Risk Factor Analysis of Type 2 Diabetic Peripheral Neuropathy Complicated with Microangiopathy
-
摘要:
目的 探究2型糖尿病性周围神经病变(diabetic peripheral neuropathy,DPN)合并微血管病变的危险因素分析。 方法 回顾性收集2021年11月1日至2022年12月31日于云南省第一人民医院内分泌科住院治疗的DPN患者197例。根据有无合并微血管病变把患者分成单纯DPN组66例,DPN合并2型糖尿病性视网膜病变(DR)组45例,DPN合并2型糖尿病性肾病(DKD)组50例,DPN合并DR、DKD组36例,收集患者一般状况及相关临床指标,分析DPN合并微血管病变的相关影响因素。 结果 单纯DPN的患病情况为33.50%,DPN合并DR的患病情况为22.84%,DPN合并DKD的患病情况为25.38%,DPN合并DR、DKD的患病情况为18.27%。在4组中年龄、病程、高血压史、收缩压(systolic blood pressure,SBP)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、肌酐(creatinine,Cr)、血尿素氮(blood urea nitrogen,BUN)、白蛋白(albumin,ALB)、白球比(albumin/globulinratio,A/G)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、空腹C肽(fasting C-peptide,C-P)、2hC肽(two hours of C-peptide,C-P2)、空腹胰岛素(fasting insulin,INS)、2h胰岛素(insulin 2 hours after a meal,INS2h)、葡萄糖在目标范围内时间(time in rage,TIR)、内脏脂肪面积(visceral fat area,VFA)、窦性心律RR间期总体标准差(standard diviation of NN intervals,SDNN)差异有统计学意义(P < 0.05)。Logistic回归分析结果显示:DPN与DPN合并DR患者相比年龄(OR = 0.882,95%CI:0.814~0.956,P = 0.002)及eGFR(OR = 0.934,95%CI:0.886~0.985,P = 0.011)是其保护因素,SBP(OR = 1.030,95%CI:1.003~1.058,P = 0.028)是其独立危险因素。DPN与DPN合并DKD患者相比SBP(OR = 1.026,95%CI:1.001~1.052,P = 0.042)是其独立危险因素。DPN与DPN合并DR、DKD患者相比FT3(OR = 0.468,95%CI:0.224~0.976,P = 0.43)是其保护因素,SBP(OR = 1.029,95%CI:1.000~1.059,P = 0.047)及VFA(OR = 1.027,95%CI:1.006~1.049,P = 0.013)是其独立危险因素。 结论 收缩压和内脏脂肪是DPN合并微血管病变发病的高危因素,促进了DPN合并微血管病变的发生与发展。 -
关键词:
- 2型糖尿病性周围神经病变 /
- 2型糖尿病性微血管病变 /
- 危险因素
Abstract:Objective To investigate the risk factors of type 2 diabetic peripheral neuropathy (DPN) complicated with microangiopathy. Methods A total of 197 DPN patients hospitalized in the Department of Endocrinology of the First People's Hospital of Yunnan Province from November 1, 2021 to December 31, 2022 were retrospectively reviewed. Patients were divided into groups based on whether they had concurrent microvascular complications: 66 cases in the pure DPN group, 45 cases in the DPN combined with type 2 diabetic retinopathy (DR) group, 50 cases in the DPN combined with type 2 diabetic kidney disease (DKD) group, and 36 cases in the DPN combined with DR and DKD group. General conditions and relevant clinical indicators of the patients were collected to analyze the factors influencing the combination of DPN with microvascular complications. Results The prevalence of DPN alone was 33.50%, DPN combined with DR Was 22.84%, DPN combined with DKD was 25.38%, and DPN combined with DR and DKD was 18.27%. In the four groups, age, disease duration, history of hypertension, systolic blood pressure (SBP), estimated glomerular filtration rate (eGFR), creatinine (Cr), blood urea nitrogen (BUN), albumin (ALB), albumin/globulin ratio (A/G), free triiodothyronine (FT3), fasting C-peptide (C-P), two hours of C-peptide (C-P2), fasting insulin (INS), insulin 2 hours after a meal (INS2h), time in range (TIR) for glucose, visceral fat area (VFA), and standard deviation of NN intervals (SDNN) for sinus rhythm all show statistically significant differences (P < 0.05). The results of logistic regression analysis show that compared to