HLA class Ⅱ alleles and risk for peripheral neuropathy in type 2 diabetes patients

The potential impact of human leukocyte antigen （HLA） genotype variations on development of diabetic peripheral neuropathy （DPN） is not well determined. This study aimed to identify the association of HLA class II alleles with DPN in type 2 diabetes （T2D） patients. Totally 106 T2D patients, 49 with DPN and 57 without DPN, and 100 ethnic-matched healthy controls were analyzed. Both groups of the patients were matched based on sex, age, body mass index （BMI） and duration of T2D. Polyneuropathy was diagnosed using electrodiagnostic methods. HLA-DRB1 and DQB1 genotyping was performed in all subjects by the polymerase chain reaction with sequence-specific primers （PCR-SSP） method. T2D patients with DPN showed higher frequencies of HLA-DRB1＊10 and DRB1＊12 alleles compared to control group （P = 0.04）. HLA-DQB1＊02 allele and HLA-DRB1＊07-DQB1＊02 haplotype were associated with a decreased risk for developing DPN in T2D patients （P = 0.02 and P = 0.05 respectively）. Also, patients with severe neuropathy showed higher frequencies of DRB1＊07 （P = 0.003） and DQB1＊02 （P = 0.02） alleles than those with mild-to-moderate form of neuropathy. The distribution of DRB 1 and DQB 1 alleles and haplotypes were not statistically different between all patients and healthy controls. Our findings implicate a possible protective role of HLA-DQB1＊02 allele and HLA-DRB1＊07-DQB1＊02 haplotype against development of peripheral neuropathy in T2D patients. Therefore, variations in HLA genotypes might be used as genetic markers for prediction and potentially management of neuropathy in T2D patients.

Association between serum Sestrin2 level and diabetic peripheral neuropathy in type 2 diabetic patients

BACKGROUND Diabetic peripheral neuropathy(DPN)is a chronic and serious microvascular complication of diabetes linked to redox imbalance.Sestrin2,a novel inducible stress protein,participates in glucose metabolic regulation and redox homeostasis.However,the association between serum Sestrin2 and DPN is unknown.AIM To explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus(T2DM).METHODS A total of 96 T2DM patients and 39 healthy volunteers,matched by age and sex,participated in this cross-sectional study.Clinical features and metabolic indices were identified.Serum Sestrin2 was measured by ELISA.The association between Sestrin2 and DPN was studied.Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN.RESULTS The 96 patients with T2DM were divided into DPN(n=47)and patients without DPN(n=49).Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined[9.10(5.41-13.53)ng/mL vs 12.75(7.44-23.80)ng/mL,P<0.01].T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers[14.58(7.93-26.62)ng/mL vs 9.10(5.41-13.53)ng/mL,P<0.01].However,T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN[9.86(6.72-21.71)ng/mL vs 14.58(7.93-26.62)ng/mL,respectively,P<0.01].Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index(r=0.672,P=0.000),hemoglobin A1c(HbA1c)(r=0.292,P=0.000),serum creatinine(r=0.206,P=0.016),triglycerides(r=0.731,P=0.000),and fasting glucose(r=0.202,P=0.040),and negatively associated with estimated glomerular filtration rate(r=-0.230,P=0.007).After adjustment for sex,age,HbA1c,and diabetes duration,multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels(P=0.000).Logistic regression analyses indicated that Sestrin2,diabetes duration,and high-density lipoprotein were strongly associated with DPN(odds ratio=0.855,1.411,and 0.041,respectively).CONCLUSION Our results show Sestrin2 is decreased in T2DM patients with DNP.As lower Sestrin2 is independently associated with DPN,Sestrin2 may contribute to progression of DPN in T2DM patients.

