Oxidative Stress Marker and Fibrinogen Level as Indicators of Severity of Diabetic Foot Ulcer
Diabetic foot ulcer (DFU) is the leading cause of lower extremity amputation and is very common in clinical practice. Oxidative stress is important in the pathogenesis of chronic wound and the lipid per oxidation product malondialdehyde (MDA) is toxic molecule which is also associated with pathogenesis of chronic complications of diabetes mellitus. Fibrinogen is a recognized marker in peripheral arterial disease (PAD) and increasing level predict an increased risk of amputation. The aim of this study was to investigate whether the plasma MDA and fibrinogen are associated with severity of DFU. In this study, the plasma MDA and fibrinogen levels were determined in 23 normal subjects, 25 diabetes without ulcer patients, 24 mild DFU patients and 25 severe DFU patients. The results showed that mean plasma MDA levels of normal subjects, diabetes without foot ulcer patients, mild DFU patients and severe DFU patients were 0.98± 0.12 μmol/L, 1.3±0.21 μmol/L, 1.61±0.22 μmol/L and 2.3±0.35 μmol/L respectively. Mean plasma fibrinogen levels of normal subjects, diabetes without foot ulcer patients, mild DFU patients and severe DFU patients were 307± 61.5 mg/dl, 429±63.8 mg/dl, 513.6±77.8 mg/dl and 643.5±71.3 mg/dl respectively. We found out that mean plasma MDA level of severe DFU patients was significantly higher than that of other groups (p<0.001). Similarly, mean plasma fibrinogen level of severe DFU patients was significantly higher than that of normal subjects, diabetic without ulcer patients and mild DFU patients (p<0.001). Therefore, we concluded that the higher level of plasma MDA and fibrinogen are significantly associated with severity of DFU.
Received: 18 October 2017
Accepted: 23 December 2017
21 April 2020 (online)
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- 1 World Health Organization (2000). Report of WHO study group, diabetes mellitus, Technical Report Series, WHO, Geneva; pp 10-14.
- 2 World Health Organization, diabetes drafting group (1985). Prevalence of small and large vessels disease in diabetic patients from 14 centers, Diabetologia;28:615-640.
- 3 Armstrong, DG. (1998). Diabetes foot ulcer: diagnosis and classification, Am Aca Fam Phy; 6:1337-1343.
- 4 King, G., Rosen, P., Nawroth, P., and Gandar, O. (2001). The role of oxidative stress in the onset and progression of diabetes and its complication, Diabetes Metab Res Rev; 17:189-212.
- 5 Slatter, DA., Bolton, CH., and Bailey, AJ. (2000). The importance of lipidderived malondialdehyde in diabetes mellitus, Diabetologia;43:550- 557.
- 6 Berliner, J., and Heinecke, JW. (1996).The role of oxidized low density lipoproteins in atherogenesis, Free Radic Biol Med; 20:707-727.
- 7 Plumbo, PJ., and Melton, LJ. (1995). Peripheral vascular disease and DM in America, National Institute of Health Publication; 95:401-408.
- 8 Woodward, M., Lee, AJ., and Tunstall, PH. (1998). Fibrinogen in relation to intermittent claudication and coronary artery disease, Br Heart J;69:338-342.
- 9 Kiwanaku, F., Asakawa, H., and Tokunaga, K. (2001). Elevation of fibrinogen in thrombin-antithrombin III complex in type 2 DM, J of Diabetes Comp;14:121-26
- 10 Bennett, JS. (2001). Platelet –fibrinogen interaction, Vas Med; 2:115- 125.
- 11 Ceriello, A., Faletti, E., Giacomello, R., and Quatraro, A. (1995). Evidence for a correlation between coagulation activation and adhesion molecule ICAM-1 increase in DM, Diabetes; 44:636-639.
- 12 Kyaw Kyaw Swe (2005). The study of diabetic foot in Orthopedic practice, M.Med.Sc Thesis in Orthopedics.
- 13 Wagner, FW. (1987). The dysvascular foot, a system for diagnosis and treatment, J Foot Ankle Surgery; 2:64-122.
- 14 Wade, CR., Jackson, PG., and van, Rij, AM. (1985). Quantitation of plasma malondialdehyde level by spectrophotometric method, Biochem Med;33:291-296.
- 15 Clauss, VA. (1957). Determination of plasma fibrinogen level by thrombin clotting time method, Acta Hematologica;17:237-246.
- 16 Dacie, JV., and Lewis, SM. (1999). Practical hematology, Fibrinogen estimation (new approach) 6th edition, Churchil Livinstone; 229-232.
- 17 Ceriello, A., Bortolotti, N., Motz, E., Crescentini, A., Lizzio,S., Russo,A., and Taboga, C. (1998). Meal-generated oxidative stress in type 2 diabetic patients, Diabetes Care;21(9):1529-1533.
- 18 Suryawanshi, NP., Bhutey, AK., Nagdeote, AN., Jadhav, AA., and Manoorkar, GS. (2006). Study of lipid peroxides and lipid profile in diabetes mellitus, Indian J of Clinical Biochem;21(1):126-130.
- 19 Rattan, R., and Nayak, K. (2008). Prognostic markers to predict outcomes in patients with DFU, The Int J of Lower Extremity Wounds; 7:198-203.
- 20 Devehat, CL., Khodabanehlou, T., and Vimeux, M. (2001). Impaired hemorheological properties in diabetic patients with lower limb ischaemia, Clin Hemorheo Microcirculation; 25:43-48.
- 21 Hanachi, P., Rashid, HM., and Latiffah, AL.(2009). Investigation of lipid peroxidation and lipid profiles in patients with type 2 diabetes, Euro J of Scientific Research;28(1):6-13.