糖尿病周围神经病变患者多伦多神经症状评分与炎症状态的相关性研究
|
摘要
目的探讨糖尿病周围神经病变(DPN)患者多伦多神经症状评分(TCSS)与炎症状态的相关性。方法收集2017年8月至2018年8月受试者132名,分为体检正常人群(NC组)33名、T2DM无神经病变(NDPN)组34例、DPN轻度(DPN+)组23例、DPN中度(DPN++)组21例和DPN重度(DPN+++)组21例。ELISA检测血浆TNF-α和IL-1β水平。比较各组临床资料、FPG、HbA1c、C-RP、红细胞沉降率(ESR)、HOMA-IR等指标,并进行相关性分析。结果 99例T2DM患者完成TCSS评分检查,平均检查时间为(13±2)min,DPN患病率为65. 7%。DPN组C-RP、TNF-α及IL-1β高于NDPN组及NC组,且随着病变程度加重而逐渐上升(P<0. 05)。Spearman相关分析显示,TCSS评分与C-RP、TNF-α和IL-1β呈现正相关(r=0. 243、0. 273、0. 558,P<0. 05),与ESR无相关性(r=-0. 035,P=0. 786)。多元线性回归分析显示,糖尿病病程、FPG、C-RP及IL-1β是TCSS的独立影响因素。结论 TCSS评分作为DPN简便、有效的严重程度分级指标,与C-RP、TNF-α和IL-1β密切相关。
Objective To investigate the correlation between the Toronto clinical scoring system(TCSS)and the inflammatory state in patients with Diabetic peripheral neuropathy(DPN).Methods A total of 132 subjects were enrolled in our hospital from August 2017 to August 2018. They were divided into 5 groups:normal group(NC,n=33),diabetes without neuropathy group(NDPN,n=34),DPN mild group(DPN+,n=23),DPN moderate group(DPN++,n=21)and DPN severe group(DPN+++,n=21).Plasma tumor necrosis factor alpha(TNF-α)and interleukin-1β(IL-1β)were measured by ELISA. The clinical data,FPG,HbA_1c,C-RP,ESR,HOMA-IR and other indicators were compared and analyzed for correlation.Results 99 T2DM patients all successfully completed the TCSS score examination,with the average examination time(13±2)min. The prevalence of neuropathy was 65. 7%. The levels of C-RP,TNF-α and IL-1β in DPN group were significantly higher than those in NDPN group and NC group,and gradually increased with the severity of neuropathy(P<0. 05). Spearman correlation analysis showed that TCSS scores were positively correlated with C-RP,TNF-α and IL-1β(r=0. 243,0. 273,0. 558,P<0. 05),and were independent of ESR(r=-0. 035,P=0. 786). Multiple linear regression analysis showed that the course of disease,FPG,C-RP and IL-1β were independent influencing factors of TCSS.Conclusion The TCSS score is a simple and effective grading index for DPN,which is closely related to the levels of C-RP,TNF-α and IL-1β.
Objective To investigate the correlation between the Toronto clinical scoring system(TCSS)and the inflammatory state in patients with Diabetic peripheral neuropathy(DPN).Methods A total of 132 subjects were enrolled in our hospital from August 2017 to August 2018. They were divided into 5 groups:normal group(NC,n=33),diabetes without neuropathy group(NDPN,n=34),DPN mild group(DPN+,n=23),DPN moderate group(DPN++,n=21)and DPN severe group(DPN+++,n=21).Plasma tumor necrosis factor alpha(TNF-α)and interleukin-1β(IL-1β)were measured by ELISA. The clinical data,FPG,HbA_1c,C-RP,ESR,HOMA-IR and other indicators were compared and analyzed for correlation.Results 99 T2DM patients all successfully completed the TCSS score examination,with the average examination time(13±2)min. The prevalence of neuropathy was 65. 7%. The levels of C-RP,TNF-α and IL-1β in DPN group were significantly higher than those in NDPN group and NC group,and gradually increased with the severity of neuropathy(P<0. 05). Spearman correlation analysis showed that TCSS scores were positively correlated with C-RP,TNF-α and IL-1β(r=0. 243,0. 273,0. 558,P<0. 05),and were independent of ESR(r=-0. 035,P=0. 786). Multiple linear regression analysis showed that the course of disease,FPG,C-RP and IL-1β were independent influencing factors of TCSS.Conclusion The TCSS score is a simple and effective grading index for DPN,which is closely related to the levels of C-RP,TNF-α and IL-1β.