Association of Hypomagnesemia in Type 2 Diabetic Patients with and without Peripheral Neuropathy

Background: Diabetes Mellitus is a wide-ranging metabolic disorder, which constitutes a most important physical condition dilemma in the world. Hypomagnesaemia accelerates the rate of diabetic complications. Objective: To analyze the association of serum magnesium (Mg) in Type 2 Diabetes Mellitus with and without complication of peripheral neuropathy. Design: A cross sectional study. Setting: This research was carried out in medicine department, Peoples Medical College Hospital Nawabshah from May 2016-April 2017. Sample Size: Total 271 patients of both genders with Type 2 DM with and without peripheral neuropathy, each group after fulfilling the selection criteria were included. Material and Methods: After a short-lived consultation, the subjects were categorized for variable analyses like sex, age, Type 2 Diabetes Mellitus with and without peripheral neuropathy, duration of diabetes mellitus and presence of hypomagnesaemia. Clinical examination with monofilament was applied for diagnosis of peripheral neuropathy. Blood samples for magnesium analysis were collected in fasting condition. Results: In 271 diagnosed patients of Type 2 diabetes mellitus, 180 male and 91 were females. Peripheral neuropathy was observed in 136 subjects out of them 94 males and 42 were females. While 135 were without peripheral neuropathy out of them 86 males and 49 were females. Normal magnesium was seen in 119 (43.91%) and low magnesium was present in 152 (56.09%) patients overall. A decreased serum level of magnesium was observed in 56.09% diabetic subjects with peripheral neuropathy and 50% subjects with diabetes without peripheral neuropathy. Conclusion: Frequency of hypomagnesaemia is common in subjects with in Type 2 DM with and without peripheral neuropathy.

Factors Associated with Peripheral Neuropathy in Type 2 Diabetes： Subclinical versus Confirmed Neuropathy

This study determined the prevalence of diabetic peripheral neuropathy(DPN) and subclinical DPN(s DPN) in patients with type 2 diabetes mellitus(T2DM) using nerve conduction study(NCS) as a diagnostic tool. We also investigated the factors associated with the development of s DPN and compared factors between the sD PN and confirmed DPN(cDPN). This cross-sectional study involved 240 T2DM patients who were successively admitted to the endocrinology wards of Wuhan Union Hospital over the period of January to December 2014. Data on the medical history, physical and laboratory examinations were collected. DPN was diagnosed using NCS. One-way ANOVA with least significant difference(LSD) analysis or chi-square tests was used to compare parameters among DNP-free, s DPN and c DPN patients. Independent factors associated with s DPN were determined using logistic regression. The results showed that 50.8% of the participants had DPN, and among them, 17.1% had sDPN. sDPN showed significant independent associations with age, height, HbA1c, presence of atherosclerosis and diabetic retinopathy. Patients with DPN differed significantly from those without DPN with respect to age, duration of disease(DOD), HbA1c, presence of atherosclerosis, diabetic retinopathy, nephropathy and hypertension. Patients with cDPN, relative to those with sDPN, had significantly longer DOD and higher prevalence of peripheral artery disease(PAD) and coronary artery disease(CAD). Our study suggests that a significant number of T2DM patients are affected by s DPN, and the development of this condition is associated with advanced age, tall stature, poor glycaemic control, presence of diabetic retinopathy and atherosclerosis. On the other hand, patients with cDPN tend to have a longer DOD and are more likely to suffer from PAD and CAD.

Peripheral Neuropathy and Vasculopathy;Frequency and Associated Risk Factors in Newly Diagnosed Treatment Naive Type 2 Diabetes

