Clinical significance of serum thrombospondin-4 for interventional restenosis in diabetes patients complicated by lower extremity arteriosclerosis obliterans

doi:10.4239/wjd.124271

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Diabetes. Oct 15, 2026; 17(10): 124271
Published online Oct 15, 2026. doi: 10.4239/wjd.124271

Table 1 Comparison of baseline features of the training and validation cohorts, n (%)/mean ± SD

Characteristic	Training cohort (n = 100)	Validation cohort (n = 43)	t/Z/χ²	P value
Male	62 (62.00)	28 (65.10)	0.125	0.723
Age (year)	70.28 ± 9.63	73.70 ± 10.42	-1.898	0.060
Diabetes duration (year)	10.00 (5.00, 15.00)	11.00 (8.00, 15.00)	-0.353	0.724
Coronary heart disease	27 (27.00)	9 (20.90)	0.588	0.443
Cerebral infarction	45 (45.00)	14 (32.60)	1.921	0.166
Smoking	43 (43.00)	22 (51.20)	0.808	0.369
Drinking	35 (35.00)	18 (41.90)	0.607	0.436
Fontaine stage			-0.356	0.722
II	39 (39.00)	13 (30.20)
III	23 (23.00)	15 (34.90)
IV	38 (38.00)	15 (34.90)
BMI (kg/m²)	23.12 ± 3.98	22.11 ± 3.40	1.465	0.145
Hb (g/L)	122.81 ± 21.83	125.79 ± 18.36	-0.784	0.435
ALB (g/L)	38.65 (36.43, 40.78)	39.00 (34.30, 40.70)	-0.704	0.481
ALT (U/L)	14.00 (11.25, 22.00)	14.00 (12.00, 19.00)	-0.659	0.510
AST (U/L)	16.00 (13.25, 21.75)	16.00 (12.00, 19.00)	-0.814	0.416
TBIL (μmol/L)	9.45 (7.13, 13.43)	8.92 (6.77, 12.28)	-1.054	0.292
Scr (μmol/L)	75.00 (60.25, 110.23)	75.00 (57.00, 91.00)	-0.920	0.357
FPG (μmol/L)	7.05 (5.87, 8.84)	6.58 (5.42, 8.31)	-1.072	0.284
HbA1c (%)	7.75 ± 1.59	7.36 ± 1.57	1.356	0.177
TC (mmol/L)	3.93 (3.09, 5.03)	3.66 (3.07, 5.06)	-0.396	0.692
TG (mmol/L)	1.31 (0.98, 1.68)	1.24 (0.97, 1.94)	-0.350	0.726
LDL-C (mmol/L)	2.57 ± 0.83	2.66 ± 0.85	-0.538	0.591
HDL-C (mmol/L)	0.96 ± 0.25	1.03 ± 0.29	-1.592	0.114
FIB (g/L)	4.04 (3.33, 5.24)	3.78 (2.94, 4.62)	-1.149	0.251
D-D (mg/L)	0.49 (0.29, 0.84)	0.43 (0.23, 0.70)	-1.231	0.218
hs-CRP (mg/L)	2.54 ± 1.25	2.29 ± 1.11	1.169	0.244
TSP-4 (ng/mL)	61.26 ± 29.46	64.47 ± 28.34	-0.605	0.546

Quantitative data are expressed as mean ± SD or median (IQR), analyzed using the t test or Mann-Whitney U test. Categorical data are expressed as n (%), analyzed using the χ² test or Mann-Whitney U test. BMI: Body mass index; Hb: Hemoglobin; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBIL: Total bilirubin; Scr: Serum creatinine; FPG: Fasting plasma glucose; HbA1c: Glycated hemoglobin A1c; TC: Total cholesterol; TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; FIB: Fibrinogen; D-D: D-dimer; hs-CRP: High-sensitivity C-reactive protein; TSP-4: Thrombospondin-4.

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Table 2 Univariate analysis of postoperative restenosis in the training cohort, n (%)/mean ± SD

