2型糖尿病亚临床性周围神经病变的危险因素分析  

Risk factors of subclinical diabetic peripheral neuropathy in type 2 diabetes mellitus

作　　者：秦洁行[1] 宋峥宏[1] 杨晓岚[1] 高丽[1] QIN Jie-xing;SONG Zheng-hong;YANG Xiao-lan(Department of Neurology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 201112,China)

机构地区：[1]上海交通大学医学院附属仁济医院神经内科,201112

出　　处：《临床神经病学杂志》2021年第5期326-330,共5页Journal of Clinical Neurology

基　　金：国家自然科学基金(81801298);上海交通大学医学院附属仁济医院南院区浦江优青计划(2018RJPUYQ)。

摘　　要：目的探讨2型糖尿病患者亚临床性周围神经病变(sDPN)的危险因素。方法对2018年1月至12月在上海仁济医院南院区住院并完成EMG检查、且无糖尿病周围神经病(DPN)临床和体征的135例2型糖尿病患者进行分析。神经传导功能检查异常诊断为sDPN。采用t检验或秩和检验及χ2检验比较无DPN组和sDPN组患者的各项临床指标,采用Logistic多因素回归分析探索与sDPN相关的独立危险因素。结果 135例无DPN症状和体征的2型糖尿病患者中,47例患者神经传导功能检查异常诊断为sDPN。与无DPN组患者相比,sDPN组患者年龄更高,长病程比例更高,空腹C肽水平更低,高尿白蛋白/肌酐比值(UACR)比例更高(均P<0.05)。低空腹C肽和高UACR是sDPN发病的独立危险因素(OR=2.233,95%CI:1.156~4.312;OR=3.255,95%CI:1.305~8.120)。结论高龄、糖尿病病程长,空腹C肽水平低、UACR高均可增加2型糖尿病患者并发sDPN的风险,尤其是大量白蛋白尿和低空腹C肽的2型糖尿病患者,即使没有DPN的症状和体征,也应考虑有sDPN的发病风险。Objective To investigate the risk factors of subclinical diabetic peripheral neuropathy(sDPN) in type 2 diabetes mellitus. Methods One hundred and thirty-five patients with type 2 diabetes mellitus admitted in Shanghai Renji Hospital south campus from January to December in 2018 were analyzed. All the patients didn’t show any clinical and physical signs of diabetic peripheral neuropathy(DPN) and completed an EMG examination. Those who had abnormal nerve conduction in EMG examination were diagnosed as sDPN. Student’s t test, the rank sum test and the χ^(2) test were applied to compare the clinical factors in non-DPN group and sDPN group. Multivariate Logistic regression analysis was used to identify independent risk factors related to sDPN. Results Among the 135 patients without symptoms and signs of DPN, 47 patients were diagnosed as sDPN with abnormal nerve conduction examination. Compared with patients in the non-DPN group, patients in the sDPN group were older, with higher rate of long diabetes duration, lower fasting C-peptide levels and higher rate of high urine albumin/creatinine ratio(UACR)(all P<0.05). Low fasting C-peptide and high UACR were independent risk factors for the onset of sDPN(OR=2.233, 95%CI: 1.156-4.312;OR=3.255, 95%CI: 1.305-8.120). Conclusion Older age, longer duration of diabetes, low fasting C-peptide levels and high UACR can increase the risk of sDPN in patients with type 2 diabetes, especially in those with albuminuria and low fasting C-peptide even if they have no symptoms of DPN.

关 键 词：2型糖尿病 亚临床性糖尿病周围神经病 空腹C肽 尿白蛋白/肌酐比值 

分 类 号：R747.9[医药卫生—神经病学与精神病学]