糖尿病周围神经病变患者血浆纤维蛋白原水平 与神经传导速度的相关性

Relationship between plasma fibrinogen and nerve conduction velocity in patients with diabetic peripheral neuropathy

摘要:

目的 探讨糖尿病周围神经病变（DPN）患者血浆纤维蛋白原（FIB）水平与神经传导速度的相关性， 并分析FIB 的影响因素。方法 选取2 型糖尿病（T2DM）患者252 例，根据是否合并DPN 分为DPN 组（150 例）和单纯T2DM 无并发症组（102 例），另选取体检健康者100 例作为健康对照组（NC 组），收集3 组临 床资料，比较纤维蛋白酶（FIB）水平。再根据FIB 水平将DPN 组分为低FIB 水平（FIB ≤ 4 mg/dl）亚组65 例和高FIB 水平（FIB>4 mg/dl）纤维蛋白酶亚组（85 例），观察两亚组临床资料分布特点，检测神经传导速度。 采用Pearson 单因素相关和多元线性回归分析FIB 的影响因素。结果 ① DPN 组腰围（WC）、收缩压（SBP）、 舒张压（DBP）、空腹血糖（FPG）、餐后2 h 血糖（2 h PG）、空腹胰岛素（Fins）、糖化血红蛋白（HbA1c）、 HOMA-IR、TG、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）及FIB 均高于NC 组和T2DM 组（P < 0.05）；T2DM 组FPG、2 h PG、Fins、HbA1c、胰岛素抵抗指数（HOMA-IR）、TC、HDL-C、FIB 及吸烟 例数均高于NC 组（P <0.05）。② FIB>4 mg/dl 亚组年龄、糖尿病（DM）病程、BMI、FPG、2 hPG、Fins、 HbA1c、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、HOMA-IR 及吸烟例数均高于FIB ≤ 4 mg/dl 亚组 （P <0.05）。③ FIB>4 mg/dl 亚组SCV 和MCV 较FIB ≤ 4 mg/dl 亚组降低（P <0.05）。④ Pearson 相关分析显 示，血浆FIB 水平与年龄、糖尿病（DM）病程、体重指数（BMI）、FPG、HbA1c、TC、TG、LDL-C 及吸 烟呈正相关（P <0.05）。⑤多元线性回归分析显示，BMI、TG、HbA1c 及吸烟为FIB 的影响因素（P <0.05）。 结论 DPN 患者血浆FIB 水平升高，神经传导速度下降，BMI、TG，HbA1c 及吸烟是DPN 患者FIB 的影响因素。

Abstract:

Objective To investigate the relationship between plasma fibrinogen and nerve conduction velocity in patients with diabetic peripheral neuropathy (DPN) and to analyze the risk factors of fibrinogen (FIB) levels. Methods A total of 252 patients with type 2 diabetes mellitus (T2DM) were selected and divided into two groups according to the diagnostic criteria of DPN: DPN group (n = 150) and T2DM group (n = 102). Another 100 healthy people were selected as normal control (NC) group. Clinical data were enrolled and FIB levels were compared among the three groups. In addition, DPN group was further divided into low FIB level subgroup (n = 65, FIB ≤ 4 mg/dl) and high FIB level subgroup (n = 85, FIB > 4 mg/dl), the peripheral nerve conduction velocity was measured in two subgroups. Results ① levels of WC, SBP, DBP, FPG, 2 h PG, Fins, HbA1c, HOMA-IR, TG, TC, HDL-C and FIB were higher in DPN group than those in NC group and T2DM group (P < 0.05); levels of FPG, 2 h PG, FIns, HbA1c, HOMA-IR, TC, HDL-C and FIB were higher in T2DM group than those in NC group (all P = 0.000). ② Levels of age, DM course, BMI, FPG, 2 h PG, Fins, HbA1c, TG, LDL-C, HOMA-IR and smoking ratio were higher in FIB > 4 mg/dl subgroup than those in FIB ≤ 4 mg/dl subgroup (P < 0.05). ③ Levels of SCV and MCV were reduced in FIB > 4 mg/dl subgroup than those in FIB ≤ 4 mg/dl subgroup (P < 0.05). ④ Pearson correlation analysis showed that plasma FIB level was positively associated with age, DM course, BMI, FPG, HbA1c, TC, TG, LDL-C and smoking (P < 0.05). ⑤ Multiple stepwise regression analysis demonstrated that BMI, TG, HbA1c and smoking were influence factors of FIB (P < 0.05). Conclusions Plasma FIB level is increased and nerve conduction velocity is decreased in DPN patients, and BMI, TG, HbA1c and smoking are influence factors of FIB in DPN patients.