Background: The prevalence of diabetes in Pakistan is 11.45%. The reported prevalence of diabetic foot ulceration in Pakistan is between 4% and 10%, with the amputation rate of 8% - 21%. Peripheral neuropathy and vasculopathy are main underlying cause of diabetic foot ulcers. Methodology: It was a cross-sectional non-interventional cohort study where all newly diagnosed treatment na&#239;ve type 2 diabetic patients were enrolled. Peripheral neuropathy and vasculopathy were detected by Michigan neuropathy screening instrument (MNSI) and ankle brachial index (ABI) respectively. Risk factors for peripheral neuropathy and vasculopathy were determined by univariate and multivariate logistic regression analysis. Statistical significance was considered with P value of Result: Fifty seven patients (37.7%) had early neuropathy with MNSI score of 3.3 ± 0.4. Thirty seven patients (20.6%) had vasculopathy with ABI score of 0.76 ± 0.11. Age (Odd ratio 1.07 (1.02 - 1.11), p 0.003), duration of symptoms (Odd ratio 1.11 95% CI: 1.05 - 1.17, p ≤ 0.001), high HbA1C % (Odd ratio 1.94 95% CI: 1.54 - 2.45, P ≤ 0.001), albumin creatinine ratio (Odd ratio 1.01, 95% CI: 1.00 - 1.01, P ≤ 0.001 ) and cholesterol level (Odd ratio 1.01 95% CI: 1.01 - 1.02, p = 0.001) were found as risk factors for early neuropathy and vasculopathy. Conclusion: Peripheral neuropathy and vasculopathy are frequently reported complications among newly diagnosed treatment na&#239;ve patients of type 2 DM. Age, duration of symptoms prior to diagnosis, metabolic parameters like raised HbA1C, hyperlipidemia and spot random albumin creatinine ratio are found to be risk factors for both peripheral neuropathy and vasculopathy.

Angiogenin gene polymorphism A risk factor for diabetic peripheral neuropathy in the northern Chinese Han population?

Angiogenin is associated with the pathogenesis of diabetic peripheral neuropathy. Here, we se- quenced the coding region of the angiogenin gene in genomic DNA from 207 patients with type 2 diabetes mellitus （129 diabetic peripheral neuropathy patients and 78 diabetic non-neuropathy pa- tients） and 268 healthy controls. All subjects were from the Han population of northern China. No mutations were found. We then compared the genotype and allele frequencies of the angiogenin synonymous single nucleotide polymorphism rs11701 between the diabetic peripheral neuropathy patients and controls, and between the diabetic neuropathy and non-neuropathy patients, using a case-control design. We detected no statistically significant genetic associations. Angiogenin may not be associated with genetic susceptibility to diabetic peripheral neuropathy in the Han population of northern China.

Effects of α-zinc sulfate combined with yiqiyangyinghuoxue therapy on related factors in patients with type 2 diabetes peripheral neuropathy

Objective: To study the effects of -zinc sulfate combined with yiqiyangyinghuoxue therapy on related factors in patients with type 2 diabetes peripheral neuropathy. Methods: A total of 90 patients with type 2 diabetes peripheral neuropathy in our hospital from September 2015 to September 2018 were enrolled in this study. The subjects were divided into the control group (n=45) and the treatment group (n=45) randomly. The control group were treated with -zinc sulfate, the treatment group were treated with -zinc sulfate combined with yiqiyangyinghuoxue therapy, the two groups were treated for 3 months. The serum NSE, UA, Hcy, hs-CRP, BDNF, HMGB1, CysC, TGF-β1, 25-(OH)D3, ESM-1, NO and plasma ET, TNF of the two groups before and after treatment were compared. Results: There were no significantly differences of the serum NSE, UA, Hcy, hs-CRP, BDNF, HMGB1, CysC, TGF-β1, 25-(OH)D3, ESM-1, NO and plasma ET, TNF of the two groups before treatment. After treatment, the serum NSE, UA, Hcy, hs-CRP, HMGB1, CysC, TGF-β1, ESM-1 and plasma ET, TNF of the two groups were significantly lower than before treatment, the serum BDNF, 25-(OH)D3, NO of the two groups were significantly higher than before treatment, and that of the treatment group after treatment were significantly better than the control group. Conclusion: α-zinc sulfate combined with yiqiyangyinghuoxue therapy on patients with type 2 diabetes peripheral neuropathy has a good efficacy, can improve the neuropathy and vascular endothelial damage, improve related factors, and it was worthy clinical application.