引文
[1]Fan G,Huang H,Lin Y,et al.Herbal medicine foot bath for the treatment of diabetic peripheral neuropathy:protocol for a random-ized,double-blind and controlled trial.Trials.2018,10,19:483.
[2]Liu F,Mao JP,Yan X.Toronto clinical scoring system in diabetic peripheral neuropathy.Zhong Nan Da Xue Xue Bao Yi Xue Ban,2008,33:1137-1141.
[3]Dasu MR,Ramirez S,Isseroff RR.Toll-like receptors and diabetes:a therapeutic perspective.Clin Sci(Loud),2012,122:203-214.
[4]孟庆胜,纪健,朱涛.TLR4/MyD88依赖性通路和Caveolin-1的表达与2型糖尿病神经病变患者炎症状态的相关性.临床麻醉学杂志,2015,31:449-453.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版).中国实用内科杂志,2018,38:292-344.
[6]Arumugam T,Razali SN,Vethakkan SR,et al.Relationship be-tween ultrasonographic nerve morphology and severity of diabetic-sensorimotor polyneuropathy.Eur J Neurol,2016,23:354-360.
[7]唐彦.糖尿病周围神经病临床诊断方法的价值评估.昆明:昆明医学院,2010.
[8]Bashiri H.Evaluation of low level laser therapy in reducing diabetic polyneuropathy related pain and sensorimotor disorders.Acta Med Iran,2013,51:543-547.
[9]Papanas N,Ziegler D.Risk factors and comorbidities in diabetic neuropahy:an update 2015.Rev Diabet Stud,2015,12:48-62.
[10]Xu L,Lin X,Guan M,et al.Correlation between different stages of diabetic nephropathy and neuropathy in patients with T2DM:a cross-sectional controlled study.Diabetes Ther,2018,9:2335-2346.
[11]Han L,Ji L,Chang J,et al.Peripheral neuropathy is associated with insulin resistance independent of metabolic syndrome.Diabe-tol Metab Syndr,2015,7:14.
[12]Vincent AM,Callaghan BC,Smith AL,et al.Diabetic neuropa-thy:cellular mechanisms as therapeutic targets.Nat Rev Neu-rol,2011,7:573-583.
[13]唐佳雯,朱涛.核因子κB抑制物在糖尿病周围神经病变中的研究进展.医学综述,2017,23:1613-1617.
[14]Leung L,Cahill CM.TNF-alpha and neuropathic pain-a review.J Neuroinflammation,2010,7:27.
[15]Yamakawa I,Kojima H,Terashima T,et al.Inactivation of TNF-alpha ameliorates diabetic neuropathy in mice.Am J Physiol En-docrinol Metab,2011,301:E844-E852.
[16]Ortmann KL,Chattopadhyay M.Decrease in neuroimmune activation by HSV-mediated gene transfer of TNFαsoluble receptor alleviates pain in rats with diabetic neuropathy.Brain Behav Im-mun,2014,41:144-151.
[17]Liao YH,Zhang GH,Jia D,et al.Spinal astrocytic activation contributes to mechanical allodynia in a mouse model of type 2 di-abetes.Brain Res,2011,1368:324-335.
[18]徐昌林,程浩.血脂、超敏C反应蛋白与2型糖尿病周围神经病变神经神经传导速度、F波的关系研究.卒中与神经疾病,2017,24:356-358,365.
