2型糖尿病性周围神经病变合并微血管病变的危险因素分析

Risk Factor Analysis of Type 2 Diabetic Peripheral Neuropathy Complicated with Microangiopathy

目的 探究2型糖尿病性周围神经病变(diabetic peripheral neuropathy,DPN)合并微血管病变的危险因素分析。方法 回顾性收集2021年11月1日至2022年12月31日于云南省第一人民医院内分泌科住院治疗的DPN患者197例。根据有无合并微血管病变把患者分成单纯DPN组66例,DPN合并2型糖尿病性视网膜病变(DR)组45例,DPN合并2型糖尿病性肾病(DKD)组50例,DPN合并DR、DKD组36例,收集患者一般状况及相关临床指标,分析DPN合并微血管病变的相关影响因素。结果 单纯DPN的患病情况为33.50%,DPN合并DR的患病情况为22.84%,DPN合并DKD的患病情况为25.38%,DPN合并DR、DKD的患病情况为18.27%。在4组中年龄、病程、高血压史、收缩压(systolic blood pressure,SBP)、估算肾小球滤过率(estimated glomerular filtration rate,e GFR)、肌酐(creatinine,Cr)、血尿素氮(blood urea nitrogen,BUN)、白蛋白(albumin,ALB)、白球比(albumin/globulinratio,A/G)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、空腹C肽(fasting C-peptide,C-P)、2h C肽(two hours of C-peptide,C-P2)、空腹胰岛素(fasting insulin,INS)、2h胰岛素(insulin 2 hours after a meal,INS2h)、葡萄糖在目标范围内时间(time in rage,TIR)、内脏脂肪面积(visceral fat area,VFA)、窦性心律RR间期总体标准差(standard diviation of NN intervals,SDNN)差异有统计学意义(P <0.05)。Logistic回归分析结果显示:DPN与DPN合并DR患者相比年龄(OR=0.882,95%CI:0.814~0.956,P=0.002)及e GFR(OR=0.934,95%CI:0.886~0.985,P=0.011)是其保护因素,SBP(OR=1.030,95%CI:1.003~1.058,P=0.028)是其独立危险因素。DPN与DPN合并DKD患者相比SBP(OR=1.026,95%CI:1.001~1.052,P=0.042)是其独立危险因素。DPN与DPN合并DR、DKD患者相比FT3(OR=0.468,95%CI:0.224~0.976,P=0.43)是其保护因素,SBP(OR=1.029, 95%CI:1.000~1.059, P=0.047)及VFA(OR=1.027, 95%CI:1.006~1.049,P=0.013)是其独立危险因素。结论 收缩压和内脏脂肪是DPN合并微血管病变发病的高危因素,促进了DPN合并微血管病变的发生与发展。

Objective To investigate the risk factors of type 2 diabetic peripheral neuropathy(DPN)complicated with microangiopathy.Methods A total of 197 DPN patients hospitalized in the Department of Endocrinology of the First People's Hospital of Yunnan Province from November 1,2021 to December 31,2022 were retrospectively reviewed.Patients were divided into groups based on whether they had concurrent microvascular complications:66 cases in the pure DPN group,45 cases in the DPN combined with type 2 diabetic retinopathy(DR)group,50 cases in the DPN combined with type 2 diabetic kidney disease(DKD)group,and 36 cases in the DPN combined with DR and DKD group.General conditions and relevant clinical indicators of the patients were collected to analyze the factors influencing the combination of DPN with microvascular complications.Results The prevalence of DPN alone was 33.50%,DPN combined with DR Was 22.84%,DPN combined with DKD was 25.38%,and DPN combined with DR and DKD was 18.27%.In the four groups,age,disease duration,history of hypertension,systolic blood pressure(SBP),estimated glomerular filtration rate(eGFR),creatinine(Cr),blood urea nitrogen(BUN),albumin(ALB),albumin/globulin ratio(A/G),free triiodothyronine(FT3),fasting C-peptide(C-P),two hours of C-peptide(C-P2),fasting insulin(INS),insulin 2 hours after a meal(INS2h),time in range(TIR)for glucose,visceral fat area(VFA),and standard deviation of NN intervals(SDNN)for sinus rhythm all show statistically significant differences(P<0.05).The results of logistic regression analysis show that compared to DPN patients,age(OR=0.882,95%CI:0.814~0.956,P=0.002)and eGFR(OR=0.934,95%CI:0.886~0.985,P=0.011)are protective factors for those with DPN and DR,while SBP(OR=1.030,95%CI:1.003~1.058,P=0.028)is an independent risk factor.When comparing DPN patients with those who have DPN and DKD,SBP(OR=1.026,95%CI:1.001~1.052,P=0.042)is an independent risk factor.Comparing DPN patients with those who have DPN and both DR and DKD,FT3(OR=0.468,95%CI:0.224~0.976,P=0.43)is a protective factor,while SBP(OR=1.029,95%CI:1.000~1.059,P=0.047)and VFA(OR=1.027,95%CI:1.006~1.049,P=0.013)are independent risk factors.Conclusion Elevated systolic blood pressure and visceral fat are high-risk factors for the development of microvascular complications in diabetic peripheral neuropathy(DPN),contributing to the occurrence and progression of microvascular complications in DPN.