DPN patients, age (OR = 0.882, 95%CI: 0.814~0.956, P = 0.002) and eGFR (OR=0.934, 95%CI: 0.886~0.985, P = 0.011) are protective factors for those with DPN and DR, while SBP (OR = 1.030, 95%CI: 1.003~1.058, P = 0.028) is an independent risk factor. When comparing DPN patients with those who have DPN and DKD, SBP (OR = 1.026, 95%CI: 1.001~1.052, P = 0.042) is an independent risk factor. Comparing DPN patients with those who have DPN and both DR and DKD, FT3 (OR = 0.468, 95%CI: 0.224~0.976, P = 0.43) is a protective factor, while SBP (OR = 1.029, 95%CI: 1.000~1.059, P = 0.047) and VFA (OR = 1.027, 95%CI: 1.006~1.049, P = 0.013) are independent risk factors. Conclusion Elevated systolic blood pressure and visceral fat are high-risk factors for the development of microvascular complications in diabetic peripheral neuropathy (DPN), contributing to the occurrence and progression of microvascular complications in DPN. -
表 1 4组患者基本情况分析[n(%)]
Table 1. Basic information analysis of four groups of patients[n(%)]
因素 A组 B组 C组 D组 χ2 P 性别 5.519 0.137 男 43(65.20) 20(44.40) 31(62.00) 23(63.90) 女 23(34.80) 25(55.60) 19(38.00) 13(36.10) 高血压史 8.885 0.031* 无 31(47.00) 30(66.70) 19(38.00) 15(41.70) 有 35(53.00) 15(33.30)c 31(62.00) 21(58.30) 吸烟史 6.701 0.082 无 34(51.50) 30(66.70) 29(58.00) 14(38.90) 有 32(48.50) 15(33.30) 21(42.20) 36(61.10) 饮酒史 3.876 0.275 无 47(71.20) 34(75.60) 43(86.00) 29(80.60) 有 19(28.80) 11(24.40) 7(14.00) 7(19.40) 与C组比较,cP < 0.05;*P < 0.05。 表 2 4组患者临床资料分析[n(%)/($\bar x \pm s $)/ M(P25,P75)]
Table 2. Clinical data of four groups [n(%)/($\bar x \pm s $)/ M(P25,P75)]
因素 A组(n=66) B组(n=45) C组(n=50) D组(n=36) F/H P 年龄(岁) 62.09±9.77 57.93±9.37c 66.48±9.07 62.06±8.30 6.766 <0.001* 病程(a) 10.00
(5.75,15.25)d10.00
(5.50,18.50)10.00
(6.75,20.00)16.00
(10.00,20.00)11.290 0.010* SBP(mmHg) 129.50
(117.50,143.25)c133.00
(122.00,145.50)c145.00
(131.75,160.25)139.50
(133.00,155.00)16.252 0.001* eGFR
[mL/(min·1.73 m2)]101.40
(91.65,111.30)d102.70
(91.40,108.00)d94.05
(75.08,105.30)93.10
(72.98,102)13.844 0.003* BUN(mmol/L) 5.90
(4.60,7.05)5.40
(4.30,6.75)d6.20
(5.18,7.40)6.20
(5.30,7.63)8.978 0.030* Cr(μmol/L) 67.00
(55.50,75.50)59.0
(49.00,71.00)cd71.00
(60.25,86.50)74.50
(61.50,89.50)13.924 0.003* ALB(g/L) 40.50
(38.85,43.15)d38.60
(37.05,41.90)39.10
(35.95,41.85)37.45
(33.63,40.3)17.308 <0.001* A/G(g/L) 1.56
(1.39,1.73)cd1.45
(1.36,1.60)1.40
(1.20,1.55)1.44
(1.19,1.57)14.259 0.003* FT3(pmol/L) 4.49
(3.92,4.81)d4.20
(3.80,4.76)4.12
(3.64,4.50)3.98
(3.21,4.38)11.905 0.008* C-P(nmol/L) 0.59
(0.36,0.82)b0.39
(0.24,0.48)c0.53
(0.30,0.88)0.45
(0.22,0.59)13.413 0.004* C-P2h(nmol/L) 1.57
(1.07,2.39)bd1.05
(0.86,1.51)1.51
(0.94,2.31)d1.03
(0.83,1.55)18.731 <0.001* INS(nmol/L) 6.24
(3.00,11.51)d3.89
(1.73,7.08)5.38
(2.61,8.10)3.80
(1.10,5.70)11.487 0.009* INS2h(nmol/L) 26.90
(15.26,56.29)18.0
(11.45,31.61)21.64
(16.04,31.14)14.51
(8.38,22.56)ac17.647 <0.001
<0.001*TIR(%) 73.00
(62.00,87.00)72.00
(59.50,81.50)65.00
(50.75,79.00)59.00
(50.00,67.00)ab16.902 <0.001* SDNN 23.98
(18.00,30.60)cd19.95
(15.37,26.21)16.66
(13.11,21.81)14.85
(8.96,30.00)14.684 0.002* VFA(cm2) 77.00
