文章摘要

25-(OH)D3与糖尿病周围神经病变的相关性

作者: 1邓 珊珊, 1龙 入虹, 1周 海洋, 1陈 国兰
1 柳州市人民医院内分泌科,广西 柳州 545006
通讯: 邓 珊珊 Email: 13557025371@163.com
DOI: 10.3978/j.issn.2095-6959.2019.09.015
基金: 广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20180279)。

摘要

目的:分析25-(OH)D3与糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的相关性,评价其在DPN中的诊断价值。方法:选取2017年11月至2018年8月于柳州市人民医院内分泌科住院的2型糖尿病患者148例作为研究对象,依据神经电生理(nerve electrophysiology,NET)检查结果分为DPN组与非DPN组。148例2型糖尿病患者血清25-(OH)D3在10.81~43.09 nmol/L,根据25-(OH)D3四分位数,将2型糖尿病患者分为4组,即A组[25-(OH)D3<13.82 nmol/L)]、B组[13.82 nmol/L≤25-(OH)D3<21.42 nmol/L]、C组[21.42 nmol/L≤25-(OH)D3<34.91 nmol/L]、D组[25-(OH)D3≥34.91 nmol/L]。分析各组血清25-(OH)D3水平,神经运动神经传导速度(motor nerve conduction velocity,MCV)、腓肠感觉神经传导速度(sensory nerve conduction velocity,SCV)、神经F波潜伏期、运动传导波幅变化。结果:DPN组、非DPN组25-(OH)D3水平分别为(35.08±2.89)nmol/L,(41.24±3.42)nmol/L,组间比较差异具有统计学意义(P<0.05);运动传导波幅在A组、B组、C组及D组四组中两两比较,差异均具有统计学意义(P<0.05);A组神经潜伏期明显高于其他3组,腓肠神经SCV明显低于其他3组,差异有统计学意义(P<0.05);B组与C组神经潜伏期明显高于D组(P<0.05)。A组、B组、C组及D组DPN发生率分别为86.49%,54.05%,48.65%及27.03%,A组、B组和C组DPN发生率明显高于D组(P<0.05);B组和C组DPN发生率明显高于D组(P<0.05)。受试者工作特征(receiver operating characteristic,ROC)分析结果显示血清25-(OH)D3水平诊断DPN曲线下面积(area under the curve,AUC)为0.642 (95%CI 0.581~0.796),最佳临界诊断值为13.45 nmol/L。结论:血清25-(OH)D3水平可作为预测DPN程度的指标。
关键词: 2型糖尿病;周围神经病变;25-(OH)D3

25-(OH)D3 and diabetic peripheral neuropathy

Authors: 1DENG Shanshan, 1LONG Ruhong, 1ZHOU Haiyang, 1CHEN Guolan
1 Department of Endocrinology, Liuzhou People’s Hospital, Liuzhou Guangxi 545006, China

CorrespondingAuthor:DENG Shanshan Email: 13557025371@163.com

Foundation: This work was supported by the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region Self-funded Scientific Research Project, China (Z20180279).

Abstract

Objective: To analyze the correlation between 25-(OH)D3 and diabetic peripheral neuropathy (DPN) and evaluate its diagnostic value in DPN. Methods: A total of 148 patients with type 2 diabetes admitted to the Endocrinology Department of Liuzhou People’s Hospital from November 2017 to August 2018 were selected as the research objects. According to the results of nerve electrophysiology (NET) examination, the patients were divided into DPN group and non-DPN group. Serum 25-(OH)D3 of 148 patients with type 2 diabetes was at 10.81–43.09 nmol/L. According to the quartile of 25-(OH)D3, type 2 diabetes patients were divided into four groups: Group A[25-(OH)D3 <13.82 nmol/L], group B[13.82 nmol/L ≤25-(OH)D3 <21.42 nmol/L], group C[21.42 nmol/L ≤ 25-(OH)D3 <34.91 nmol/L], group D[25-(OH)D3 ≥34.91 nmol/L], and then analyze the serum 25-(OH)D3 level, median nerve MCV, sural nerve SCV, median nerve F wave latency, motion conduction amplitude changes. Results: The levels of 25-(OH)D3 in the DPN group and non-DPN group were (35.08±2.89) nmol/L and (41.24±3.42) nmol/L, respectively. Pairwise comparison of motion conduction amplitude in group A, group B, group C and group D showed statistical significance (P<0.05). The latency of median nerve in group A was significantly higher than that of the other three groups, and the SCV of sural nerve was significantly lower than that of the other three groups, with statistical significance (P<0.05). The latency of median nerve in group B and group C was significantly higher than that in group D, with statistical significance (P<0.05). The DPN incidence in group A, group B, group C and group D was 86.49%, 54.05%, 48.65% and 27.03%, respectively. The DPN incidence in group A, group B and group C was significantly higher than that in group D, with statistical significance (P<0.05). DPN incidence in group B and group C was significantly higher than that in group D, with statistical significance (P<0.05). Receiver operating characteristic (ROC) analysis showed that the area under curve (AUC) of DPN diagnosed at serum 25-(OH)D3 level was 0.642 (95% CI 0.581–0.796), and the optimal critical diagnostic value was 13.45 nmol/L. Conclusion: Serum 25-(OH)D3 level can be used as an indicator to predict the degree of DPN.
Keywords: type 2 diabetes mellitus; peripheral neuropathy; 25-(OH)D3