8-isoPGF2α、Metrnl、LC3B-Ⅱ/LC3B-Ⅰ与T2MD患者血糖在目标范围内时间的相关性及预测糖尿病周围神经病变的价值

目的探讨8-异前列腺素F2α(8-isoPGF2α)、镍纹样蛋白(Metrnl)、微管相关蛋白3B-Ⅱ(LC3B-Ⅱ)/微管相关蛋白-Ⅰ(LC3B-Ⅰ)与2型糖尿病(T2MD)患者血糖在目标范围内时间(TIR)的相关性及对糖尿病周围神经病变(DPN)预测价值。方法选取2020年5月至2022年10月新乡医学院第一附属医院收治的187例T2DM患者进行前瞻性研究,根据是否合并DPN分为DPN组(n=48)和无DPN组(n=139)。比较两组患者及根据TIR四分位数分组的患者8-isoPGF2α、Metrnl、LC3B-Ⅱ/LC3B-Ⅰ水平,采用Pearson相关性分析8-isoPGF2α、Metrnl、LC3B-Ⅱ/LC3B-Ⅰ与TIR相关性,采用多因素Logistic回归分析DPN的相关影响因素;绘制受试者工作特征曲线(ROC)评价8-isoPGF2α、Metrnl、LC3B-Ⅱ预测DPN的价值。结果DPN组患者的TIR为(51.43±7.68)%,明显低于无DPN组的(56.94±8.12)%,差异有统计学意义(P<0.05);DPN组患者的8-isoPGF2α、Metrnl分别为(162.78±51.33)pg/mL、(259.18±74.42)pg/mL,明显高于无DPN组的(129.56±43.00)pg/mL、(208.37±65.61)pg/mL,LC3B-Ⅱ/LC3B-Ⅰ为0.89±0.27,明显低于无DPN组的1.15±0.31,差异均有统计学意义(P<0.05);根据TIR第25、50、75百分位数将全部患者分为Q1~Q4四组,8-isoPGF2α、Metrnl在Q4组最低,LC3B-Ⅱ/LC3B-Ⅰ在Q4组最高;8-isoPGF2α、Metrnl随着TIR降低逐渐升高,LC3B-Ⅱ/LC3B-Ⅰ随着TIR降低而降低,四组间比较差异均有统计学意义(P<0.05);Pearson相关性分析结果显示,8-isoPGF2α、Metrnl与TIR呈显著负相关(r=-0.786、-0.665,P<0.01),LC3B-Ⅱ/LC3B-Ⅰ与TIR呈显著正相关(r=0.711,P<0.01);多因素Logistic回归分析结果显示,TIR、LC3B-Ⅱ/LC3B-Ⅰ是DPN的独立相关保护因素(P<0.05),8-isoPGF2α、Metrnl是DPN的独立相关危险因素(P<0.05);ROC分析结果显示,单一指标中,Metrnl预测DPN的AUC最大(0.830),特异度最高(87.05%),8-isoPGF2α+Metrnl+LC3B-Ⅱ预测DPN的AUC为0.923(95%CI:0.875~0.957),大于Metrnl,预测敏感度为87.50%,特异度为85.61%(P<0.05)。结论8-isoPGF2α、Metrnl、LC3B-Ⅱ/LC3B-Ⅰ与T2MD患者TIR有关,均是患者并发DPN的预警因素。联合检测三者能为临床分层管理和早期识别DPN高风险人群提供参考。

Physical Exercise as Treatment for Type 2 Diabetes Distal Symmetric Polyneuropathy: A Systematic Review of Randomized and Controlled Studies

