2型糖尿病患者周围神经病变相关危险因素分析Analysis of the related risk factors of peripheral neuropathy in type 2 diabetic patients
常琦;吴元波;任明山;吴元洁;叶山东;杨光伟;
摘要(Abstract):
目的探讨2型糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)相关危险因素。方法回顾性分析710例2型糖尿病住院患者的病史资料,采用震动感觉阈值(vibration perception threshold,VPT)评估DPN病情严重程度,根据VPT评分将DPN严重程度分为轻、中、重3组,分别与无DPN组比较临床特征、血生化及常规指标等的差异;采用Ordinal回归分析探讨DPN发生的危险因素。结果本组资料DPN的总发生率为57.2%,其中轻、中、重度3组患者DPN的发生率分别为22.4%、21.0%、13.8%。病程、体重指数(BMI)、糖化血红蛋白(HbAlc)、血清丙氨酸氨基转移酶(ALT)、天氡氨酸氨基转移酶(AST)、红细胞体积分布宽度(RDW-CV)、平均红细胞血红蛋白浓度(MCHC)、糖尿病视网膜病变(DR)发生率、外周动脉疾病(PAD)发生率在轻、中、重度DPN组和无DPN组间比较差异有统计学意义(均P<0.05)。Ordinal回归分析显示病程、HbAlc、BMI、AST、RDW-CV、DR、PAD为DPN发生的影响因素(均P<0.05)。结论病程、HbAlc、BMI、AST、RDW-CV、并发PAD及并发DR可能是DPN发生的危险因素。
关键词(KeyWords): 糖尿病,2型;糖尿病并发症;震动感觉阈值;危险因素
基金项目(Foundation): 国家自然科学基金资助项目(81102626H2716)
作者(Author): 常琦;吴元波;任明山;吴元洁;叶山东;杨光伟;
Email:
DOI:
参考文献(References):
- [1]Xu Y,Wang L,He J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.
- [2]Wu YB,Shi LL,Wu YJ,et al.Protective effect of gliclazide on diabetic peripheral neuropathy through Drp-1mediated-oxidative stress and apoptosis[J].Neurosci Lett,2012,523(1):45-49.
- [3]Miralles-Garcia JM,De Pablos-Velasco P,Cabrerizo L,et al.Prevalence of distal diabetic polyneuropathy using quantitative sensory methods in a population with diabetes of more than 10years’disease duration[J].Endocrinol Nutr,2010,57(9):414-420.
- [4]Jayaprakash P,Bhansali A,Bhansali S,et al.Validation of bedside methods in evaluation of diabetic peripheral neuropathy[J].Indian J Med Res,2011,133(6):645-649.
- [5]Young MJ,Breddy JL,Veves A,et al.The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds.A prospective study[J].Diabetes Care,1994,17(6):557-560.
- [6]Al-Geffari M.Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in Primary Health Care setting[J].Int J Health Sci(Qassim),2012,6(2):127-134.
- [7]侯宇,刘莎,朱婷婷,等.利用ROC曲线评价振动觉阈值检查在糖尿病周围神经病变诊断中的意义[J].中南大学学报(医学版),2012,37(9):951-956.
- [8]Moghtaderi A,Bakhshipour A,Rashidi H.Validation of michigan neuropathy screening instrument for diabetic peripheral neuropathy[J].Clin Neurol Neurosurg,2006,108(5):477-481.
- [9]Hussain G,Rizvi S A,Singhal S,et al.Cross sectional study to evaluate the effect of duration of type 2diabetes mellitus on the nerve conduction velocity in diabetic peripheral neuropathy[J].Diabetes Metab Syndr,2014,8(1):48-52.
- [10]胡泓,李红,郑芬萍,等.不同神经病变评分系统在无症状糖尿病周围神经病变筛查中的临床价值比较[J].中华内科杂志,2012,51(1):13-17.
- [11]Wang DD,Bakhotmah BA,Hu FB,et al.Prevalence and correlates of diabetic peripheral neuropathy in a Saudi Arabic population:a cross-sectional study[J].PLoS One,2014,9(9):e106935.
- [12]聂琛,鲍海萍.糖尿病周围神经病变的相关危险因素分析[J].中华实验和临床病毒学杂志,2012,26(6):467-469.
- [13]Drouet L,Bal DSC,Henry P.The basis of platelets:platelets and atherothrombosis:an understanding of the lack of efficacy of aspirin in peripheral arterial disease(PAD)and diabetic patients[J].Drugs,2010,70(Suppl 1):9-14.
- [14]Wang L,Du F,Mao H,et al.Prevalence and related risk factors of peripheral arterial disease in elderly patients with type 2diabetes in Wuhan,Central China[J].Chin Med J(Engl),2011,124(24):4264-4268.
- [15]Edwards JL,Quattrini A,Lentz SI,et al.Diabetes regulates mitochondrial biogenesis and fission in mouse neurons[J].Diabetologia,2010,53(1):160-169.
- [16]Tsuboi S,Miyauchi K,Kasai T,et al.Impact of red blood cell distribution width on long-term mortality in diabetic patients after percutaneous coronary intervention[J].Circ J,2013,77(2):456-461.
- [17]Malandrino N,Wu WC,Taveira TH,et al.Association between red blood cell distribution width and macrovascular and microvascular complications in diabetes[J].Diabetologia,2012,55(1):226-235.
- [18]Magri CJ,Fava S.Red blood cell distribution width and diabetes-associated complications[J].Diabetes Metab Syndr,2014,8(1):13-17.