2型糖尿病患者胰岛素抵抗与合并周围神经病变的相关性分析

  目的 探讨2型糖尿病患者胰岛素抵抗与周围神经病变的关系。方法 收集152例2型糖尿病患者的临床资料，根据是否合并糖尿病周围神经病变将其分为不合并糖尿病周围神经病变组（NDPN组，57例）和合并糖尿病周围神经病变组（DPN组，95例），比较两组间血糖、胰岛素水平、空腹胰岛素抵抗（HOMA-IR）及餐后胰岛素敏感性（Matsuda指数）等临床指标的差异。结果 DPN组患者与NDPN组比较，年龄偏高[（55.15±1.17）岁 ∶（ 50.18±1.54）岁，P<0.05）、糖尿病病程较长[（8.35±0.76）年 ∶（5.44±0.67）年，P<0.05）、OGTT120min胰岛素水平较低[（36.12±3.19）pmol/L ∶（ 44.93±4.70）pmol/L，P<0.05），Matsuda指数较高[（2.44±0.22）∶（1.95±0.09），P<0.05）。Logistic回归显示，年龄、空腹血糖及胰岛素水平、Matsuda指数是2型糖尿病患者合并周围神经病变的独立危险因素。结论 空腹胰岛素抵抗是2型糖尿病患者发生周围神经病变的危险因素，而餐后胰岛素抵抗是其保护因素。

The Relationship between Insulin Resistance and Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus

Objective To investigate the relationship between insulin resistance and peripheral neuropathy in type 2 diabetes mellitus.Methods A total of 152 patients with type 2 diabetes were recruited into our retrospective control study and were divided into diabetic peripheral neuropathy(DPN) group(95 cases) and non-diabetic peripheral neuropathy(NDPN) group(57 cases).Differences of clinical indexes between the two groups such as blood glucose,serum insulin level,and degree of insulin resistance were compared.SPSS 18.0 software was used for statistical analysis.Results Compared with patients in NDPN group,patients in DPN group were older(55.15±1.17 vs 50.18±1.54 years old,P < 0.05),with longer diabetic duration(8.35±0.76 vs 5.44±0.67 years,P < 0.05),lower OGTT2h insulin level(36.12±3.19 vs 44.93±4.70 pmol/L,P < 0.05),higher HOMA-IR(5.48±0.52 vs 4.54±0.33,P > 0.05) and higher Matsuda index(2.44±0.22 vs 1.95±0.09,P < 0.05).Logistic regression showed that age,fasting blood glucose,fasting insulin levels and Matsuda index were independent risk factors of DPN in type 2 diabetes.Conclusion Fasting insulin resistance is the risk factor of DPN in type 2 diabetes,while post-prandial insulin resistance is preventable for DPN.