Pharmaceuticals targeting the pathogenesis of diabetic distal symmetric polyneuropathy have all failed in clinical trials, limiting recourse to palliative treatments. The American Diabetes Association regards the effectiveness of glycemic control and lifestyle modification therapies on diabetic neuropathies as inconclusive. The objective of this research was to determine if and how physical exercise influences distal symmetric polyneuropathic severity in type 2 diabetes patients. Embase, MEDLINE, and Google Scholar were searched to collect randomized and controlled studies published between January 1, 2012 and April 20, 2020. Titles had to mention diabetes, physical exercise of any type or lifestyle interventions in general, and neuropathy. Abstracts had to indicate satisfaction of PICOS criteria, whereas full-text reviews had to be fully confirmatory. Extracted data was thematically synthesized based primarily on relationships between exercise interventions and effects on distal symmetric polyneuropathic severity outcomes in type 2 diabetes patients. Qualitative analysis scoring criteria objectively mirrored PICO except for the bias and limitation score component, which assessed common markers of validity for randomized trials (as specified in the PRISMA statement). Database searches yielded 379 unique records, 15 of which passed eligibility screening. Thematic synthesis supported exercise as an ameliorative treatment of type 2 diabetes distal symmetric polyneuropathy through improved Michigan Diabetic Neuropathy Scores and increased sural sensory nerve conduction velocity, though efficacy may be limited by neuropathic severity. This is the first systematic review to acquire these results, and to do so within the context of neuropathic severity. This review protocol is registered on PROSPERO (CRD42020181211) at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020181211

Clinical Features and Microvascular Complications Risk Factors of Early-onset Type 2 Diabetes Mellitus

The aim of this research was to study the clinical features and microvascular complications risk factors of early-onset type 2 diabetes mellitus(T2DM).We analyzed the clinical data from 1421 T2DM inpatients at Wuhan Union Hospital.Subjects were divided into early-onset T2DM group(diagnostic age<40 years)and late-onset T2DM group(diagnostic age>40 years).All subjects underwent a standardized assessment of microvascular complications.Data were compared with independent-samples t test or Chi-square test.Multiple logistic regression was used to determine the risk factors of microvascular complications.Patients with early-onset T2DM were more inclined to have a lower systolic blood pressure(SBP),a longer duration of diabetes and higher levels of body mass index(BM1),uric acid(UA),fasting plasma glucose(FPG),total cholesterol(TC),triglyceride(TG)and glycosylated hemoglobin(HbAlc)than those with lateonset T2DM(P<0.05).The prevalence of diabetic retinopathy(DR)was significantly higher and that of diabetic peripheral neuropathy(DPN)was significantly lower in early-onset group than in late-onset group(P<0.05).For DN,UA was an independent risk factor in early-onset T2DM.SBP and TG were independent risk factors in late-onset T2DM.For DR,duration of diabetes and SBP were independent risk factors in early-onset T2DM.Duration of diabetes,SBP and HbAlc were independent risk factors in late-onset T2DM.This study demonstrated that the clinical characteristics of early-onset T2DM were metabolic disorders,including glucose metabolism,lipid metabolism and amino acid metabolism.Early-onset T2DM was more likely to be associated with DR.The potential pathogenesis of early and late-onset T2DM might be different.The management of metabolic risk factors especially HbA1c,SBP,TG and UA is advised to be performed in the early stage of diabetes.

Continuous glucose monitoring defined time-in-range is associated with sudomotor dysfunction in type 2 diabetes

BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the relationship between TIR obtained from continuous glucose monitoring(CGM)and sudomotor function detected by SUDOSCAN in subjects with type 2 diabetes.METHODS The research enrolled 466 inpatients with type 2 diabetes.All subjects underwent 3-d CGM and SUDOSCAN.SUDOSCAN was assessed with electrochemical skin conductance in hands(HESC)and feet(FESC).Average feet ESC<60μS was defined as sudomotor dysfunction(+),otherwise it was sudomotor dysfunction(-).TIR refers to the percentage of time when blood glucose is between 3.9-10 mmol/L during 1 d period.RESULTS Among the enrolled subjects,135(28.97%)presented with sudomotor dysfunction.Patients with sudomotor dysfunction(+)showed a decreased level of TIR(P<0.001).Compared to the lowest tertile of TIR,the middle and the highest tertiles of TIR was associated with an obviously lower prevalence of sudomotor dysfunction(20.51%and 21.94%vs 44.52%)(P<0.001).In addition,with the increase of TIR,HESC and FESC increased(P<0.001).Regression analysis demonstrated that TIR was inversely and independently linked with the prevalence of sudomotor dysfunction after adjusting for confounding values(odds ratio=0.979,95%CI:0.971-0.987,P<0.001).CONCLUSION The tight glycemic control assessed by TIR is of vitally protective value for sudomotor dysfunction in type 2 diabetes mellitus.

