Outcomes of arterial revascularization in obliterating atherosclerosis, combined with type 2 diabetes mellitus, depending on the osteoprotegerin, homocysteine and endothelin-1

Introduction. The number of patients worldwide suffering from obliterating atherosclerosis and diabetes mellitus increases annually. Both of the above-mentioned diseases are multifactorial. The most thoroughly studied mechanisms of their development are endothelial dysfunction, hyperhomocysteinemia, as well as their relationship with bone metabolism.

Objective. To study endothelin-1, homocysteine, and osteoprotegerin levels in patients with obliterating atherosclerosis of the lower extremity arteries combined with type 2 diabetes mellitus, and the impact of their dynamics in the postoperative period on the outcomes of revascularization operations.

Materials and methods. Osteoprotegerin, endothelin-1 and homocysteine were determined in 129 patients with chronic lower limb ischemia due to a combination of obliterating atherosclerosis and type 2 diabetes mellitus (group 1). The comparison group consisted of conditionally healthy patients (n = 51). In group 1, 78 patients were observed for 24 months after revascularization surgery. Depending on the outcome of the surgery, patients in this group were divided into subgroup 1A (patients who required repeated surgery or amputation on the operated lower limb, n = 31; 39.74 %) and 1B (without such need, n = 47; 60.26 %).

Results. The concentrations of osteoprotegerin, endothelin-1 and homocysteine were higher in group 1. Analyzing the data in Table 2, it should be noted that the initial concentrations of OPG, ET-1 and HC were higher in subgroup 1B. In the postoperative period, in patients of subgroup 1A, the concentration of OPG gradually decreased after 14 days and 3 months, while in patients of subgroup 1B it increased at the above-mentioned times (p < 0.05 both after 14 days and after 3 months). The ET-1 values in subgroup 1A gradually decreased at the above- mentioned intervals, while in subgroup 1B, after a significant decrease (by 15.67 %) in the first 14 days, this indicator increased and exceeded the preoperative values after 3 months (p < 0.05 for all measurements). In the postoperative period, in subgroup 1A, an insignificant increase in the concentration of HC is observed in the first 14 days. However, over the next 3 months, its concentration decreases, while in subgroup 1B an inverse relationship is observed. The greatest impact on the outcome of revascularization is provided by the dynamics of the HC index in the first two weeks and 3 months after surgery (p < 0.05 for the difference of 1 and 2).

Conclusion. The outcome of revascularization surgery for chronic lower limb ischemia in patients with obliterating atherosclerosis combined with type 2 diabetes mellitus is influenced not only by the initial values of the concentration of osteoprotegerin, endothelin-1 and homocysteine, but also by their dynamics in the early and late postoperative periods. The developed equation for assessing the probability of an unfavorable outcome of revascularization in chronic lower limb ischemia in patients with obliterating atherosclerosis combined with type 2 diabetes mellitus will allow predicting it with a sensitivity of 88.89 %, a specificity of 85 % and an accuracy of 86.21 %.

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