骨代谢标志物与糖尿病周围神经病变的相关性研究

Correlation between bone metabolic markers and diabetic peripheral neuropathy

目的研究骨代谢标志物与糖尿病周围神经病变的相关性。方法选取绍兴市人民医院肌电图室2021年1月至2022年2月就诊的糖尿病患者187例,合并糖尿病周围神经病变(diabeticperipheral neuropathy,DPN)的入DPN组,没有合并DPN的入NDPN组。最终DPN组入组70例,NDPN组入组117例。所有入组患者均测量身高、体质量;测定糖化血红蛋白(glycosylatedhemoglobin,HbA1c)、血清钙(Ca)、血清磷(P)、25羟维生素D[25-hydroxy vitaminD,25(OH)D]、骨钙素、Ⅰ型前胶原氨基端前肽(amino-terminal propeptide of typeⅠprocollagen,PINP)、Ⅰ型胶原羧基端肽β特殊序列(typeⅠcollagencarboxy terminalpeptideβspecialsequence,β-CTX);记录患者出生年月、年龄、糖尿病病程及并发症情况。结果与NDPN组相比,DPN组的患者年龄大、糖尿病病程长,此外,高血压的患病率、糖尿病的慢性并发症比例也更高(P均<0.05)。DPN组的患者25(OH)D、Ca显著低于NDPN组患者。相关性分析显示,患者年龄、病程、高血压及糖尿病慢性并发症患病率与DPN呈正相关(P<0.05),25(OH)D、Ca水平与DPN呈负相关(P<0.05)。Logistic回归显示,糖尿病病程、Ca偏低是DPN的独立危险因素(P<0.05)。结论骨代谢标志物中25(OH)D、Ca与DPN呈负相关,Ca偏低是DPN的独立危险因素。因此,糖尿病患者积极监测25(OH)D、Ca的变化或可为DPN的预测提供参考,补钙或许能够对糖尿病患者的周围神经起到保护作用,延缓DPN的发生和发展。

Objective To study the association between bone metabolic markers and diabetic peripheral neuropathy(DPN)in diabetic patients.Methods A total of 187 diabetic patients admitted to the EMG Department of Shaoxing People’s Hospital from January 2021 to February 2022 were selected.Based on the presence or absence of nerve damage,the patients were divided into two groups.One is DPN group and the other is NDPN group.Height and weight were measured and body mass index(BMI)was calculated.The levels of HbA1c,Ca,P,25(OH)D,BG-2,amino-terminal propeptide of typeⅠprocollagen(PINP)and typeⅠcollagen carboxy terminal peptideβspecial sequence(β-CTX)were measured.Register age,course of disease,complications.Results Compared with NDPN group,patients in DPN group were older,had a longer duration of diabetes,and had a higher incidence of hypertension and chronic complications of diabetes.The levels of 25(OH)D and Ca in DPN group were significantly lower than those in NDPN group.Spearman correlation analysis showed that DPN was positively correlated with age,duration of diabetes,prevalence of hypertension and chronic diabetic complications(P<0.05),25(OH)D and Ca levels were showed the opposite relationships.Logistic regression analysis showed that the duration of diabetes mellitus and low Ca were independent risk factors for DPN(P<0.05).Conclusion The markers of bone metabolism,25(OH)D and Ca were negatively correlated with DPN,and low Ca was an independent risk factor for DPN.Therefore,active monitoring of the changes of 25(OH)D and Ca in diabetic patients may provide reference for the prediction of DPN,and calcium supplementation may protect peripheral nerves and delay diabetic peripheral neuropathy.