糖尿病周围神经病变的维生素D水平及与IL-13、IL-17的相关性研究

Correlations of levels of vitamin D with inflammatory cytokines in diabetic peripheral neuropathy

目的糖尿病周围神经病变(diabeticperipheralneuropathy,DPN)的维生素D水平及与白细胞介素13(interleukin-13,IL-13)、白细胞介素17(interleukin-17,IL-17)的相关性。方法选取2017年1月-2018年11月在河北省秦皇岛军工医院诊疗的82例2型糖尿病(type 2 diabetes mellitus,T2DM)患者(T2DM组)。与其同时纳入30名体检健康志愿者(健康对照组)。根据有无DPN将82例T2DM患者分为DPN组(n=53)与无DPN组(NDPN组,n=29)。比较T2DM组患者与健康对照组25-(OH)D水平,进一步比较DPN组与NDPN组患者的25-(OH)D水平。采用Pearson’s检验分析25-(OH)D与IL-13、IL-17相关性。采用多因素Logistics回归分析探讨T2DM患者发生DPN的危险因素。结果 T2DM组患者25(OH)D水平低于健康对照组(P<0.05);DPN组年龄、病程、空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(HbAlc)、IL-17均高于NDPN组(P<0.05);正中神经运动神经传导速度(median motor nerve conduction velocity,MNCV)、正中神经振幅(median nerve amplitude,MNA)、腓总神经运动神经传导速度(peroneal motor nerve conduction velocity,PMCV)、腓运动神经振幅(peroneal motor nerve amplitude,PMNA)、正中神经感觉神经传导速度(median nerve sensory nerve conductionvelocity,MSCV)、正中运动神经振幅(medianmotornerveamplitude,MMNA)、25(OH)D、IL-13均低于NDPN(P<0.05)。疼痛型DPN患者的25(OH)D水平低于无痛型DPN患者且差异具有统计学意义(P=0.003);NDS评分中重度患者25(OH)D水平高于轻度、低于中度患者(P<0.05);DPN组患者25(OH)D与IL-13呈正相关(r=0.559,P=0.000);与IL-17呈负相关(r=-0.363,P=0.008);年龄、病程、HbAlc、IL-17是T2DM患者发生DPN的危险因素(P<0.05);25(OH)D、IL-13是T2DM患者发生DPN的保护因素(P<0.05)。结论维生素D缺乏可以下调IL-13水平,上调IL-17水平来促进DPN的发生,且与DPN类型及神经病变的严重程度相关,但是这一结论需要进一步的研究来证实。

Objective To investigate the levels of vitamin D in patients with diabetic peripheral neuropathy(DPN)and their correlations with IL-13 and IL-17. Methods Eighty-two patients with T2DM(the T2DM group)were selected in our hospital between January 2017 and November 2018. At the same time, another 30 healthy volunteers(healthy control group)were enrolled. According to the incidence of DPN, the 82 patients with T2DM were divided into the DPN group(n=53)and NDPN group(n=29). The levels of 25-(OH)D were compared between the T2DM group and healthy control group, and between the DPN group and NDPN group. Pearson’s test was used to analyze the correlations between 25-(OH)D and IL-13、IL-17. Logistic regression analysis was used to explore the risk factors for DPN in patients with T2DM. Results The level of 25(OH)D in the T2DM group was lower than that of the healthy control group(P<0.05).The age, course of disease and levels of FBG, HbAlc and IL-17 in the DPN group were above those in the NDPN group(P<0.05).The levels of MNCV, MNA, PMCV, PMNA, MSCV, MMNA, 25(OH)D and IL-13 in the DPN group were lower than those in the NDPN group(P<0.05). The levels of 25(OH)D in painful DPN patients were lower than those of painless DPN patients(P=0.003).The levels of 25(OH)D in moderate and severe patients were lower than those of mild and moderate patients in NDS scores(P<0.05).In the DPN group, 25(OH)D was positively correlated with IL-13(r=0.559, P=0.000)but negatively with IL-17(r=-0.363, P=0.008). Age, courses of disease and levels of HbAlc and IL-17 were risk factors for DPN in patients with T2DM(P<0.05), while 25(OH)D and IL-13 were protective factors(P<0.05). Conclusion Vitamin D deficiency can stimulate the occurrence of DPN by down-regulating IL-13 and up-regulating IL-17 levels, which is related to DPN type and severity of neuropathy, but this conclusion needs to be confirmed.