痛性糖尿病周围神经病变:维生素D3缺乏及补体升高相关性研究

Painful diabetic peripheral neuropathy: Research of association of vitamin D3 deficiency and elevated complement

摘要:

目的：糖尿病神经病理性痛(Diabetic neuropathic pain,DNP)是糖尿病周围神经病变(Diabetic peripheral neuropathy, DPN)的重要临床表现之一,其确切致病机制尚不清楚。既往研究提示,维生素D家族缺乏及补体升高可能参与DPN的发生和发展。本研究旨在深入评估维生素D及补体水平在痛性糖尿病周围神经病变(Painful diabetic peripheral neuropathy PDPN)中的可能变化及相关性,为临床减轻糖尿病神经病理性痛提供科研证据。方法：将120例患者分为无DPN-2型糖尿病组(n = 37)、无痛性DPN组(n = 43)和痛性DPN组(n = 40)。收集患者基本资料、肌电图检查结果及实验室检测结果(血清25-羟基维生素D3、血沉(ESR)、补体C3、补体C4、补体C1q、白细胞介素6、白细胞介素8、糖化血红蛋白等),对DNP患者进行DN4评分、VAS评分。结果：与对照组相比,痛性DPN组的25-羟基维生素D3明显降低,糖化血红蛋白、补体C3、补体C4、补体C1q明显升高(P < 0.05),维生素D3与补体C1q、补体C3水平、VAS评分、DN4评分呈负相关,与腓肠、腓浅感觉神经传导速度呈正相关(P < 0.05)。多因素logistic分析结果显示,25-羟基维生素D3降低、补体C3、补体C4升高是痛性DPN的独立危险因素(OR=0.608、15.378、2036.988,均P < 0.05)。结论：维生素D3降低、补体C3/C4升高是2型糖尿病患者并发痛性糖尿病周围神经病变的独立危险因素。在临床对症治疗基础上,补充维生素D3,抑制补体激活,可能减轻糖尿病周围神经病变所诱发的神经病理性痛。

Abstract:

Aim: Diabetic neuropathic pain (DNP) is one of the important clinical manifestations of diabetic peripheral neuropathy (DPN). The exact pathogenesis is still unclear. Previous studies suggest that vitamin D family deficiency and complement elevation may be involved in the occurrence and development of DPN. The aim of this study was to further evaluate the possible effects of vitamin D and complement levels on painful DPN. Methods: 120 patients were divided into Non-DPN type 2 diabetic group (n = 37), DPN painless group (n = 43) and DPN pain group (n = 40). Basic data, electromyography results, and laboratory test results (serum 25-hydroxyvitamin D3, erythrocyte sedimentation rate (ESR), complement C3, complement C4, complement C1q, interleukin 6, interleukin 8, glycosylated hemoglobin, etc.) were collected, The patients with DNP were evaluated by DN4 score and VAS score. Results Compared with the control group, the levels of 25-hydroxyvitamin D3 in painful DPN were significantly decreased, and the levels of HBA1c, C3, C4 and C1q were significantly increased (P < 0.05). Vitamin D3 was negatively correlated with the levels of complement C1q 、complement C3 and DN4、VAS score. It was positively correlated with sural and superficial sensory nerve conduction velocity (P < 0.05). Multivariate logistic analysis showed that the decrease of 25-hydroxyvitamin D3 and the increase of complement C3 and C4 were independent risk factors for painful DPN (OR=0.608, 15.378, 2036.988, P < 0.05). Conclusion: The decrease of vitamin D3 and the increase of complement C3 and complement C4 are independent risk factors for painful diabetic peripheral neuropathy in patients with type 2 diabetes. In clinical treatment, the neuropathic pain induced by diabetic peripheral neuropathy can be alleviated by supplementing vitamin D3 and inhibiting complement activation.