Variables	Training cohort		t/Z/χ²	P value
Variables	Restenosis (n = 45)	Non-restenosis (n = 55)	t/Z/χ²	P value
Male	30 (66.70)	32 (58.20)	0.756	0.414
Age (year)	75.00 (66.50, 82.00)	70.00 (63.00, 74.00)	-3.343	0.001^b
Diabetes duration (year)	11.70 ± 7.66	11.75 ± 7.28	-0.030	0.976
Coronary heart disease	13 (28.90)	14 (25.50)	0.148	0.822
Cerebral infarction	23 (51.10)	22 (40.00)	1.235	0.315
Smoking	24 (53.30)	19 (34.50)	3.564	0.070
Drinking	18 (40.00)	17 (30.90)	0.899	0.402
Fontaine stage			-2.839	0.005^b
II	11 (24.40)	28 (50.90)
III	11 (24.40)	12 (21.80)
IV	23 (51.10)	15 (27.30)
BMI (kg/m²)	23.20 ± 4.21	23.06 ± 3.81	0.170	0.865
Hb (g/L)	125.02 ± 20.57	121.00 ± 22.84	0.916	0.362
ALB (g/L)	38.26 ± 4.97	38.86 ± 3.95	-0.676	0.500
ALT (U/L)	14.00 (10.50, 23.00)	15.00 (12.00, 22.00)	-0.285	0.778
AST (U/L)	16.00 (13.00, 20.00)	17.00 (14.00, 22.00)	-0.198	0.845
TBIL (μmol/L)	9.97 (6.69, 13.60)	9.40 (7.40, 13.22)	-0.461	0.648
Scr (μmol/L)	76.00 (64.00, 123.00)	74.00 (57.00, 93.00)	-0.142	0.887
FPG (mmol/L)	7.59 (6.16, 10.26)	6.64 (5.71, 8.30)	-1.559	0.120
HbA1c (%)	8.19 ± 1.55	7.39 ± 1.53	2.606	0.011^a
TC (mmol/L)	4.36 ± 1.59	4.11 ± 1.26	0.874	0.384
TG (mmol/L)	1.23 (0.93, 1.94)	1.31 (1.00, 1.64)	-0.215	0.832
LDL-C (mmol/L)	3.03 ± 0.71	2.21 ± 0.73	5.618	< 0.001^b
HDL-C (mmol/L)	0.96 ± 0.30	0.96 ± 0.20	-0.023	0.982
FIB (g/L)	4.31 (3.46, 5.30)	3.79 (3.06, 5.26)	-1.022	0.309
D-D (mg/L)	0.58 (0.33, 0.99)	0.42 (0.23, 0.69)	-2.450	0.014^a
hs-CRP (mg/L)	3.43 (2.59, 3.84)	1.75 (1.20, 2.70)	-4.958	< 0.001^b
TSP-4 (ng/mL)	76.60 (60.67, 92.54)	48.70 (23.30, 65.99)	-5.020	< 0.001^b

^aP < 0.05.

^bP < 0.01.

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Table 3 Multivariable logistic regression analysis for restenosis

Variable	β	SE	Wald	OR	95%CI	P value
Age	0.057	0.029	3.869	1.058	1.000-1.120	0.049
LDL-C	0.891	0.429	4.309	2.437	1.051-5.653	0.038
TSP-4	0.032	0.013	6.501	1.033	1.007-1.059	0.011

Multivariable logistic regression analysis using backward stepwise selection (Backward Likelihood Ratio); only the statistics of the final model are presented in the table. SE: Standard error; OR: Odds ratio; CI: Confidence interval; LDL-C: Low-density lipoprotein cholesterol; TSP-4: Thrombospondin-4.

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Table 4 Variable assignment methods

Variable	Assignment
Age	Continuous variable
Fontaine stage	I = 1, II = 2, III = 3, IV = 4
HbA1c (%)	Continuous variable
LDL-C (mmol/L)	Continuous variable
D-D (mg/L)	Continuous variable
hs-CRP (mg/L)	Continuous variable
TSP-4 (ng/mL)	Continuous variable

HbA1c: Glycated hemoglobin A1c; LDL-C: Low-density lipoprotein cholesterol; D-D: D-dimer; hs-CRP: High-sensitivity C-reactive protein; TSP-4: Thrombospondin-4.

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Table 5 Collinearity diagnostics

Variable	VIF	Tolerance
Age	1.082	0.924
LDL-C	1.821	0.549
TSP-4	1.836	0.545

Variance inflation factor ≥ 10 generally considered indicative of significant multicollinearity. VIF: Variance inflation factor; LDL-C: Low-density lipoprotein cholesterol; TSP-4: Thrombospondin-4.

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Table 6 Comparison of predictive efficacy of the nomogram model for interventional restenosis between the training and validation cohorts

Cohort	AUC	95%CI	Sensitivity	Specificity	P value
Training cohort	0.839	0.762-0.916	0.689	0.855	< 0.001
Validation cohort	0.826	0.703-0.950	0.800	0.739	< 0.001

Receiver operating characteristic curve analysis was used to compare the discriminatory ability of the nomogram model. AUC: Area under the curve; CI: Confidence interval.

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Citation: Hu D, Lin XY, Zhao TQ, Ji H, Chen MW, Zhao XT. Clinical significance of serum thrombospondin-4 for interventional restenosis in diabetes patients complicated by lower extremity arteriosclerosis obliterans. World J Diabetes 2026; 17(10): 124271
URL: https://www.wjgnet.com/1948-9358/full/v17/i10/124271.htm
DOI: https://dx.doi.org/10.4239/wjd.124271

Hu D, Lin XY, Zhao TQ, Ji H, Chen MW, Zhao XT. Clinical significance of serum thrombospondin-4 for interventional restenosis in diabetes patients complicated by lower extremity arteriosclerosis obliterans. World J Diabetes 2026; 17(10): 124271 [DOI: 10.4239/wjd.124271]

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