糖尿病周围神经病变患者的胆红素变化对硫辛酸疗效的预测作用  

The predictive role of serum bilirubin changes for curative effect of lipoic acid on the patients with diabetic peripheral neuropathy

作　　者：王保法[1] 傅莉萍[1] 朱岚[1] 洪郁芝[1] WANG Bao-fa;FU Li-ping;ZHU Lan;HONG Yu-zhi(Department of Metabolism and Endocrinology,Hangzhou Traditional Chinese Medical Hospital,Hangzhou,Zhejiang Province 310006,China)

机构地区：[1]杭州市中医院内分泌代谢科,浙江省杭州310006

出　　处：《中国慢性病预防与控制》2018年第7期490-494,共5页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：杭州市科技计划基金资助项目(2015KJJ18)

摘　　要：目的探讨糖尿病周围神经病变(DPN)患者血清胆红素水平及其变化对硫辛酸疗效的预测价值,为DPN的抗氧化应激治疗提供指导。方法选择2016年8月至2017年6月在杭州市中医院内分泌科住院的232例2型糖尿病患者为研究对象,收集研究对象的基线资料、治疗前后的生化指标等,根据是否合并DPN分为DPN组和对照组,各116例。所有患者均严格控制血糖,进行调脂治疗,其中DPN组在对照组治疗基础上给予硫辛酸注射液600 mg/d,静滴14 d,比较对照组和DPN组治疗前、后的生化指标,以及DPN组治疗前、后的神经传导速度检测数据和周围神经病变的总症状评分(TSS)。根据治疗前后DPN组血清总胆红素(TBIL)变化值又分为TBIL增高组(50例)和TBIL降低组(66例),比较两组临床资料和生化指标。采用SPSS 20.0软件进行t检验、χ~2检验、协方差分析、非参数检验、Pearson相关分析、logistic回归分析和多元线性逐步回归分析。结果 DPN组基线血清TBIL、直接胆红素(DBIL)显著低于对照组基线水平,差异均有统计学意义(P<0.05)。经过硫辛酸治疗后,DPN组患者运动和感觉神经传导速度显著改善,差异均有统计学意义(P<0.01)。TBIL增高组的TSS改善率(78.00%)高于TBIL降低组(56.06%),而TBIL增高组基线TBIL、间接胆红素(IBIL)、DBIL及游离脂肪酸(FFA)水平显著低于TBIL降低组基线水平,差异均有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,TBIL变化值是影响硫辛酸疗效的独立危险因素,有统计学意义(OR=6.072,95%CI:1.104~33.408,P<0.05)。Pearson分析结果显示,TBIL变化值与基线FFA水平呈正相关(r=0.249,P<0.01)。多元线性逐步回归分析结果显示,基线FFA水平是TBIL变化值的影响因素。结论 DPN患者血清胆红素水平低下。TBIL水平变化可以反映DPN患者抗氧化应激疗效,可能是硫辛酸疗效评估的一项预测指标。Objective To explore the predictive value of serum bilirubin level and change for the curative effect of lipoic acid on patients with diabetic peripheral neuropathy（DPN）,and to provide the guidance for the anti-oxidation stress treatment of DPN.Methods From August of 2016 to June of 2017,232 inpatients with type 2 diabetes mellitus（T2 DM） in the endocrinology department of Hangzhou traditional Chinese medical hospital were served as the subjects. The baseline data and the biochemical indexes before or after treatment of the subjects were collected. According to the combination of DPN,the subjects were divided into DPN group（116 cases） and control group（116 cases）. The blood glucose and lipid therapy of all patients were controlled strictly,DPN group received intravenous drip of lipoic acid 600 mg/d for 14 days on the basis of control group therapy. The DPN group was compared with control group for the biochemical indexes before or after treatment,and the nerve conduction test data and total symptom score of peripheral neuropathy（TSS） were compared between baseline values and post-treatment values in the DPN group. According to the change of serum total bilirubin（TBIL）,DPN group was divided into the TBIL increase subgroup（50 cases） and TBIL decrease subgroup（66 cases）. The differences of clinical data and baseline biochemical indexes between the two subgroups were compared. The t test,χ^2 test,covariance analysis,non-parametric test,Pearson correlation analysis,logistic regression analysis and multiple linear stepwise regression analysis were used to analyze the data,the used software was SPSS 20.0.Results The baseline TBIL and direct bilirubin（DBIL） in DPN group were significantly lower than those in control group（P〈0.05）. After lipoic acid treatment,the motor and sensory nerve conduction velocities in DPN group were significantly improved（P〈0.01）. TSS improvement rate（78.00%） in TBIL increase subgroup was significantly higher than that（56.06%） in TBIL decr

关 键 词：糖尿病周围神经病变 血清胆红素 硫辛酸 

分 类 号：R589.1[医药卫生—内分泌]