1型糖尿病性亚临床周围神经病变相关危险因素分析

Analysis of risk factors associated with subclinical peripheral neuropathy in type 1 diabetes mellitus

目的探讨糖尿病性亚临床周围神经病变进展为临床周围神经病变的危险因素。方法回顾性分析2017—2022年青岛大学附属医院收治的75例1型糖尿病周围神经病变患者的临床资料,包括年龄、性别、病程、体重指数(BMI)、吸烟史、家族史、合并糖尿病酮症酸中毒史(DKA)、合并视网膜病变、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血浆葡萄糖(FPG)、空腹C肽(FCP)、餐后2 h C肽(2 h CP)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、餐后2 h胰岛素(2 h INS)、胰岛素自身抗体(INS-Ab)、谷氨酸脱羧酶自身抗体(GAD-Ab)、尿酸(UA)、25-羟维生素D。根据患者是否具有临床症状分为糖尿病性亚临床周围神经病变组(33例)与临床糖尿病性周围神经病变组(42例),对单因素分析中差异有统计学意义的因素进行logistic回归分析。结果单因素分析结果显示,临床糖尿病性周围神经病变与病程、年龄、BMI、HDL-C、25-羟维生素D、合并视网膜病变有关,差异有统计学意义(P<0.05)。采用logistic回归模型进行多因素分析结果显示,病程长(β=0.002,OR=1.002,95%CI=1.001~1.003)是1型糖尿病亚临床周围神经病变进展为临床糖尿病性周围神经病变的独立危险因素(P<0.05);高水平25-羟维生素D(β=-0.013,OR=0.987,95%CI=0.981~0.994)是临床糖尿病性周围神经病变的独立保护因素(P<0.05)。结论病程长、低水平的25-羟维生素D可能导致临床糖尿病周围神经病变进展,因此及时检测和补充维生素D可能可以延缓临床糖尿病周围神经病变的进展。

Objective To investigate the risk factors of diabetic subclinical peripheral neuropathy progressing to clinical peripheral neuropathy.Methods The clinical data of 75 patients with type 1 diabetic peripheral neuropathy admitted to the Affiliated Hospital of Qingdao University from 2017 to 2022 were retrospectively analyzed,including age,sex,course of disease,body mass index(BMI),smoking history,family history,history of diabetic ketoacidosis(DKA),retinopathy,triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),fasting plasma glucose(FPG),and fasting C peptide(FCP),postprandial 2 h C peptide(2 h CP),glycated hemoglobin(HbA1c),fasting insulin(FINS),postprandial 2 h insulin(2 h INS),insulin autoantibodies(INS-Ab),glutamate decarboxylase autoantibodies(GAD-Ab),uric acid(UA),25-hydroxyvitamin D.According to whether the patients had clinical symptoms,they were divided into diabetic subclinical peripheral neuropathy group(33 cases)and clinical diabetic peripheral neuropathy group(42 cases).Logistic regression analysis was performed for the factors with statistical significance in the univariate analysis.Results Univariate analysis showed that clinical diabetic peripheral neuropathy was associated with the course of disease,age,BMI,HDL-C,25-hydroxyvitamin D and retinopathy,and the differences were statistically significant(P<0.05).Multivariate analysis using logistic regression model showed that long course of disease(β=0.002,OR=1.002,95%CI=1.001-1.003)was an independent risk factor for progression of subclinical peripheral neuropathy in type 1 diabetes mellitus to clinical diabetic peripheral neuropathy(P<0.05).High level of 25-hydroxyvitamin D(β=-0.013,OR=0.987,95%CI=0.981-0.994)was independent protective factor for clinical diabetic peripheral neuropathy(P<0.05).Conclusion Long course of disease and low level of 25-hydroxyvitamin D may lead to clinical diabetic peripheral neuropathy progression,so timely detection and supplementation of vitamin D may delay the progression of clinical diabetic peripheral neuropathy.