天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (3): 345-348.doi: 10.11958/20150105

• 临床研究 • 上一篇    下一篇

进展性肝纤维化与2型糖尿病周围神经病变的关系

谢春晓 1， 贾国瑜 2， 王璐 2， 李强 2， 王绍程 2， 杨玲 1， 邸阜生   

  1. 1 天津医科大学三中心临床学院（邮编 300170）；2天津市第三中心医院、天津市人工细胞重点实验室
  • 收稿日期:2015-08-12 修回日期:2015-10-30 出版日期:2016-03-15 发布日期:2016-03-15
  • 通讯作者: 邸阜生 E-mail:xiechunxiao890224@163.com
  • 作者简介: 谢春晓（1988）， 女， 硕士研究生， 主要从事脂肪肝及糖尿病并发症相关研究
  • 基金资助:
    天津市应用基础与前沿技术研究计划项目（15JCYBJC27700）

The relationship between advanced fibrosis and diabetic neuropathy

XIE Chunxiao1, JIA Guoyu2, WANG Lu2, LI Qiang2, WANG Shaocheng2, YANG Ling1, DI Fusheng2△   

  1. 1 The Third Central Clinical Medical College of Tianjin Medical University, Tianjin 300170， China; 2 Tianjin Third CentralHospital， Key Laboratory of Regenerative Medicine
  • Received:2015-08-12 Revised:2015-10-30 Published:2016-03-15 Online:2016-03-15
  • Contact: DI Fusheng E-mail:xiechunxiao890224@163.com

PDF (PC)

4049

摘要： 摘要:目的 研究进展性肝纤维化（advanced fibrosis）与2型糖尿病性周围神经病变（DPN）之间的关系。方法 选取近3年（2013.02-2015.02）在天津市第三中心医院住院的2型糖尿病患者173例（男88例，女85例），根据非酒精性脂肪性肝病纤维化评分（NAFLD fibrosis score，NFS）分为三组：A组（Low NFS，NFS≤—1.455，49例），B组（Intermediate NFS，—1.455＜NFS＜0.676，95例），C组（High NFS，NFS≥0.676，29例），比较3组糖尿病性周围神经病变（diabetic peripheral neuropathy，DPN）的发生率。DPN由神经电图确诊，肝纤维化严重程度由NFS确定。结果 A组患者DPN的发生率为69.4%，B组患者DPN的发生率为78.9%，C组患者DPN的发生率为86.2%；C组患者神经病变的发生率与A组患者相比明显升高（OR=5.96，P=0.014），B组患者神经病变的发生率较A组增高，但统计无显著差异性（OR=1.76，P=0.155）。与A组患者相比，C组患者感觉神经病变（sensory nerve conduction abnormalities，SNCA）和运动神经病变（motor nerve conduction abnormalities，MNCA）的发生率均明显升高（OR=6.50 vs 5.96，均P＜0.05）。应用Logistic回归对年龄、糖尿病病程、HOMA-IR、血脂水平、肝功能及炎症因子水平进行调整后，进展性肝纤维化仍能明显增加DPN、MNCA的发生率（OR=2.16 vs 2.28，均P＜0.05），与SNCA的发生率不再具有统计学差异（OR=1.88，P=0.087）。结论 进展性肝纤维化与糖尿病性周围神经病变的发生率增加密切相关，尤其对运动神经病变的影响更为显著。

关键词: 糖尿病, 2型, 非酒精性脂肪性肝病, 进展性肝纤维化, 肝脂含量, 糖尿病性神经病变, 脂肪肝

Abstract: Abstract: Objective To investigate the relationship between advanced fibrosis and peripheral neuropathy in patients with type 2 diabetes mellitus (T2DM). Methods Select 173 patients (88 men and 85 women) with type 2 diabetes who hospitalized in tianjin third central hospital within nearly three years（2013.02-2015.02）and divide the participants into 3 groups according to NAFLD fibrosis score: group A (Low NFS，NFS≤—1.455), group B (Intermediate NFS，—1.455＜NFS＜0.676) and group C (High NFS，NFS≥0.676). Compare the prevalence of DPN between three groups. Diabetic neuropathy was ascertained by electroneurogram and liver fibrosis severity was ascertained by NAFLD fibrosis score. Results The prevalence of DPN in group A, group B and group C was 69.4%, 78.9% 86.2%, respectively. The prevalence of DPN was significantly higher in group C compared with group A (OR=5.96, P=0.014); there was no significant statistical difference between group B and group A (OR=1.76, P=0.155) in spite of that the prevalence of DPN was higher in group B than group A. Moreover, the prevalence of SNCA and MNCA were significantly higher in group C than group A (OR=6.50 vs 5.96, all P＜0.05). After adjustment for confounding factors, such as age, diabetic duration, HOMA-IR, serum lipid level, liver function and inflammatory factors, advanced fibrosis remained significantly associated with a higher odds ratio of DPN and MNCA(OR=2.16 vs 2.28, all P＜0.05), but no longer with SNCA(OR=1.88，P=0.087). Conclusion Advanced fibrosis has a close relationship with diabetic neuropathy, especially with motor nerve conduction abnormalities.

Key words: Type 2 diabetes mellitus, Non-alcoholic fatty liver disease, Advanced fibrosis, Liver fat content, Diabetic neuropathy