糖尿病神经病变不同神经纤维损伤的机制研究  

Study on mechanism of nerve fiber injury in diabetic neuropathy

作　　者：袁方圆[1] 王慧丽 岳媛媛[2] 莫莉 孙蔚[4] YUAN Fang-yuan;WANG Hui-li;YUE Yuan-yuan;Mo Li;SUN Wei(AICU,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Geriatric Endocrinology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Endocrinology,Beijing Airport Hospital,Beijing 100000,China;Department of Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院AICU,郑州450000 [2]郑州大学第一附属医院老年内分泌科,郑州450000 [3]北京空港医院内分泌科,北京100000 [4]郑州大学第一附属医院手术部,郑州450000

出　　处：《医药论坛杂志》2024年第13期1379-1383,共5页Journal of Medical Forum

摘　　要：目的研究2型糖尿病患者超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)与周围神经病变不同神经纤维损伤的关系。方法选择2020年3月至2021年12月在郑州大学第一附属医院内分泌科住院治疗的2型糖尿病患者238例。根据临床表现及定量感觉检查结果将患者分为4组,无周围神经病变组(60例)、粗有髓鞘神经纤维病变组(粗髓组,60例)、细有髓鞘神经纤维病变组(细髓组,59例)和无髓鞘神经纤维病变组(无髓组,59例)。获取所有患者性别、年龄、病史、血压、体质指数、糖尿病病程及血生化检测值;测定各组患者hs-CRP水平和电流感觉阈值(current perception threshold,CPT),并分析其上述指标与不同种类神经病变的相关性。然后基于抑郁自评量表(self-rating depression Scale,SDS)和焦虑自评量表(self-rating anxiety scale,SAS)对所有研究对象进行评估。结果hs-CRP分别为:粗髓组(5.76±5.21)mg/L,细髓组(4.07±3.77)mg/L,无髓组(3.83±3.49)mg/L,无神经病变组(2.75±2.34)mg/L;粗髓组hs-CRP明显高于细髓组、无髓组、无神经病变组(P<0.05)。各组电流感觉阈值(CPT)分别为:粗髓组20.16±6.64,细髓组16.78±4.66,无髓组(17.02±4.61,无神经病变组9.19±1.85),神经病变组患者明显高于无神经病变组(P<0.05);神经病变各组间CPT比较均无明显差异(P>0.05)。双因素相关性分析提示,粗髓组hs-CRP与CPT具有正相关性(r值=0.885,P<0.01)。各组SDS、SAS分别为:粗髓组(32.8±9.4),(31.2±9.9);细髓组(43.8±8.2),(42.2±8.6);无髓组(50.6±10.8),(50.6±10.8);无神经病变组(52.3±11.5),(51.0±11.6)。结论hs-CRP可能在2型糖尿病周围神经病变粗有髓鞘神经纤维病变的发病机制中起作用;提示粗有髓鞘神经纤维损伤的可能与血管损害有关。Objective To explore the relationship between different nerve fiber injuries and the high sensitivity C reactive protein,to identify the type of nerve fiber injuries in patients with type 2 diabetic peripheral neuropath by the sensory nerve quantitative detector.Methods The study enrolled 246 participants with type 2 diabetes admitted in Endocrine Department of The Second Artillery General Hospital PLA from March,2020 to December,2021.The participants were divided into 4 groups according to their medical history,clinical symptoms,signs and the performance of diabetic peripheral neuropathy,combined with the quantitative sensory detector test results.The patients were divided into Group without peripheral neuropathy(60 cases),Group with coarse myelinated nerve fibers lesion(60 cases),Group with fine myelinated nerve fibers lesion(59 cases)and Group without myelinated nerve fibers lesion(59 cases).All of the patients'gender,age,blood pressure,body mass index(BMI),duration of diabetes and blood biochemical values were obtained.The changes of high sensitivity C reactive protein were observed between groups.And the analysis of variance and multipleχ~2 test were adopted for the comparison between groups.Then,all subjects were evaluated based on Self-Rating Depression Scale(SDS)and Self-Rating Anxiety Scale(SAS).Results hs-CRP was(5.76±5.21)mg/L in crude pulp group,(4.07±3.77)mg/L in fine pulp group,(3.83±3.49)mg/L in non-pulp group and(2.75±2.34)mg/L in non-neuropathy group,respectively.hs-CRP in coarse pulp group was significantly higher than that in fine pulp group,no pulp group and no neuropathy group(P<0.05).The CPT of each group was(20.16±6.64)in the coarse pulp group,(16.78±4.66)in the fine pulp group,(17.02±4.61)in the non-pulp group,and(9.19±1.85)in the non-neuropathy group,which was significantly higher in the neuropathy group than in the non-neuropathy group(P<0.05).There were no significant differences in CPT among neuropathy groups(P>0.05).Two-factor correlation analysis indicated that hs-CRP was po

关 键 词：2型糖尿病 糖尿病周围神经病变 不同神经纤维损伤 超敏C反应蛋白 感觉定量检测 

分 类 号：R587.2[医药卫生—内分泌]