糖尿病神经病变患者血清抗神经节苷脂抗体与代谢、免疫的关系

The relationship among metabolism,immunity and serum anti-gangliosides antibody in type 2 diabetes mellitus patients with peripheral neuropathy

目的 探讨糖尿病周围神经病变 (DPN)血清抗神经节苷脂抗体 (anti GS Ab)与代谢、免疫间的关系。方法 受试者分为三组 ,DPN组、糖尿病无神经病变组 (DM组 )和正常对照组 (N组 ) ,每组 30例。采用固相酶联免疫吸附法测定各组anti GS Ab同时测定糖化血红蛋白 (HbA1c)、白介素 1β(IL 1β)、肿瘤坏死因子α(TNF α)、一氧化氮 (NO)、超氧化物歧化酶 (SOD)和神经传导速度。结果 DPN组anti GS IgM Ab、anti GS IgG Ab的阳性率分别为 4 5 6 7%及 2 0 % ,显著高于N组及DM组。DPN组anti GS Ab与糖尿病神经病变临床分级 (DPNC)、TNF α、IL 1β、HbA1c和NO呈显著正相关 ,而与SOD呈显著负相关 ;对anti GS Ab有显著作用的因素依次为DPNC、IL 1β ;对HbA1c有显著作用的因素依次为IL 1β、anti GS Ab、TNF α、NO ;对TNF α有显著作用的因素为HbA1c。 结论 DPN患者体内存在代谢紊乱 ,细胞因子分泌失调 ,自由基清除障碍。这些因素与anti GS Ab增多密切相关且相互影响 ,提示anti GS Ab可作为一项了解DPN自身免疫状况的指标 。

Objective To investigate the relationship among antigangliosides antibody (anti GS Ab)and metabolism,immunity in diabetic polyneuropathy (DPN).Methods The subjects were divided into three groups:diabetes with non peripheral neuropathy (DM group),DPN group and healthy controls (N group),each group having 30 individuals.The anti GS Ab was detected by solid enzyme immunoassay.Glycosylated hemoglobin(HbA1c),interleukin 1 (IL 1),tumor necrosis factor (TNF α),NO and the speed of nervous conduction were determined accordingly.Results The positive results of anti GS IgM Ab and anti GS IgG Ab were respectively 46 47% and 20% of the DPN group,which were much higher than those of N and DM groups.The anti GS Ab results of DPN group were also seen a significant positive correlation with DPNC,IL 1,TNF α,HbA 1C and NO,but negatively correlated with SOD.The multiple regression analysis showed that the influencing factors of anti GS Ab were DPNC,and IL 1β sequentially,while the significant influencing factors of HbA1c were IL 1β,anti GS Ab,TNF α,and NO sequentially.But TNF α has only one influencing factor of HbA1c.Conclusion The presence of metabolic disturbance,failure of secretion of cell gene factors and impairment of removal of free radicals in DPN might greatly influence the level of anti GS Ab,suggesting that anti GS Ab may serve as an index to the autoimmunity of DPN patients,and be clinically valuable in the diagnosis of DPN.