High TNF-alpha plasma levels and macrophages iNOS and TNF-alpha expression as risk factors for painful diabetic neuropathy.
High TNF-alpha plasma levels and macrophages iNOS and TNF-alpha expression as risk factors for painful diabetic neuropathy.
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DOI：
10.2147/jpr.s21751
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发表时间：
2011-01-01
影响因子：
2.7
通讯作者：
Purwata, Thomas Eko
中科院分区：
文献类型：
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作者：
Purwata, Thomas Eko
痛性糖尿病神经病变（PDN）是糖尿病最常见的并发症之一。近年来研究表明，一氧化氮（NO）和促炎细胞因子在PDN的发病机制中起重要作用。我们通过对110例2型糖尿病患者进行横断面和病例对照研究，调查细胞因子肿瘤坏死因子α（TNF-α）和NO是否在PDN发病机制中发挥作用。在110名受试者中，59名患者患有PDN（病例），其余为无痛性DN（对照）。横截面上，血浆TNF-α水平和诱导型NO合酶（iNOS）和TNF-α的免疫反应性在视觉模拟量表上疼痛更严重的患者中更高。轻度和重度疼痛之间TNF-α水平、iNOS免疫反应性和TNF-α免疫反应性存在统计学显著差异。轻度和重度疼痛之间TNF-α水平（平均15.24 pg/mL ± 5.42 vs 20.44 ± 10.34）、iNOS免疫反应性（9.76% ± 8.60% vs 15.48% ± 11.56%）和TNF-α免疫反应性（13.0% ± 9.48% vs 20.44% ± 11.75%）存在统计学显著差异。病例对照研究显示，TNF-α的比值比为5.053（P < 0.001），TNF-α免疫反应性为4.125（P < 0.001），iNOS免疫反应性为3.546（P = 0.002）。具有高TNF-α水平和巨噬细胞中高iNOS和TNF-α表达的DN患者处于遭受疼痛的风险中。TNF-α水平、iNOS和TNF-α免疫反应性越高，疼痛越严重。这些发现可以为进一步研究更好地管理PDN奠定基础。
Painful diabetic neuropathy (PDN) is one of the most common complications of diabetes mellitus. Recently it has become clear that nitric oxide (NO) and proinflammatory cytokines play an important role in the pathogenesis of PDN. We investigated whether the cytokine tumor necrosis factor alpha (TNF-alpha) and NO play a role in PDN pathogenesis by performing a cross-sectional and a case-control study in 110 type 2 diabetic patients. Of 110 subjects, 59 patients suffered from PDN (cases) and the remaining were painless DN (controls). Cross-sectionally, plasma TNF-alpha levels and immunoreactivity for inducible NO synthase (iNOS) and TNF-alpha were higher in patients with more severe pain on the visual analog scale. There were statistically significant differences between mild and severe pain for TNF-alpha levels, iNOS immunoreactivity, and TNF-alpha immunoreactivity. There were statistically significant differences between mild and severe pain for TNF-alpha levels (mean 15.24 pg/mL ± 5.42 vs 20.44 ± 10.34), iNOS immunoreactivity (9.76% ± 8.60% vs 15.48% ± 11.56%), and TNF-alpha immunoreactivity (13.0% ± 9.48% vs 20.44% ± 11.75%). The case-control study showed that TNF-alpha had an odds ratio of 5.053 (P < 0.001), TNF-alpha immunoreactivity of 4.125 (P < 0.001), and iNOS immunoreactivity of 3.546 (P = 0.002). DN patients with high TNF-alpha levels, and high iNOS and TNF-alpha expression in macrophages are at risk of suffering from pain. The higher the TNF-alpha level, and iNOS and TNF-alpha immunoreactivity, the more severe the pain. These findings could form the basis of further research into better management of PDN.