Influence of blood glucose fluctuation, inflammation and immune factors on recurrence of condyloma acuminatum in patients with diabetes
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摘要:
目的 探讨糖尿病合并尖锐湿疣(DMCA)患者CO2激光及咪喹莫特(CO2-Ⅰ)治疗后血糖波动联合白介素-6(IL-6)及血清肿瘤坏死因子-α(TNF-α)与复发的相关性。 方法 纳入2020年8月—2022年12月期间在亳州市人民医院实施CO2-Ⅰ治疗的136例DMCA患者进行研究,所有患者均在治疗后持续72 h监测血糖水平并计算平均血糖波动幅度(MAGE)。出院后对患者跟踪随访6个月,统计患者短期复发情况,依据治疗后复发情况将患者分为复发组(34例)与非复发组(102例),并分析糖尿病合并CA患者CO2-Ⅰ治疗后血糖波动对短期复发的影响。 结果 经统计,136例DMCA患者复发34例,占25.00%,未复发患者共102例,占75.00%。复发组的MAGE、IL-6和TNF-α水平均高于非复发组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,MAGE值高(≥3.9 mmol/L,OR=1.527,P<0.001)、肛门和(或)生殖器区域糜烂(OR=2.786,P=0.016)、TNF-α水平高(≥6.39 μg/L,OR=1.746,P=0.001)、IL-6水平低(<5.26 pg/mL,OR=1.725,P=0.001)均为复发的危险因素。 结论 DMCA患者CO2-Ⅰ治疗后MAGE、TNF-α越高、IL-6越低,肛门和(或)生殖器区域糜烂,短期复发风险越大,具有一定的临床意义,可能为预后提供评估依据。 -
关键词:
- 尖锐湿疣 /
- 糖尿病 /
- CO2激光及咪喹莫特治疗 /
- 血糖波动 /
- 复发
Abstract:Objective This study aimed to investigate the correlation between blood glucose fluctuations, interleukin-6 (IL-6), and serum tumor necrosis factor-alpha (TNF-α) levels following CO2 laser and imiquimod treatment (CO2-Ⅰ) in patients with diabetes mellitus complicated by anogenital (DMCA), and their association with recurrence rates. Methods A prospective cohort study was conducted on 136 DMCA patients treated with CO2-Ⅰ at the People's Hospital of Bozhou, from August 2020 to December 2022. Post-treatment, all patients underwent continuous blood glucose monitoring for 72 hours to calculate the mean amplitude of glycemic excursion (MAGE). After discharge, patients were followed up for six months to evaluate short-term recurrence. Patients were divided into a recurrence group and a non-recurrence group based on their post-treatment recurrence status. The impact of blood glucose fluctuations on short-term recurrence in diabetic patients with condyloma acuminatum (DMCA) following CO2 laser treatment (CO2-Ⅰ) was analyzed. Results Among the 136 DMCA patients, 34 (25.00%) experienced recurrence, while 102 (75.00%) did not. The recurrence group exhibited significantly higher levels of MAGE, IL-6, and TNF-α compared to the non-recurrence group, with these differences being statistically significant (P < 0.05). Multivariate logistic regression analysis indicated that higher MAGE values (≥3.9 mmol/L, OR=1.527, P < 0.001), higher incidence of anorectal and/or genital erosion (OR=2.786, P=0.016), elevated TNF-α levels (≥6.39 μg/L, OR=1.746, P=0.001), and