丹藤通脉方治疗2型糖尿病周围神经病变患者的临床疗效观察

目的:探讨丹藤通脉方用于治疗2型糖尿病周围神经病变的临床疗效。方法:选择2019年1月-2021年12月在南京中医药大学附属徐州市中医院内分泌科住院治疗的2型糖尿病周围神经病变患者60例;采用随机法将上述患者分为观察组和对照组(每组30例);对照组给予基础治疗联合甲钴胺治疗,观察组在对照组治疗基础上给予联合丹藤通脉方治疗。治疗周期共12周,对比两组疗效。结果:治疗后组间效果比较,观察组患者的总有效率高于对照组(P<0.05)。多伦多临床评分系统(Troronto Clinical Scoring System,TCSS)评分低于对照组(P<0.05);空腹血糖(Glucose,GLU)、餐后2小时血糖(2-hour Postprandial Blood Glucose,2 h PG)、糖化血红蛋白(Hemoglobin A1c,HbA1c)水平低于对照组(P<0.05);总胆固醇(Total Cholesterol,TC)、三酰甘油(Triglycerides,TG)、低密度脂蛋白(Low Density Lipoprotein,LDL)水平低于对照组(P<0.05);右腓神经及正中神经的运动神经传导速度(Sensory Nerve Conduction Velocity,SNCV)和感觉神经传导速度(Motor Nerve Conduction Velocity,MNCV)高于对照组(P<0.05)。与治疗前比较,观察组和对照组治疗后的TCSS、GLU、2 h PG、HbA1c水平及TC、TG、LDL水平均降低(P<0.05),右腓神经及正中神经的MNCV和SNCV均升高(P<0.05)。结论:丹藤通脉方治疗糖尿病周围神经病变患者疗效确切,安全性良好,值得进一步推广。

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

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。

2型糖尿病合并DPN与糖尿病肾病、下肢动脉粥样硬化症的相关性

目的探讨2型糖尿病合并糖尿病周围神经病变(DPN)与糖尿病肾病、下肢动脉粥样硬化症的相关性。方法选取2020年1-12月在该院内分泌科住院的T2DM患者298例,根据患者是否合并DPN分为DPN组(178例)和非DPN组(120例)。比较2组随机尿白蛋白/肌酐比值(UACR)、空腹血糖(FBS)、餐后2 h C肽(2 h CP)水平及下肢动脉粥样硬化症、糖尿病肾病发生率等指标,同时分析DPN的独立危险因素。结果2组年龄、性别、病程及随机UACR、FBS、2 h CP水平比较,差异有统计学意义(P<0.05),而其余指标比较,差异无统计学意义(P>0.05)。2组下肢动脉粥样硬化症及糖尿病肾病发生率比较,差异有统计学意义(P<0.05)。下肢动脉粥样硬化症、糖尿病肾病是DPN的独立危险因素(P<0.05)。结论DPN与糖尿病肾病、下肢动脉粥样硬化症显著相关。

计时起立-行走测试对老年2型糖尿病周围神经病变病人跌倒预测与风险评估价值研究

目的:分析计时起立-行走测试(TUGT)对老年2型糖尿病周围神经病变病人跌倒风险的评估价值。方法:回顾性分析2020年1月—2022年12月在我院内分泌科纳入治疗的2型糖尿病周围神经病变病人120例为研究对象,收集病人一般资料、TUGT测试结果,采用SPSS 22.0、R Studio 1.4.1103进行联合数据分析,研究相关性和预测价值。结果:本研究纳入的120例病人均顺利完成TUGT测试,完成率为100%,数据收集率为100%。所有病人TUGT时间为(16.03±3.29)s。Spearman相关性分析结果显示,TUGT时间与跌倒史、性别之间呈正相关(P<0.05);TUGT时间与2型糖尿病病程、合并周围神经病变病程、年龄之间无明显相关关系。TUGT时间用于预测老年2型糖尿病周围神经病变病人跌倒风险的最佳临界值为14.19 s,受试者工作特征曲线(ROC)曲线下面积(AUC)值为0.773,敏感度为86.29%,特异度为67.16%。结论:跌倒史、性别是影响老年2型糖尿病周围神经病变病人TUGT时间的危险因素,同时,TUGT时间对老年2型糖尿病周围神经病变病人跌倒具有良好的预测价值。

