2型糖尿病并发周围神经病理性疼痛的患病率及危险因素分析

 目的 探讨住院患者2型糖尿病(type 2 diabetes mellitus,T2DM)并发周围神经病理性疼痛(diabetic peripheral neuropathic pain, DPNP)的患病率及危险因素。方法 选取2020-10至2021-02山西医科大学附属第二医院T2DM周围神经病变的住院患者260例。根据神经病理性症状和体征评分(LANSS)问卷,≥12分诊断为DPNP,＜12分为非DPNP,将患者分为DPNP组(129例)和非DPNP组(131例)。比较两组的一般资料和实验室资料,将组间比较有意义的变量纳入二元Logistic回归分析。结果 DPNP组与非DPNP组一般资料比较,病程、合并糖尿病视网膜病变和合并糖尿病肾病差异有统计学意义(P<0.05),性别、年龄、BMI、吸烟史、饮酒史、家族史、学历、合并高血压、合并心血管疾病、用药情况、监测血糖情况、治疗方案、体重管理、饮食控制和身体活动差异无统计学意义。实验室资料比较,两组HbA₁c、HDL-C、尿微量白蛋白和UACR差异有统计学意义(P<0.05);空腹血糖及C肽、餐后2 h血糖及C肽、三酰甘油、总胆固醇、LDL-C、尿素、肌酐、尿酸和尿肌酐差异无统计学意义。二元Logistic回归分析得出,病程(OR=1.042,95%CI 1.001～1.085,P=0.045)、合并糖尿病肾病(OR=3.565,95%CI 1.497～8.487, P=0.004)、HbA₁c(OR=1.179,95%CI 1.041～1.334,P=0.009)、HDL-C(OR=0.228,95%CI 0.073～0.705,P=0.010)、UACR(OR=1.004,95%CI 1.001～1.008, P=0.027)是DPNP发生的危险因素。结论 对于病程较长,合并糖尿病肾病、HbA₁c升高、HDL-C降低、UACR升高的患者,应警惕DPNP发生的风险。

Incidence and risk factors of type 2 diabetes complicated by peripheral neuropathic pain among inpatients

Objective To study the incidence and risk factors of diabetic peripheral neuropathic pain (DPNP) among inpatients with type 2 diabetes. Methods Two hundred and sixty patients with type 2 diabetic peripheral neuropathy were selected, and the basic information and laboratory data on these patients were collected. According to the Leeds Assessment of Neuropathic Symptoms and Signs(LANSS)questionnaire, a score ≥12 was diagnosed as DPNP, while a score of less than 12 was classified as non-DPNP. Patients were divided into the DPNP group (n=129) and non-DPNP group(n=131). The related data was compared between the two groups, and the significant variables between the groups were included in the binary logistic regression analysis. Statistical analysis showed that the course of disease, diabetic nephropathy, HbA₁c, low HDL-C, and UACR were risk factors for DPNP. Results There was statistically significant difference between the two groups in the course of disease and the incidence of complications with diabetic retinopathy and diabetic nephropathy (all P＜0.05), but not in gender, age, BMI, smoking history, drinking history, family history of disease, levels of education, complications with hypertension and cardiovascular diseases, medication, blood glucose monitoring, treatment plans, weight control, diet control or physical activity (all P＞0.05). Levels of HbA₁c, HDL-C, urinary microalbumin and UACR were statistically different between the two groups (all P＜0.05), but those of fasting blood glucose and C peptide, 2 h postprandial blood glucose and C peptide, triglycerides, total cholesterol, LDL-C, urea, creatinine, uric acid and urine creatinine were not (all P＞0.05). Binary Logistic regression analysis showed that the course of disease (OR=1.042, 95%CI 1.001-1.085, P=0.045), diabetic nephropathy (OR=3.565, 95%CI 1.497-8.487, P=0.004), HbA₁c (OR=1.179, 95%CI 1.041-1.334, P=0.009), HDL-C (OR=0.228, 95%CI 0.073-0.705, P=0.010)and UACR (OR=1.004, 95%CI 1.001-1.008, P=0.027) were risk factors for DPNP. Conclusions Patients with a longer clinical course, diabetic nephropathy, increased HbA₁c, decreased HDL-C, and increased UACR are at high risk of diabetic peripheral neuropathic pain.