decreased IL-6 levels (< 5.26 pg/mL, OR=1.725, P=0.001) were risk factors for the recurrence. Conclusion In DMCA patients treated with CO2-Ⅰ, high MAGE values, increased expression of TNF-α and lower IL-6, and the presence of anorectal and/or genital erosion significantly increase the risk of short-term recurrence. These findings hold certain clinical implications and may provide a basis for prognosis assessment. -
表 1 2组MDCA患者基线资料及实验室指标比较
Table 1. Comparison of baseline characteristics and laboratory indicators between the two groups of MDCA patients
项目 复发组(n=34) 非复发组(n=102) 统计量 P值 性别[例(%)] 0.411a 0.840 男性 21(61.76) 61(59.80) 女性 13(38.24) 41(40.20) 年龄(x±s,岁) 41.32±6.48 39.07±7.64 1.545b 0.125 糖尿病病程(x±s,年) 5.79±1.89 5.93±1.38 0.456b 0.649 CA病程(x±s,月) 5.79±1.81 6.28±2.77 0.964b 0.337 疣体数量(x±s,个) 5.88±1.55 5.76±1.62 0.370b 0.712 吸烟[例(%)] 1.813a 0.178 是 12(35.29) 24(23.53) 否 22(64.71) 78(76.47) 饮酒[例(%)] 1.454a 0.228 是 10(29.41) 22(21.57) 否 24(70.59) 80(78.43) HPV感染类型[例(%)] 1.070a 0.586 高危型 8(23.53) 31(30.39) 低危型 17(50.00) 41(40.20) 高-低危混合感染型 9(26.47) 30(29.41) 性伴侣感染HPV[例(%)] 0.046a 0.830 是 11(32.35) 31(30.39) 否 23(66.65) 71(69.61) 性生活中使用安全套[例(%)] 是 22(64.71) 43(42.16) 0.066a 0.797 否 12(35.29) 59(57.84) 肛门和(或)生殖器区域糜烂[例(%)] 5.857a 0.016 是 10(29.41) 12(11.76) 否 24(70.59) 90(88.24) TC(x±s,mmol/L) 5.89±1.39 5.67±1.31 0.875b 0.383 TG(x±s,%) 2.89±0.62 2.95±0.72 1.437b 0.663 HDL-C(x±s,mmol/L) 1.28±0.22 1.25±0.28 0.578b 0.564 LDL-C(x±s,pg/mL) 3.52±0.67 3.58±0.71 0.433b 0.666 TSH(x±s,μIU/mL) 3.08±0.51 3.13±0.59 0.440b 0.661 糖化血红蛋白(x±s,%) 7.58±1.66 7.21±1.69 1.113b 0.268 注:a为χ2值,b为t值。 表 2 2组MDCA患者血糖波动及IL-6、TNF-α比较(x±s)
Table 2. Comparison of blood glucose fluctuation, IL-6 and TNF-α in two groups of MDCA patients(x±s)
组别 例数 MAGE(mmol/L) IL-6(pg/mL) TNF-α(μg/L) 复发组 34 5.89±1.50 4.37±1.14 6.59±1.92 非复发组 102 3.10±0.67 5.71±1.26 5.43±1.67 t值 14.903 5.718 3.400 P值 <0.001 0.002 0.001 表 3 DMCA患者CO2-Ⅰ治疗后复发的影响因素分析
Table 3. Analysis of factors affecting recurrence in DMCA patients after CO2-Ⅰ treatment
变量 B SE Waldχ2 P值 OR值 95% CI 肛门和(或)生殖器区域糜烂(是) 1.025 0.847 9.652 0.016 2.786 0.711~16.376 MAGE≥3.9 mmol/L 0.423 0.317 13.457 0.001 1.527 1.149~2.495 TNF-α≥6.39 μg/L 0.558 0.164 9.458 0.001 1.746 6.393~8.347 IL-6<5.26 pg/mL 0.545 0.338 8.326 0.002 1.725 1.267~4.903 注:赋值情况如下,性生活中使用安全套,是=0,否=1;肛门和(或)生殖器区域糜烂,是=0,否=1;MAGE<3.9 mmol/L=0,≥3.9 mmol/L=1;TNF-α<6.39 μg/L=0,≥6.39 μg/L=1;IL-6<5.26 pg/mL=0,≥5.26 pg/mL=1。 -
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