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Elevated Serum Levels of Lp-PLA2 and IL-18 are Associated with Progression of Diabetic Foot Ulcers by Tian Chen, Jianhua Yu, Jing Wang, Qi Chang, Chao Qian

Background: Diabetic foot (DF) is a common complication of diabetes with insidious onset, making it difficult for patients to receive timely diagnosis and treatment. This study aimed to evaluate the change in lipoprotein-associated phospholipase A2 (Lp-PLA2) and interleukin-18 (IL-18) in the serum of type 2 diabetes mellitus (T2DM) pa-tients with and without DF, thereby assessing the association between progression of DF and levels of Lp-PLA2 together with IL-18.
Methods: In this study, 50 patients with diabetes without foot ulcers (group I, T2DM group), 135 patients with diabetes with foot ulcers (group II, DF group), and 30 matched healthy controls (group III) were enrolled. Fasting venous blood was collected for detection of inflammatory markers including Lp-PLA2, IL-18, interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), plasminogen activator inhibitor 1 (PAI-1), fibrinogen (FIB), C-reactive protein (CRP), and WBC and neutrophil percentage (Neu%). Baseline indicators such as glycated hemoglobin (HbA1C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were tested simultaneously.
Results: The serum levels of Lp-PLA2 and IL-18 increased significantly with T2DM progression and were positively associated with severity of T2DM, with the highest concentrations identified in patients with Wagner grade 4 ulcers (p < 0.05). Univariate logistic regression analysis showed that age, diabetes course, Lp-PLA2, IL-18, FIB, CRP, and WBC and Neu% were risk factors for DF. Multivariate logistic regression analysis revealed that Lp-PLA2, IL-18, FIB, and CRP were independent risk factors for DF.
Conclusions: Increased serum levels of Lp-PLA2 and IL-18 were positively associated with the progression of DF disease. Detection of Lp-PLA2 and IL-18 can assist clinicians’ assessment of the severity of DF. Dynamic detection can also help understand disease progression and treatment efficacy.

DOI: 10.7754/Clin.Lab.2020.191253