2型糖尿病患者内脏脂肪面积与糖尿病周围神经病变的相关性研究  

Visceral fat area and diabetic peripheral neuropathy in patients with type 2 diabetes

作　　者：郁静嘉 李学毓 李佳霖[1] 励丽[1] Yu Jingjia;Li Xueyu;Li Jialin;Li Li(Department of Endocrinology and Metabolism,Ningbo First Hospital,Ningbo 315010,China)

机构地区：[1]宁波市第一医院内分泌科,315010

出　　处：《中华内分泌代谢杂志》2022年第3期195-200,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：浙江省医药卫生科技计划项目(2020KY824)。

摘　　要：目的探讨2型糖尿病患者内脏脂肪面积(VFA)与糖尿病周围神经病变(DPN)的关系。方法2018年3月至2021年2月在宁波市第一医院纳入国家标准化代谢性疾病管理中心(MMC)的2615例2型糖尿病患者,对其进行病史采集、问卷调查、收集各项测定生化指标,并应用生物电阻抗法测定VFA、神经电生理检查筛查DPN。根据VFA和体重指数将患者分为以下4组:VFA<100 cm^(2)且体重指数<24 kg/m^(2)组[VA(-)OB(-)组]、VFA<100 cm^(2)且体重指数≥24 kg/m^(2)组[VA(-)OB(+)组]、VFA≥100 cm^(2)且体重指数<24 kg/m^(2)组[VA(+)OB(-)组]以及VFA≥100 cm^(2)且体重指数≥24 kg/m^(2)组[VA(+)OB(+)组]。进行多元logistic回归分析,以确定2型糖尿病患者VFA和体重指数与DPN的关系。结果本研究中DPN的比例为46.96%。DPN组年龄较大,男性比例较高,病程较长,吸烟比例较高,舒张压较低,HbA1C水平较高,总胆固醇较低,高密度脂蛋白胆固醇较低,低密度脂蛋白胆固醇较低,血肌酐水平较高,尿微量白蛋白/肌酐比值较高,VFA水平较高(均P<0.01)。根据VFA和体重指数的分组中,VA(+)OB(-)组有68.1%的患者合并DPN,为4组内最高。多因素logistic回归分析显示,与VA(-)OB(-)组相比,VA(+)OB(-)组发生DPN的风险显著增高(OR=2.234,95%CI 1.339~3.728,P=0.002),VA(+)OB(+)组次之(OR=1.281,95%CI 1.030~1.592,P=0.026)。结论无论体重指数是否超标,在2型糖尿病患者中VFA与DPN均密切相关。VA(+)OB(-)组DPN患病风险最高。内脏肥胖的评估对于早期筛查和防治2型糖尿病DPN具有重要临床意义。Objective To assess the relationship between visceral fat area(VFA)and diabetic peripheral neuropathy(DPN)in type 2 diabets mellitues(T2DM)patients.Methods A total of 2615 patients with T2DM were enrolled from the National Metabolic Management Center at Ningbo First Hospital between March 2018 and February 2021.The medical history,questionnaire survey,and laboratory parameters were collected,VFA was measured using bioelectrical impedance analysis,DPN was diagnosed based on neurophysiological examination.Patients were divided into four groups by VFA and body mass index as the following:VFA<100 cm^(2) and body mass index<24 kg/m^(2) group[VA(-)OB(-)group],VFA<100 cm^(2) and body mass index≥24 kg/m^(2) group[VA(-)OB(+)group],VFA≥100 cm^(2) and body mass index<24 kg/m^(2) group[VA(+)OB(-)group],and VFA≥100 cm^(2) and body mass index≥24 kg/m^(2) group[VA(+)OB(+)group].Multivariable logistic regression analysis was done to determine the relationship between body mass index,VFA and DPN in patients with T2DM.Results The proportion of DPN in this study was 46.96%.DPN group featured with older age,higher proportion of men,longer duration of disease,higher proportion of smoking,lower diastolic blood pressure,higher HbA1C level,lower total cholesterol,lower high density lipoprotein-cholesterol,lower low density lipoprotein-cholesterol,higher blood creatinine levels,higher urinary albumin-to-creatinine ratio,higher VFA level(all P<0.01).Grouping according to VFA and body mass index,68.1%in the VA(+)OB(-)group had DPN,which was highest among the four groups.In multivariable logistic regression analysis,compared with VA(-)OB(-)group,VA(+)OB(-)group had a significantly higher risk of DPN(OR=2.234,95%CI 1.339-3.728,P=0.002),VA(+)OB(+)group took second place(OR=1.281,95%CI 1.030-1.592,P=0.026).Conclusions VFA was associated with DPN in T2DM regardless of body mass index.The VA(+)OB(-)group has the highest risk of DPN.Therefore,evaluation of visceral adiposity may have important clinical significance for the early screening

关 键 词：糖尿病 2型 糖尿病周围神经病变 内脏脂肪面积 国家标准化代谢性疾病管理中心 

分 类 号：R587.2[医药卫生—内分泌] R747.9[医药卫生—内科学]