2型糖尿病周围神经病变与胰岛β细胞功能的相关性研究

Relationship between peripheral neuropathy andβ-cell function in patients with type 2 diabetes mellitus

目的探讨2型糖尿病周围神经病变与胰岛β细胞功能的相关性。方法选取2020年1月至12月广西医科大学第二附属医院收治的298例2型糖尿病患者为研究对象,根据是否合并周围神经病变将其分为周围神经病变组(n=178)和无周围神经病变组(n=120)。采用二两馒头餐后30min净增C肽与葡萄糖比值(ΔC肽30/ΔG30)和30min净增胰岛素与葡萄糖比值(Δ胰岛素30/ΔG30)评估早期阶段胰岛分泌功能;采用二两馒头餐后120min血糖曲线下面积(area under the curve,AUC)校正后的C肽和胰岛素AUC(C肽_(AUC)/G_(AUC)、胰岛素_(AUC)/G_(AUC))评估总的β细胞分泌功能。多因素Logistic回归分析探讨2型糖尿病并发周围神经病变的危险因素。结果周围神经病变组患者的餐后60min C肽、120min C肽、ΔC肽30/ΔG30、C肽_(AUC)/G_(AUC)均显著低于无周围神经病变组(P<0.05)。ΔC肽30/ΔG30和C肽_(AUC)/G_(AUC)与高密度脂蛋白胆固醇、空腹血糖、餐后2h血糖、糖化血红蛋白均呈负相关,与体质量指数、尿酸均呈正相关(P<0.05)。多因素Logistic回归分析结果显示,空腹血糖升高、C肽_(AUC)/G_(AUC)降低均是糖尿病患者发生周围神经病变的独立危险因素(P<0.05)。结论2型糖尿病患者胰岛β细胞功能下降是糖尿病周围神经病变发病的独立危险因素,应积极保护胰岛β细胞功能以延缓周围神经病变的发生。

Objective To investigate the relationship between peripheral neuropathy andβ-cell function in patients with type 2 diabetes mellitus(T2DM).Methods A total of 298 patients with T2DM admitted to the Second Affiliated Hospital of Guangxi Medical University from January to December 2020 were selected as study objects,and divided into peripheral neuropathy group(n=178)and non-peripheral neuropathy group(n=120)according to whether they were complicated with peripheral neuropathy.Early-phase insulin secretion function was assessed with the ratio of 30 min increment in C-peptide levels to 30 min increment in glucose levels(ΔC-P30/ΔG30)and the ratio of 30 min increment in insulin levels to 30 min increment in glucose levels(ΔI30/ΔG30)after eating two steamed buns.Totalβ-cell function was assessed with ratio of area under the curve(AUC)of C-peptide to the AUC of glucose in 120 min(C-PAUC/G_(AUC))and ratio of the AUC of insulin to the AUC of glucose in 120 min(I_(AUC)/G_(AUC))after eating two steamed buns.Multivariate Logistic regression analysis was uesd to investigate the risk factors of T2DM complicated with peripheral neuropathy.Results The levels of 60min C-P,120min C-P,ΔC-P30/ΔG30 and C-PAUC/G_(AUC)in peripheral neuropathy group were significantly lower than those in non-peripheral neuropathy group(P<0.05).ΔC-P30/ΔG30 and C-PAUC/G_(AUC)were negatively correlated with high density lipoprotein-cholesterol,fasting blood glucose,2h postmeal blood glucose,and glycosylated hemoglobin,while positively correlated with body mass index and uric acid(P<0.05).Multivariate Logistic regression analysis showed that increased fasting blood glucose and decreased C-PAUC/G_(AUC)were independent risk factors for peripheral neuropathy in T2DM patients(P<0.05).Conclusion The decline ofβ-cell function is an independent risk factor for peripheral neuropathy in patients with T2DM,and the function ofβ-cell should be actively protected to delay the occurrence of peripheral neuropathy.