甲钴胺穴位注射治疗2型糖尿病周围神经病变临床观察

目的:观察甲钴胺穴位注射治疗2型糖尿病周围神经病变的临床效果。方法:选取符合纳入标准的62例2型糖尿病性周围神经病变患者,随机分为两组各31例。两组均接受基础治疗,对照组予甲钴胺片口服治疗;治疗组予甲钴胺注射液0.5 mg注射双侧足三里、悬钟穴位。两组疗程均为30天。比较两组患者治疗前后中医证候积分、多伦多临床评分(TCSS)的变化。结果:治疗组总有效率为93.55%,高于对照组的67.74%(P<0.05)。治疗后,两组患者中医证候评分和多伦多临床评分(TCSS)均较治疗前降低(P<0.01),且治疗组均优于对照组(P<0.05)。结论:采用甲钴胺注射液穴位注射治疗2型糖尿病周围神经病变能够改善患者临床症状,临床疗效较好。

α-硫辛酸联合依帕司他对2型糖尿病伴糖尿病周围神经病变患者肌电图、血清炎症因子及血流变学的影响

目的探讨α-硫辛酸联合依帕司他治疗2型糖尿病(T2DM)伴糖尿病周围神经病变(DPN)患者的效果,并分析其对肌电图、血清炎症因子和血流变学指标的影响。方法按照随机数字表法将2021年9月至2023年9月广西科技大学第一附属医院收治的84例T2DM合并DPN患者分为对照组(给予依帕司他治疗)和观察组(给予α-硫辛酸联合依帕司他治疗),各42例。比较两组患者肌电图指标、炎症因子和血流变学指标。结果治疗后,两组患者正中和腓总神经的运动神经传导速度(MCV)和感觉神经传导速度(SCV)水平均升高,且观察组均高于对照组(均P<0.05)。治疗后,两组患者超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)水平均较治疗前降低,且观察组均低于对照组(P<0.05)。治疗后,两组患者全血高切黏度、全血低切黏度和血浆黏度均低于治疗前,且观察组均低于对照组(均P<0.05)。结论给予T2DM合并DPN患者α-硫辛酸联合依帕司他治疗的效果显著,可有效提高神经传导速度,抑制炎症反应,调节血流变学。

Review of systematic reviews of acupuncture for diabetic peripheral neuropathy

Objective:To review the systematic reviews of acupuncture for diabetic peripheral neuropathy(DPN)and to provide evidence for clinical decisions.Methods:Published systematic reviews targeting acupuncture treatment of DPN were searched using computer through both Chinese and English databases till July 1,2019.Two researchers screened the papers based on inclusion and exclusion criteria and conducted report quality evaluation,methodological quality assessment and evidence quality grading using the preferred reporting items for systematic reviews and meta-analyses(PRISMA),assessment of multiple systematic review 2(AMSTAR 2)and grading of recommendations assessment,development and evaluation(GRADE).Results:Ten systematic reviews were included,involving 11 outcome measures.According to PRISMA,6 items were sufficiently reported while 1 item was not;AMSTAR 2 appraised that all the included systematic reviews were of low quality in the methodological evaluation;according to GRADE,of the 30 clinical evidences,only 5 were graded moderate while the remained were graded low or extremely low.Descriptive analysis showed that acupuncture can significantly improve DPN symptoms,accelerate the conduction velocities of sensory and motor nerves,and up-regulate the content of plasma nitric oxide(NO),while the adverse reaction rate was low.Conclusion:Acupuncture can produce satisfactory clinical efficacy in treating DPN,but the existing problems,such as low-quality evidence,unitary outcome measures,poor methodological quality of systematic reviews and nonstandard reporting,need to be treated cautiously;meanwhile,more high-quality clinical trials are required to elevate the level of evidence.

