2型糖尿病亚临床周围神经病变与TIR的相关性及危险因素探讨

Correlation analysis and risk factors of subclinical peripheral neuropathy and TIR in type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)亚临床周围神经病变(sDPN)与葡萄糖目标范围内时间(TIR)的相关性,并分析sDPN发生的危险因素。方法选取无糖尿病周围神经病变(DPN)症状且接受肌电图(EMG)检查的T2DM患者485例为研究对象,根据神经功能传导检查有无异常分为sDPN组(209例)和非sDPN组(276例),比较2组患者年龄、病程、血压、合并症、生化指标及动态血糖监测指标,分析sDPN与TIR的相关性。Logistic回归分析sDPN发生的影响因素。结果与非sDPN组患者相比,sDPN组患者年龄更大、糖尿病病程更长,收缩压(SBP)、尿白蛋白/尿肌酐(UACR)、餐后1 h血糖(1 h-PG)、餐后2 h血糖(2 h-PG)、葡萄糖在目标范围之下时间(TBR)、平均血糖波动幅度(MAGE)、血糖水平标准差(SD)、血糖变异系数(CV)水平更高,高血压(HT)、糖尿病肾病(DN)、糖尿病视网膜病变(DR)、糖尿病周围血管病变(PAD)的患病比例更高,总胆固醇(TC)、右侧肢体踝肱指数(R-ABI)、左侧肢体踝肱指数(L-ABI)、糖化血红蛋白(HbA1c)、TIR水平更低(P<0.05)。sDPN的发生与TBR(r_(s)=0.104,P<0.05)呈正相关,与TIR(r_(s)=-0.093,P<0.05)呈负相关。Logistic回归分析结果提示,TBR升高(OR=1.093,95%CI:1.009~1.183)、合并DN(OR=3.004,95%CI:1.020~8.849)、合并DR(OR=9.736,95%CI:3.499~27.087)是sDPN发生的独立危险因素,R-ABI升高(OR=0.005,95%CI:0.000~0.424)是sDPN发生的保护因素。结论sDPN与TIR呈负相关,对于合并DN、DR及ABI降低的T2DM患者需及时完善神经电生理检查以尽早识别sDPN,并早期干预。

Objective To investigate the correlation between subclinical peripheral neuropathy(sDPN)and time in range(TIR)in type 2 diabetes mellitus(T2DM),and to explore the risk factor_(s) of sDPN.Methods A total of 485 T2DM patients without DPN symptoms and underwent EMG examination during hospitalization were divided into the sDPN group(n=209)and the non-sDPN group(n=276)according to nerve function conduction examination.The differences of age,cour_(s)e of the disease,blood pressure,complications,biochemical index and continuous glucose monitoring index were compared between the two groups of patients.The correlation between sDPN and TIR was analyzed.Logistic regression analysis was used to analyze influence factor_(s) of sDPN.Results Compared with the non-sDPN group,patients in the sDPN group were older and had longer diabetes cour_(s)e,higher systolic blood pressure(SBP),urinary albumin/urinary creatinine(UACR),blood glucose 1 h postprandial(1 h-PG),2 h-PG,TBR,mean blood glucose fluctuation range(MAGE),standard deviation of blood glucose level(SD)and glycemic coefficient of variation(CV)levels,higher proportion of hypertension(HT),diabetic nephropathy(DN),diabetic retinopathy(DR)and diabetic peripheral vascular disease(PAD),and lower levels of total cholesterol(TC),right limb ankle brachial index(R-ABI),L-ABI,hemoglobin A1c(HbA1c)and TIR.The differences in the above indexes were statistically significant(P<0.05).The occurrence of sDPN was positively correlated with TBR(r_(s)=0.104,P<0.05),and negatively correlated with TIR(r_(s)=-0.093,P<0.05).Logistic regression analysis showed that increased TBR(OR=1.093,95%CI:1.009-1.183),combined with DN(OR=3.004,95%CI:1.020-8.849)and DR(OR=9.736,95%CI:3.499-27.087)were independent risk factor_(s) for sDPN,and increased R-ABI(OR=0.005,95%CI:0.000-0.424)was protective factor for sDPN.Conclusion sDPN was negatively correlated with TIR.For patients with T2DM complicated with DN,DR and decreased ABI,it is necessary to timely improve neuroelectrophysiological examination to identify sDPN as soon as possible and give early intervention.