) s; The average APTT of control group, type 2 diabetes group and diabetes foot group was (32.02±4.22) s, (29.97±3.97) s, (25.69±4.07) s; The mean PT values of control group, type 2 diabetes group and diabetes foot group were (12.64±1.49) s, (11.41±1.04) s and (10.50±1.08) s. The TT, APTT and PT values in the diabetes foot group were significantly lower than those in the type 2 diabetes group and the control group, and those in the type 2 diabetes group were significantly lower than those in the control group ( P<0.05) ; The level of FIB index was positively correlated with the occurrence of diabetes foot, while TT, APTT and PT indexes were negatively correlated with the occurrence of diabetes foot ( P<0.05). The AUC values of FIB, TT, APTT and PT indexes for the diagnosis of diabetes foot were 0.898, 0.879, 0.859 and 0.871, respectively. Conclusions:There are significant differences in FIB, TT, APTT and PT index levels between diabetic foot patients and type 2 diabetic patients and healthy people, and the occurrence of diabetic foot is significantly related to blood coagulation indicators. The detection of blood coagulation indicators has certain clinical significance for the diagnosis of diabetic foot.
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Objective:To observe heart rate circadian rhythm in patients with chronic kidney disease (CKD) stage 5 and to analyze the effects of parathyroidectomy (PTX) on heart rate circadian rhythm in severe secondary hyperparathyroidism (SHPT) patients.Methods:A cross-sectional observation was performed in 213 patients with CKD stage 5 and 96 controls, and the patients were divided into those with severe SHPT (PTX group, n=70) and without severe SHPT (non-PTX group, n=143). Forty-six PTX patients were followed up prospectively. The baseline data were compared among these groups. Holter electrocardiogram was performed for each participant. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Multiple linear regression analysis was used to analyze the related factors of heart rate circadian rhythm in patients with CKD stage 5. Results:The 24-hour, daytime and nighttime mean heart rate in patients with CKD stage 5 were all higher than those in controls, especially in PTX group (all P<0.05). The night/day heart rate ratios of controls and CKD stage 5 patients were (0.81±0.08) and (0.91±0.08) respectively ( P<0.01). Correlation analysis showed 24-hour and daytime or nighttime mean heart rate in patients with CKD stage 5 were positively correlated with serum levels of phosphorus and ln(alkaline phosphatase), while nighttime mean heart rate and night/day heart rate ratio were positively related with serum intact parathyroid hormone level. After adjusting with postoperative follow-up period (median time: 10.9 months), 24-hour and nighttime mean heart rate, and night/day heart rate ratio in PTX patients all decreased significantly (all P<0.01). Conclusions:Heart rate is increased and circadian rhythm is abnormal in patients with CKD stage 5, which are related with mineral and bone disorder. PTX significantly decreases 24-hour and nighttime mean heart rate in severe SHPT patients, and improves the heart rate circadian rhythm.
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Objective:To investigate the predictive value of abnormal heart rate circadian rhythm for all-cause mortality in stage 5 chronic kidney disease (CKD 5) patients.Methods:The retrospective study was performed in CKD 5 patients enrolled from the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) and the Affiliated BenQ Hospital of Nanjing Medical University from February, 2011 to December, 2019. A total of 159 healthy volunteers were enrolled as the healthy control group during the same period. The circadian rhythm of heart rate was monitored by 24-hour Holter. Related indices (including 24-hour, daytime and nighttime mean heart rate, night/day heart rate ratio, 24-hour maximum heart rate, 24-hour minimum heart rate and difference between maximum and minimum of 24-hour heart rate) were calculated. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Cox regression model was used to analyze the risk factors of all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve and Log-rank test were used to compare the differences of cumulative mortality between high ratio group (night/day heart rate ratio>0.91) and low ratio group (night/day heart rate ratio≤0.91). The nonlinear relationship between night/day heart rate ratio and all-cause mortality was analyzed by restricted cubic spline plot. Time-dependent receiver operating characteristic (ROC) curve was used to analyze the predictive value of night/day heart rate ratio for all-cause mortality in CKD 5 patients.Results:A total of 159 healthy volunteers and 221 CKD 5 patients were included in this study. There were 123 males (55.66%) and the age was (52.72±13.13) years old in CKD 5 patients. The total median follow-up time was 50.0 months. Compared with controls, 24-hour, nighttime mean heart rate, 24-hour minimum heart rate in CKD 5 patients were increased (all P<0.05), furthermore, the night/day heart rate ratio was higher [(0.91±0.09) vs (0.81±0.08), P<0.001], showing "non-dipping heart rate". However, the 24-hour maximum heart rate and the difference between maximum and minimum of 24-hour heart rate in CKD 5 patients were lower than controls (both P<0.05). Multivariate Cox regression analysis showed that the increased night/day heart rate ratio (per 0.1 increase, HR=1.557, 95% CI 1.073-2.258, P=0.020) was an independent influencing factor for all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve analysis showed that the cumulative mortality of the high ratio group was significantly increased than that of the low ratio group (Log-rank test χ 2=7.232, P=0.007). From the restricted cubic spline plot, there was a linear effect between night/day heart rate ratio and all-cause mortality ( P=0.141), and when night/day heart rate ratio was above 0.91, the risk of all-cause mortality was significantly increased in CKD 5 patients. According to time-dependent ROC curve, the accuracy of night/day heart rate ratio in predicting all-cause mortality was 70.90% even when the survival time was up to 70.0 months. Conclusions:The circadian rhythm of heart rate in CKD 5 patients displays "non-dipping" state. High night/day heart rate ratio is an independent influencing factor for all-cause mortality in CKD 5 patients.