(64.50,96.25)66.00
(48.00,79.00)82.50
(55.75,94.50)79.00
(44.25,104.50)9.136 0.028* 与D组比较,dP < 0.05;与C组比较,cP < 0.05;与B组比较,bP < 0.05;*P < 0.05。 表 3 DPN与DPN合并DR患者Logistic回归分析
Table 3. Logistic regression analysis of DPN and DPN combined with DR patients
因素 B SE Wald P OR 95%CI 年龄(岁) −0.125 0.041 9.348 0.002* 0.882 0.814~0.956 eGFR[mL/(min·1.73 m2)] −0.068 0.027 6.423 0.011* 0.934 0.886~0.985 SBP(mmHg) 0.030 0.014 4.802 0.028* 1.030 1.003~1.058 *P < 0.05。 表 4 DPN与DPN合并DKD患者Logistic回归分析
Table 4. Logistic regression analysis of DPN and DPN combined with DKD patients
因素 B SE Wald P OR 95%CI SBP(mmHg) 0.026 0.013 4.133 0.042* 1.030 1.001~1.052 *P < 0.05。 表 5 DPN合并DKD与DPN合并DR、DKD患者Logistic回归分析
Table 5. Logistic regression analysis of DPN patients with DKD and DPN patients with DR And DKD
因素 B SE Wald P OR 95%CI VFA(cm2) 0.027 0.011 6.193 0.013* 1.027 1.006~1.049 SBP(mmHg) 0.029 0.014 3.928 0.047* 1.029 1.000~1.059 FT3(pmol/L) −0.760 0.375 4.101 0.043* 0.468 0.224~0.976 *P < 0.05。 -
[1] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020 年版)[J]. 国际内分泌代谢杂志,2021,41(5):482-548. doi: 10.3760/cma.j.cn121383-20210825-08063 [2] 吴遵平,吴利利. 基于Apriori模型分析糖尿病周围神经病变患者的联合用药情况[J]. 海峡药学,2022,34(8):118-121. [3] Cheng Y,Cao W,Zhang J,et al. Determinants of diabetic peripheral neuropathy and their clinical significance: A retrospective cohort study[J]. Front Endocrinol (Lausanne),2022,13:934020. doi: 10.3389/fendo.2022.934020 [4] 王志平, 熊英琼. 电流感觉阈值检测仪的临床应用[J]. 江西中医药大学学报,2017,(3):115-117. [5] 中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏病防治指南(2021年版)[J]. 中华糖尿病杂志,2021,13(8):762-784. doi: 10.3760/cma.j.cn115791-20210706-00369 [6] 张燕. 2型糖尿病周围神经病变和其他微血管病变相互关系的研究[D]. 重庆: 重庆医科大学,2013. [7] 马丽丽. 2型糖尿病微血管病变的相关危险因素分析[J]. 医学食疗与健康,2023,21(13):156-158. [8] 王霞,严靓,李伟琴,等. 不同糖尿病微血管病变患者血清N-钙黏蛋白、E-钙黏蛋白水平变化及其诊断效能分析[J]. 山东医药,2023,63(32):11-15. doi: 10.3969/j.issn.1002-266X.2023.32.003 [9] 徐瑞君,韦玉和,沈文明,等. 中性粒细胞与淋巴细胞比值与2型糖尿病血管病变的相关性研究[J]. 齐齐哈尔医学院学报,2020,41(3):267-270. doi: 10.3969/j.issn.1002-1256.2020.03.002 [10] Woolf S H,Davidson M B,Greenfield S. Controlling blood glucose levels in patients with type 2 diabetes mellitus. An evidence-based policy statement by the American Academy of Family Physicians and American Diabetes Association[J]. J Fam Pract,2000,49(5):453-460. [11] Zhong J B,Yao Y F,Zeng G Q,et al. A closer association between blood urea nitrogen and the probability of diabetic retinopathy in patients with shorter type 2 diabetes duration[J]. Sci Rep,2023,13(1):9881. doi: 10.1038/s41598-023-35653-z [12] Du K,Luo W. Association between blood urea nitrogen levels and diabetic retinopathy in diabetic adults in the United States (NHANES 2005-2018)[J]. Front Endocrinol (Lausanne),2024,15:1403456. doi: 10.3389/fendo.2024.1403456 [13] Wang X,Yang W,Zhu Y,et al. Genomic DNA methylation in diabetic chronic complications in patients with type 2 diabetes mellitus[J]. Front Endocrinol (Lausanne),2022,13:896511. doi: 10.3389/fendo.2022.896511 [14] Wang G X,Fang Z B,Li J T,et al. The correlation between serum albumin and diabetic retinopathy among people with type 2 diabetes mellitus: NHANES 