[19]Azenabor A,Ogbera AO,Adejumo NE,et al.Acute phase reactant dynamics and incidence of microvascular dysfunctions in type 2 diabetes mellitus.J Res Med Sci,2011,16:1298-1305.
[20]张珊珊,杨磊.血液流变学指标在糖尿病病情评估中的诊断价值.国际检验医学杂志,2017,38:2777-2779.
[2]Liu F,Mao JP,Yan X.Toronto clinical scoring system in diabetic peripheral neuropathy.Zhong Nan Da Xue Xue Bao Yi Xue Ban,2008,33:1137-1141.
[3]Dasu MR,Ramirez S,Isseroff RR.Toll-like receptors and diabetes:a therapeutic perspective.Clin Sci(Loud),2012,122:203-214.
[4]孟庆胜,纪健,朱涛.TLR4/MyD88依赖性通路和Caveolin-1的表达与2型糖尿病神经病变患者炎症状态的相关性.临床麻醉学杂志,2015,31:449-453.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版).中国实用内科杂志,2018,38:292-344.
[6]Arumugam T,Razali SN,Vethakkan SR,et al.Relationship be-tween ultrasonographic nerve morphology and severity of diabetic-sensorimotor polyneuropathy.Eur J Neurol,2016,23:354-360.
[7]唐彦.糖尿病周围神经病临床诊断方法的价值评估.昆明:昆明医学院,2010.
[8]Bashiri H.Evaluation of low level laser therapy in reducing diabetic polyneuropathy related pain and sensorimotor disorders.Acta Med Iran,2013,51:543-547.
[9]Papanas N,Ziegler D.Risk factors and comorbidities in diabetic neuropahy:an update 2015.Rev Diabet Stud,2015,12:48-62.
[10]Xu L,Lin X,Guan M,et al.Correlation between different stages of diabetic nephropathy and neuropathy in patients with T2DM:a cross-sectional controlled study.Diabetes Ther,2018,9:2335-2346.
[11]Han L,Ji L,Chang J,et al.Peripheral neuropathy is associated with insulin resistance independent of metabolic syndrome.Diabe-tol Metab Syndr,2015,7:14.
[12]Vincent AM,Callaghan BC,Smith AL,et al.Diabetic neuropa-thy:cellular mechanisms as therapeutic targets.Nat Rev Neu-rol,2011,7:573-583.
[13]唐佳雯,朱涛.核因子κB抑制物在糖尿病周围神经病变中的研究进展.医学综述,2017,23:1613-1617.
[14]Leung L,Cahill CM.TNF-alpha and neuropathic pain-a review.J Neuroinflammation,2010,7:27.
[15]Yamakawa I,Kojima H,Terashima T,et al.Inactivation of TNF-alpha ameliorates diabetic neuropathy in mice.Am J Physiol En-docrinol Metab,2011,301:E844-E852.
[16]Ortmann KL,Chattopadhyay M.Decrease in neuroimmune activation by HSV-mediated gene transfer of TNFαsoluble receptor alleviates pain in rats with diabetic neuropathy.Brain Behav Im-mun,2014,41:144-151.
[17]Liao YH,Zhang GH,Jia D,et al.Spinal astrocytic activation contributes to mechanical allodynia in a mouse model of type 2 di-abetes.Brain Res,2011,1368:324-335.
[18]徐昌林,程浩.血脂、超敏C反应蛋白与2型糖尿病周围神经病变神经神经传导速度、F波的关系研究.卒中与神经疾病,2017,24:356-358,365.
[19]Azenabor A,Ogbera AO,Adejumo NE,et al.Acute phase reactant dynamics and incidence of microvascular dysfunctions in type 2 diabetes mellitus.J Res Med Sci,2011,16:1298-1305.
[20]张珊珊,杨磊.血液流变学指标在糖尿病病情评估中的诊断价值.国际检验医学杂志,2017,38:2777-2779.