2型糖尿病周围神经病变患者血清FOXO3a、PDGF表达及临床意义

The expression and clinical significance of serum FOXO3a and PDGF in patients with type 2 diabetes mellitus and diabetic peripheral neuropathy

目的 探究2型糖尿病周围神经病变(DPN)患者血清叉头盒O类转录因子-3a(FOXO3a)、血小板源性生长因子(PDGF)表达及临床意义。方法 选取2020年12月—2022年12月中部战区总医院接收的110例2型糖尿病患者作为研究对象。根据是否并发DPN将患者分为无并发症组(NDPN组)和周围神经病变组(DPN组),分别有45和65例,随机选取同期在该院体检的健康人群30例作为对照组(NC组)。采集受试者的一般资料及血脂、血糖等相关生化指标。采用酶联免疫吸附试验检测3组受试者血清FOXO3a、PDGF水平。采用受试者工作特征(ROC)曲线分析血清FOXO3a、PDGF水平对2型糖尿病发生DPN的预测价值。结果 各组年龄、病程比较,差异均有统计学意义(P <0.05)。各组性别构成、体质量指数、舒张压、收缩压、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮水平比较,差异均无统计学意义(P>0.05)。NDPN组与DPN组动脉粥样硬化、视网膜病变、降压药使用史、注射胰岛素、服用二甲双胍构成比比较,差异均无统计学意义(P>0.05)。各组总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、空腹C肽、踝肱指数比较,差异均无统计学意义(P>0.05)。NDPN组、DPN组糖化血红蛋白、空腹血糖水平较NC组高(P <0.05),DPN组运动神经传导速度、感觉神经传导速度水平较NDPN组低(P <0.05)。NDPN组、DPN组FOXO3a、PDGF水平较NC组高(P <0.05),DPN组FOXO3a、PDGF水平较NDPN组高(P <0.05)。ROC曲线分析结果显示,血清FOXO3a、PDGF以及联合诊断糖尿病患者是否发生DPN的曲线下面积分别为0.695(95%CI:0.590,0.779)、0.636(95%CI:0.539,0.726)、0.732(95%CI:0.639,0.812),敏感性分别为80.00%(95%CI:0.733,0.848)、92.31%(95%CI:0.856,0.977)、89.23%(95%CI:0.838,0.954),特异性分别为55.56%(95%CI:0.438,0.654)、33.33%(95%CI:0.238,0.452)、51.11%(95%CI:0.416,0.597)。结论 2型糖尿病DPN患者体内血清FOXO3a、PDGF水平异常,提示其与2型糖尿病周围神经病变发生、发展有相关性。

Objective To investigate the expression and clinical significance of serum forkhead box protein O3a(FOXO3a)and platelet-derived growth factor(PDGF)in patients with type 2 diabetes mellitus and diabetic peripheral neuropathy(DPN).Methods A total of 110 patients with type 2 diabetes mellitus admitted to our hospital from December 2020 to December 2022 were selected,and were divided into non-DPN(NDPN)group(45 cases)and DPN group(65 cases)according to whether they were complicated by DPN.Another 30 healthy people who underwent health checkup during the same period in our hospital were randomly selected as the control group(NC group).The general information and data on biochemical indicators including blood lipids and glucose were collected.ELISA was used to detect the serum levels of FOXO3a and PDGF of patients in the three groups.The receiver operating characteristic(ROC)curve was applied to analyze the predictive values of serum levels of FOXO3a and PDGF for the occurrence of DPN in type 2 diabetes mellitus.Results The age of patients and the disease course were different among the three groups(P<0.05),while there was no statistically significant difference in sex composition,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),and levels of alanine aminotransferase,aspartate aminotransferase,creatinine,and urea nitrogen among the groups(P>0.05).There was no significant difference between the NDPN group and the DPN group in proportions of patients with atherosclerosis,retinopathy,history of antihypertensive drug use,insulin injection,and metformin use(P>0.05).There was no statistically significant difference in levels of TC,TG,LDL-C,HDL-C,FCP and ABI among the three groups(P>0.05).Compared with the NC group,the levels of HbAlc and FPG were higher in the NDPN group and the DPN group(P<0.05).Compared with the NDPN group,the levels of MNCV and SNCV were lower in the DPN group(P<0.05).Compared with the NC group,the levels of FOXO3a and PDGF were higher in the NDPN group and the DPN group(P<0.05).Compared with the NDPN group,the levels of FOXO3a and PDGF were even higher in the DPN group(P<0.05).ROC curve analysis showed that the areas under the curves(AUCs)of serum FOXO3a,PDGF and their combined detection for predicting DPN in diabetic patients were 0.695(95%CI:0.590,0.779),0.636(95%CI:0.539,0.726),and 0.732(95%CI:0.639,0.812),with the sensitivities being 80.00%(95%CI:0.733,0.848),92.31%(95%CI:0.856,0.977),and 89.23%(95%CI:0.838,0.954),and the specificities being 55.56%(95%CI:0.438,0.654),33.33%(95%CI:0.238,0.452),and 51.11%(95%CI:0.416,0.597),respectively.Conclusion The abnormal serum levels of FOXO3a and PDGF in patients with type 2 diabetes mellitus and DPN suggest their associations with the occurrence and progression of DNP in type 2 diabetes mellitus.