基于TXNIP/NLRP3炎性小体通路研究芪归通络颗粒对2型糖尿病大鼠坐骨神经的保护作用

目的:基于硫氧还蛋白相互作用蛋白(TXNIP)/核苷酸结合寡聚化结构域样受体蛋白(NLRP)3炎性小体通路研究芪归通络颗粒对2型糖尿病大鼠坐骨神经的保护作用及潜在机制。方法:90只雄性SD大鼠随机选取10只为空白组,其余大鼠采取高脂饲料喂养联合STZ腹腔注射方法构建2型糖尿病周围神经病变大鼠模型,将造模成功大鼠随机分为模型组、硫辛酸组(60 mg/kg)、芪归通络颗粒高、中、低剂量组,剂量分别为9、4.5、2.25 g/(kg·d)。各给药组给予相应剂量药物灌胃,持续12周。实验过程中观察大鼠一般状态及血糖水平;处死前检测大鼠机械痛阈值(PWMT)和坐骨神经运动传导速度(MNCV);通过酶联免疫吸附试验(ELISA)检测血清炎症因子白介素(IL)-1β、IL-18、IL-6、肿瘤坏死因子-α(TNF-α)、环氧合酶-2(COX-2)、诱导型一氧化氮合酶(iNOS)水平,苏木素-伊红(HE)染色观察坐骨神经形态,Western blot检测坐骨神经组织TXNIP/NLRP3通路相关蛋白表达水平。结果:与空白组相比,模型组大鼠血糖、IL-1β、IL-18、IL-6、TNF-α、COX-2、iNOS明显升高(P<0.05),PWMT和MNCV明显下降(P<0.05),坐骨神经TXNIP、NLRP3、ASC、Caspase-1、IL-1β蛋白相对表达显著上调(P<0.05)。与模型组比较,用药治疗组的PWMT和MNCV明显增加(P<0.05),TXNIP、NLRP3、ASC、Caspase-1、IL-1β蛋白相对表达显著下调(P<0.05),血清IL-1β、IL-18、IL-6、TNF-α、COX-2、iNOS水平下降(P<0.05),坐骨神经病理形态明显改善。结论:芪归通络颗粒可增强2型糖尿病大鼠的坐骨神经功能,改善糖尿病周围神经病变,其潜在作用机制可能与抑制TXNIP/NLRP3炎性小体通路的激活有关。

玉泉胶囊联合依帕司他治疗2型糖尿病周围神经病变患者疗效与机制研究

目的探讨玉泉胶囊联合依帕司他治疗2型糖尿病周围神经病变患者的疗效及对Keap1/Nrf2/ARE通路的影响。方法选取2021年6月—2023年1月石家庄市中医院收治的163例2型糖尿病周围神经病变患者,将其随机分为观察组(82例)和对照组(81例)。对照组患者给予依帕司他片,观察组患者在此基础上联合使用玉泉胶囊,两组均治疗6个月,比较两组患者的临床疗效、神经传导功能变化以及血清Keap1、Nrf2、ARE表达情况。结果观察组患者治疗总有效率显著高于对照组(P<0.05)。治疗后两组患者正中神经、腓总神经运动神经(感觉神经)传导速度以及振幅均较治疗前显著升高(P<0.05),而潜伏期较治疗前显著降低(P<0.05),治疗后观察组改善情况优于对照组(P<0.05)。治疗后两组患者Keap1蛋白相对表达量较治疗前显著降低(P<0.05),而NQO1、Nrf2以及ARE蛋白相对表达量均较治疗前显著升高(P<0.05),治疗后观察组改善情况优于对照组(P<0.05)。两组患者治疗期间均未发生药物相关不良反应。结论玉泉胶囊联合依帕司他治疗糖尿病周围神经病变可有效提高患者临床疗效,改善患者神经传导功能,其作用机制可能与调控Keap1/Nrf2/ARE信号传导通路有关。