Correlation Between Different Stages of Diabetic Nephropathy and Neuropathy in Patients with T2DM: A Cross-Sectional Controlled Study.
Correlation Between Different Stages of Diabetic Nephropathy and Neuropathy in Patients with T2DM: A Cross-Sectional Controlled Study.
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DOI：
10.1007/s13300-018-0519-9
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Liu Y
中科院分区：
文献类型：
--
作者：
Xu L;Lin X;Guan M;Liu Y
由于缺乏针对性治疗，早期发现糖尿病周围神经病变（DPN）对2型糖尿病（T2 DM）患者至关重要。我们研究了不同阶段的糖尿病肾病和DPN之间的关系，试图阐明蛋白尿是否可以作为DPN进展的早期预警信号。本研究于2016年1月至2016年6月在南方医院内分泌科共招募了217例符合入选标准的T2 DM患者。根据尿白蛋白排泄率（UAER）和估计的肾小球滤过率对这些患者进行分组。进行神经传导研究、Semmes-Weinstein单丝测试（SWMT）和振动感知阈值（VPT）测试。采用多元线性回归分析、多因素Logistic回归分析和受试者工作特征（ROC）分析，探讨糖尿病肾病不同分期与DPN的关系。感觉/运动神经电位传导速度（CV）和波幅在糖尿病肾病不同阶段患者间差异均有统计学意义（均P < 0.05）。UAER和糖尿病病程是与感觉/运动神经电位的平均CV和振幅相关的独立因素（均p < 0.05）。病程> 10年（p = 0.025）和总胆固醇值较高（p = 0.024）与SWMT结果异常显著相关。UAER> 300 mg/24 h（p = 0.007）和舒张压> 100 mmHg（p = 0.042）与VPT异常风险较高相关。观察到UAER> 300 mg/24 h（p < 0.001）和病程> 10年（p = 0.02）与DPN显著相关。ROC分析显示，UAER和病程作为DPN指标的最佳临界值分别为90.5 mg/24 h和9.5年（均p < 0.001）。结果提示，糖尿病肾病与2型糖尿病患者DPN的发生密切相关，UAER和病程可作为DPN进展的预警指标。ChiCTR-ROC-16007701。
Early detection of diabetic peripheral neuropathy (DPN) is critical in patients with type 2 diabetes mellitus (T2DM) due to the lack of targeted therapy for DPN. We have investigated the relationship between different stages of diabetic nephropathy and DPN in an attempt to elucidate whether albuminuria can be used as an early warning signal of DPN progression. A total of 217 T2DM patients who met the inclusion criteria were recruited from the Department of Endocrinology, Nanfang Hospital between January 2016 and June 2016. These patients were placed in groups based on urinary albumin excretion rate (UAER) and estimated glomerular filtration rate. Nerve conduction studies, the Semmes–Weinstein monofilament test (SWMT) and the vibration perception threshold (VPT) test were conducted. Multiple linear regression analysis, multivariate logistic regression and receiver-operating characteristic (ROC) analysis were performed to investigate the relationship between different stages of diabetic nephropathy and DPN in these patients. Significant differences were observed in the conduction velocity (CV) and amplitude of sensory/motor nerve potential among the T2DM patients at different stages of diabetic nephropathy (all p < 0.05). The UAER and duration of diabetes were found to be independent factors associated with the mean CV and amplitude of sensory/motor nerve potential (all p < 0.05). A disease duration of > 10 years (p = 0.025) and a higher total cholesterol value (p = 0.024) were found to be significantly associated with abnormal SWMT results. A UAER of > 300 mg/24 h (p = 0.007) and a diastolic blood pressure of > 100 mmHg (p = 0.042) were associated with a higher risk for abnormal VPT. A UAER of > 300 mg/24 h (p < 0.001) and a disease duration of > 10 years (p = 0.02) were observed to be significantly correlated with DPN. The ROC analysis showed that the optimal cutoff values of UAER and duration as indicators of DPN were 90.5 mg/24 h and 9.5 years, respectively (both p < 0.001). The results suggest that diabetic nephropathy is closely associated with the development of DPN in T2DM patients and that UAER and disease duration can be used as warning indicators of DPN progression. ChiCTR-ROC-16007701.
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