糖尿病周围神经病变患者血清神经元特异性烯醇化酶、铁蛋白和胆红素水平及其临床意义

Serum levels of neuron specific enolase, ferritin and bilirubin in diabetic peri-pheral neuropathy patients and their clinical significances

摘要:

目的 探讨老年糖尿病周围神经病变(DPN)患者血清神经元特异性烯醇化酶(NSE)、铁蛋白(SF)、胆红素水平的变化及其临床意义。方法 选取2016年1月至2017年7月西安市第九医院内分泌科收治的单纯2型糖尿病(T2DM)患者(T2DM组)90例及确诊的DPN患者(DPN组)90例,检测并比较2组患者血清NSE、SF、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、空腹血糖(FPG)、糖化血红蛋白A1c(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)。采用SPSS 16.0统计软件对数据进行分析。根据数据类型,组间比较采用t检验或χ²检验。采用多因素logistic回归分析法探讨DPN 发生的独立危险因素。采用ROC曲线重点分析NSE、SF及胆红素预测DNP发生的最佳截断点。结果 与T2DM组比较,DPN组患者FPG、HbA1c、LDL-C、TC、TG、NSE、SF水平显著升高,HDL-C、TBIL、DBIL、IBIL水平显著降低,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,血清NSE、SF、FPG、HbA1c升高和IBIL、HDL-C水平降低是T2DM患者发生DPN的独立危险因素(P<0.05)。ROC曲线显示,NSE、SF及IBIL预测DPN的最佳截断点、曲线下面积、灵敏度及特异度依次为13.61μg/L、0.855、89.33%、80.26%；589.6ng/ml、0.782、81.30%、73.26%；11.40μmol/L、0.760、67.09%、77.43%。结论 T2DM患者发生DPN受到多种因素的影响,血清NSE、SF升高与血清IBIL水平降低可能与发生DPN有关,且检测NSE、SF及IBIL水平可能对诊断DPN的发生具有重要意义。

Abstract:

Objective To investigate the changes of serum neuron specific enolase (NSE), ferritin (SF) and bilirubin levels in the elderly patients with diabetic peripheral neuropathy (DPN) and explore their clinical significances. Methods Ninety patients with simple type 2 diabetes mellitus (T2DM group) and 90 patients with confirmed DPN (DPN group) hospitalized in our department from January 2016 to July 2017 were recruited in this study. Their levels of NSE, SF, total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), fasting blood glucose (FPG), glycosylated hemoglobin Alc (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TG) were measured and compared between 2 groups. SPSS statistics 16.0 was used to analyze the data. According to the data type, Student′s t test or Chi-square test was used for intergroup comparison. Multivariate logistic regression analysis was employed to explore the independent risk factors for DPN. Receiver operating characteristic (ROC) curve was applied to analyze the cut-off points of NSE, SF and bilirubin in prediction of DNP. Results The levels of FPG, HbA1c, LDL-C, TC, TG, NSE and SF were significantly higher in the DPN group than the T2DM group, while those of HDL-C, TBIL, DBIL and IBIL were decreased significantly (P<0.05). Multivariate logistic regression analysis indicated that the increases of serum NSE, SF, FPG and HbA1c levels and the decreases of IBIL and HDL-C levels were independent risk factors for DPN in T2DM patients (P<0.05). ROC curve analysis showed that the best cut-off point, area under ROC curve (AUC), sensitivity and specificity of DPN predicted by NSE, SF and IBIL were 13.61μg/L, 0.855,9.33%, 80.26%; 589.6ng/ml, 0.782,1.30%, 73.26%; and 11.40mmol/L, 0.760,7.09%, 77.43%, respectively. Conclusion The occurrenceof DPN in T2DMpatients is affected by many factors. The increases of serum NSE and SF levels and the decreases of serum IBIL level may be related to its occurrence, and the detection of their levels may be of great significances in the diagnosis of DPN.