精氨酸试验中C肽释放水平与2型糖尿病合并无症状周围神经病变的相关性  

Relationship between C-peptide release level in arginine test and type 2 diabetes mellitus with asymptomatic peripheral neuropathy

作　　者：张丽娥 常薪霞 卞华 董继宏 颜红梅 夏明锋 李小英 ZHANG Li-e;CHANG Xin-xia;BIAN Hua;DONG Ji-hong;YAN Hong-mei;XIA Ming-feng;LI Xiao-ying(Department of Endocrinology,Zhongshan Hospital,Fudan University,Shanghai200032,China;Department of Internal Medicine,Maternal and Child Health Hospital of Linhe District,Bayannaoer015000,Inner Mongolia,China;Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai200032,China)

机构地区：[1]复旦大学附属中山医院内分泌科,上海200032 [2]内蒙古自治区巴彦淖尔市临河区妇幼保健院内科,巴彦淖尔015000 [3]复旦大学附属中山医院神经内科,上海200032

出　　处：《中国临床医学》2019年第4期513-517,共5页Chinese Journal of Clinical Medicine

基　　金：国家重点研发计划(2017YFC1309800,2017YFC1309801,2017YFC1309804,2017YFC1309805)~~

摘　　要：目的:探讨C肽水平在筛查无症状糖尿病周围神经病变(DPN)和分型诊断方面的价值。方法:入组2016年1月至12月在复旦大学附属中山医院内分泌科住院的600例无神经系统症状的2型糖尿病(T 2DM)患者。所有患者均行完整病史采集、体格检查、血生化指标检测、精氨酸试验及肌电图检查。结果:600例2型糖尿病(T 2DM)患者中,307例(51.2%)合并无症状DPN,其中远端对称性多发性周围神经病变(DSPN)患者173例(28.8%)、局灶性非对称性DPN患者134例(22.3%)。与不合并DPN的T2DM患者相比,无症状DPN患者年龄更大、病程更长、血糖控制更差,且精氨酸释放后0、2、4、6 min时C肽水平更低(P<0.05)。C肽水平降低是无症状DSPN独立危险因素(P<0.01),而与局灶性非对称性DPN无关。空腹C肽水平联合年龄、性别、糖尿病病程、糖化血红蛋白预测无症状DSPN的AUC为0.758(95%CI 0.720~0.792,P=0.032)。结论:C肽释放水平降低是DSPN的独立危险因素,对合并C肽水平降低的T 2DM患者,应警惕无症状DSPN的可能。Objective:To investigate the value of C-peptide release level in screrning and diagnosis of type 2 diabetes mellitus with asymptomatic diabetic peripheral neuropathy(DPN).Methods:A total of 600 cases of type 2 diabetic inpatients without neurological symptoms were enrolled from the Department of Endocrinology,Zhongshan Hospital from January to December,2016.Each patient received complete history-taking,physical examination,serum biochemical examination,arginine stimulation test,and electromyogram(EMG)examination.Results:Among the 600 cases of diabetic inpatients,307 patients(51.2%)was diagnosed as asymptomatic DPN by EMG,among whom 173 cases(28.8%)had distal symmetric polyneuropathy(DSPN)and 134 cases(22.3%)had focal asymmetric DPN.Patients with asymptomatic DPN were older and had longer disease course and poorer glucose control.Arginine-stimulated release of C-peptide was significantly decreased in patients with asymptomatic DPN(P<0.05).Further analyses showed that reduction of C-peptide level was an independent risk factor for asymmetric DSPN(P<0.01)but not for focal DPN.The area under the ROC curve for the combination of fasting C peptide with age,gender,course of diabetes,and HbA1c in diagnosing asymmetric DSPN was 0.758(95%CI 0.720 to 0.792,P=0.032).Conclusions:Reduced arginine-stimulated C-peptide level is an independent risk factor for asymptomatic DSPN,and may indicate latent DSPN in type 2 diabetes patients.

关 键 词：2型糖尿病 无症状糖尿病周围神经病变 肌电图 C肽 精氨酸试验 

分 类 号：R587.1[医药卫生—内分泌]