2011-2020[J]. PLoS One,2022,17(6):e0270019. doi: 10.1371/journal.pone.0270019 [15] Adnan Khalaf M,Ghassan Zainal I. Investigation of antioxidant markers in diabetic patients[J]. Arch Razi Inst,2021,76(5):1453-1460. [16] Cai Y W,Zhang H F,Gao J W,et al. Serum albumin and risk of incident diabetes and diabetic microvascular complications in the UK Biobank cohort[J]. Diabetes Metab,2023,49(5):101472. doi: 10.1016/j.diabet.2023.101472 [17] Chen J,Huang Y,Liu C,et al. The role of C-peptide in diabetes and its complications: An updated review[J]. Front Endocrinol (Lausanne),2023,14:1256093. doi: 10.3389/fendo.2023.1256093 [18] Vejrazkova D,Vankova M,Lukasova P,et al. Insights into the physiology of C-peptide[J]. Physiol Res,2020,69(Suppl 2):S237-S243. [19] Ido Y,Vindigni A,Chang K,et al. Prevention of vascular and neural dysfunction in diabetic rats by C-peptide[J]. Science,1997,277(5325):563-566. doi: 10.1126/science.277.5325.563 [20] Johansson B L,Kernell A,Sjöberg S,et al. Influence of combined C-peptide and insulin administration on renal function and metabolic control in diabetes type 1[J]. J Clin Endocrinol Metab,1993,77(4):976-981. [21] Wahren J,Foyt H,Daniels M,et al. Long-acting C-peptide and neuropathy in type 1 diabetes: A 12-month clinical trial[J]. Diabetes Care,2016,39(4):596-602. doi: 10.2337/dc15-2068 [22] 戴艳环,陈莉,张伟. 2型糖尿病患者血清胰岛素及C肽释放水平变化的探讨[J]. 糖尿病新世界,2023,26(23):52-54,62. [23] Mayeda L,Katz R,Ahmad I,et al. Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease[J]. BMJ Open Diabetes Res Care,2020,8(1):e000991. doi: 10.1136/bmjdrc-2019-000991 [24] 叶倩呈,黄洁微,周佩如. 葡萄糖目标范围内时间与糖尿病慢性并发症的相关性研究进展[J]. 循证护理,2022,8(3):322-325. doi: 10.12102/j.issn.2095-8668.2022.03.007 [25] 周侠,安秀敏,潘明麟,等. 2型糖尿病及其并发症与自主神经功能的关系探讨[J]. 医学研究杂志,2017,46(11):106-110,120. doi: 10.11969/j.issn.1673-548X.2017.11.026 [26] Chen M,Wang Y,Feng P,et al. Association between age at type 2 diabetes onset and diabetic retinopathy: A double-center retrospective study[J]. J Diabetes Res,2023,2023:5919468. [27] 蔡文瑶,杨丽辉,阿米娜. 2型糖尿病患者发生糖尿病视网膜病变的危险因素分析[J]. 西藏医药,2023,44(2):68-70. [28] 赖丽平,刘贺,黄锡岚,等. 2型糖尿病患者的糖尿病视网膜病变患病率及危险因素[J]. 广西医学,2022,44(4):370-375. [29] 陶俊,周漫,李艳. 2型糖尿病病人估算肾小球滤过率与糖尿病视网膜病变的相关性研究[J]. 安徽医药,2021,25(10):1954-1957. doi: 10.3969/j.issn.1009-6469.2021.10.011 [30] 温良,张继祥. 2型糖尿病患者肾小球滤过率与糖尿病视网膜病变的相关关系研究[J]. 中国实用医药,2019,14(8):54-56. [31] Samsu N. Diabetic nephropathy: challenges in pathogenesis,diagnosis,and treatment[J]. Biomed Res Int,2021,2021:1497449. [32] 张健,胡怡. 2型糖尿病患者并发糖尿病肾病的危险因素及Nomogram风险预测模型构建[J]. 广西医科大学学报,2023,40(11):1843-1849. [33] 张杉杉,纪锴,王艳,等. 内脏脂肪面积与2型糖尿病患者周围神经病变的相关性分析[J]. 中国糖尿病杂志,2022,30(10):741-745. [34] Wu Y,Wan Q,Xu Y,et al. Lower visceral fat area in patients with type 2 diabetic peripheral neuropathy[J]. Diabetes Metab Syndr Obes,2022,15:3639-3654. doi: 10.2147/DMSO.S388330 [35] Zheng H,Sun W,Zhang Q,et al. Proinflammatory cytokines predict the incidence of diabetic peripheral neuropathy over 5 years in Chinese type 2 diabetes patients: A prospective cohort study[J]. EClinicalMedicine,2020,31:100649. [36] 陶琪,毛樱. 甲状腺激素及抗体表达水平与糖尿病周围神经病变的相关性分析[J]. 中国现代医生,2023,61(5):43-46,51.