2型糖尿病周围神经病变的危险因素分析及与血清C肽水平的相关性研究

The risk factors of type 2 diabetic peripheral neuropathy and its association study with C-peptide

目的观察2型糖尿病周围神经病变(Diabetic Peripheral Neuropathy,DPN)患者行口服葡萄糖耐量试验后不同时间点血清C肽(C-peptide,CP)水平的变化及临床意义。方法入选176例2型糖尿病患者,根据是否存在DPN分为单纯糖尿病(SDM)组66例和DPN组110例。采用散射比浊法测定血清CP水平,比较两组间临床指标及CP水平,并分析DPN发生的危险因素。结果 (1)两组间单因素比较,DPN组病程、年龄、尿微量白蛋白/肌酐、D-二聚体、空腹血糖、糖化血红蛋白(Hb A1c)水平较SDM组高,DPN组体重指数(BMI)、空腹C肽(Fasting C-peptide,FCP)、胰岛素抵抗指数较SDM组水平低。(2)经重复测量方差分析,两组间C肽无差异,尚未发现时间与组别间存在交互作用,不同时间点进一步做两两比较,各个时间点间差异均有统计学意义,随着时间的延长C肽逐渐上升,2 h达到高峰,3 h下降。(3)Logistic回归分析显示病程、年龄、BMI、Hb A1c、糖尿病肾脏病是DPN发生的独立危险因素。结论 2型糖尿病患者发生DPN时FCP水平下降,口服葡萄糖耐量试验后的SDM与DPN两组间C肽无差异,病程、年龄、BMI、Hb A1c、糖尿病肾脏病是DPN发生的独立危险因素。

Objective To obsearve the level and changes of serum C-peptide（ CP） at different time points after oral glucose tolerance test in type 2 diabetic peripheral neuropathy（ DPN） patients,and explore the risk factors for DPN.Methods 176 patients with type 2 diabetes were divided into simple type 2 diabetes mellitus（ SDM） group（ n = 66） and DPN group（ n = 110） according to the existing of DPN. The level of serum CP was determined by nephelometry method and compared between two groups as well as clinical parameters; Logistic regession model was used to analyze the risk factors of DPN. Results（ 1） Univariate analysis between two groups showed that DPN group had a higher duration,age,urinary A /Cr,D-dimer,FCP,Hb A1 c level than those in SDM group,while a lower BMI,FCP,HOMA-IR level than those in SDM group.（ 2） Repeated measures analysis of variance showed that there was no difference between the two groups for CP,we had not yet found there was an interaction between time and group,further pairwise comparison between different time points suggested significant differences,CP increased as time prolonged after OGTT,it reached a peak at two hours then fell down till 3 hours.（ 3） Logistic regression analysis showed that duration,age,BMI,Hb A1 c,diabetic kidney disease were independent risk factors of DPN（ P〈0. 05）. Conclusion The level of FCP decreased when T2 DM patients came up with peripheral neuropathy. There was no difference of C-peptide between SDM group and DPN group after OGTT. Duration,age,BMI,Hb A1 c,diabetic kidney disease are independent risk factors of DPN.