Objectives: Adenosine deaminase (ADA) is a critical enzyme in the catabolism of adenosine acid during purine metabolism and plays a significant role in the diagnosis and monitoring of various diseases. This study aims to investigate the relationship between serum ADA levels and risk of diabetic foot ulcers (DFU) in patients with type 2 diabetes mellitus (T2DM), providing a clinical basis for the prevention and treatment of DFU.
Methods: A retrospective study was conducted on 2 719 T2DM patients diagnosed at the Southwest Hospital of Army Medical University from January 2019 to January 2020. Patients were divided into a non-DFU group (n=1 952) and a DFU group (n=767) based on the presence of DFU. Serum ADA levels were collected, and participants were divided into quartiles: Q1, Q2, Q3, and Q4. Spearman correlation analysis and multivariate logistic regression were used to assess the relationship between serum ADA levels and DFU risk in T2DM patients. Additionally, changes in serum ADA levels among DFU patients with different Wagner grades were compared.
Results: The prevalence of DFU in T2DM patients was 28.21%, and the prevalence increased with higher serum ADA levels. Multivariate-adjusted logistic regression analysis showed that for every 1-unit increase in serum ADA, the risk of DFU increased by 3% (OR=1.03, 95% CI 1.01 to 1.05, P=0.003). Compared with the Q1 group, the risk of DFU increased in the Q2 (OR=1.77, 95% CI 1.30 to 2.43, P<0.001), Q3 (OR=2.11, 95% CI 1.54 to 2.89, P<0.001), and Q4 (OR=2.27, 95% CI 1.64 to 3.16, P<0.001) groups. Additionally, serum ADA levels increased with higher Wagner grades from 0 to 5 (P<0.001).
Conclusions: Elevated serum ADA levels in T2DM patients are associated with an increased risk of DFU, suggesting that serum ADA may play an important role in the development of DFU in T2DM patients.
目的: 腺苷脱氨酶(adenosine deaminase，ADA)是嘌呤代谢过程中参与腺苷酸分解代谢的关键酶之一，在多种疾病的诊断和病情监测中扮演重要角色。本研究拟探讨血清ADA水平与2型糖尿病(type 2 diabetes mellitus，T2DM)患者发生糖尿病足溃疡(diabetic foot ulcer，DFU)风险的关系，为DFU的防治提供临床依据。方法: 回顾性收集2019年1月至2020年1月陆军军医大学第一附属医院确诊的T2DM患者2 719例，根据是否合并DFU分为非DFU组(n=1 952)和DFU组(n=767)。收集患者的血清ADA水平，并根据ADA四分位数将所有参与者分为最低四分位数(Q1)组、第2四分位数(Q2)组、第3四分位数(Q3)组、第4四分位数(Q4)组。采用Spearman相关性分析和多因素Logistic回归评估血清ADA水平与T2DM患者发生DFU风险的关系，并比较不同Wagner分级的DFU患者血清ADA水平的变化情况。结果: 在T2DM患者中，DFU的患病率为28.21%，随着血清ADA水平升高，DFU的患病率逐渐升高。多因素矫正的Logistic回归分析显示：血清ADA水平每增加1个单位，发生DFU的风险增加3%(OR=1.03，95% CI 1.01~1.05，P=0.003)；相比Q1组，Q2(OR=1.77，95% CI 1.30~2.43，P<0.001)、Q3(OR=2.11，95% CI 1.54~2.89，P<0.001)和Q4(OR=2.27，95% CI 1.64~3.16，P<0.001)组患者发生DFU的风险升高。Wagner 0~5级的DFU患者血清ADA水平呈上升趋势(P<0.001)。结论: T2DM患者的高血清ADA水平与DFU风险增加相关，提示血清ADA水平可能在T2DM患者DFU发生过程中起重要作用。.
Keywords: Wagner grading; adenosine deaminase; diabetic foot ulcers; type 2 diabetes mellitus.