初诊2型糖尿病患者血小板分布宽度与糖尿病周围神经病变的关系

【摘要】目的 探索初诊2型糖尿病（type 2 diabetes mellitus，T2DM）患者血小板分布宽度（platelet distribution width，PDW）水平与糖尿病周围神经病变（diabetic peripheral neuropathy，DPN）风险之间的相关性。方法 按顺序连续纳入2017年1月至2021年12月徐州医科大学附属徐州市立医院内分泌科住院的初诊T2DM患者1001例，采集患者的一般资料、空腹血糖（fasting plasma glucose，FPG）、糖化血红蛋白（glycated hemoglobin，HbA1c）、甘油三酯（triglyceride，TG）、总胆固醇（total cholesterol，TC）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）、血小板（platelet，PLT）、PDW、血小板压积（plateletocrit，PCT）、平均血小板体积（mean platelet volume，MPV）、血小板大细胞比率（platelet large cell ratio，PLCR）、尿微量白蛋白/尿肌酐（microalbumin/creatinine，MALB/CREA，ACR），根据有无DPN分为T2DM伴DPN组（n=481）和T2DM不伴DPN组（n=520），以Logistic回归分析评估PDW水平与DPN风险的相关性。结果T2DM伴DPN组的PDW水平较T2DM不伴DPN组显著增高（14.58 ± 2.26 vs 14.20 ± 2.41 fl，P=0.01）。校正年龄、性别、吸烟、饮酒、阿司匹林使用史、糖尿病病程、体重指数、血压、FPG、HbA1c、TG、TC、LDL-C、HDL-C、PLT、PCT、MPV、PLCR、ACR的多因素Logistic回归分析显示，PDW水平与DPN独立相关，PDW每增加1个单位DPN风险增加11%（OR=1.11，P<0.05），PDW每增加1个标准差DPN风险增加29%（OR=1.29，P<0.05）。与第一分位相比，PDW在第三分位（OR=2.43，P=0.01）和第四分位（OR=2.01，P<0.05）时DPN风险显著增加。将DPN作为定量指标进行多因素线性回归分析显示，PDW水平与神经传导速度显著负相关。结论 初诊T2DM患者中，DPN者的PDW水平较非DPN者显著升高，PDW水平增高是DPN风险的独立危险因素。

Association between platelet distribution width and diabetic peripheral neuropathy in newly diagnosed type 2 diabetic patients

[Abstract] Objective To explore the association between platelet distribution width (PDW) and the risk of diabetic peripheral neuropathy (DPN) in newly diagnosed type 2 diabetes mellitus (T2DM). Methods A total of 1001 newly diagnosed T2DM patients admitted to the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University from January 2017 to December 2021 were included sequentially. The patient’s clinical data were collected and included general data, sociodemographic and anthropometric indicators, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), platelet count (PLT), PDW, plateletcrit (PCT), mean platelet volume (MPV), platelet large cell ratio (PLCR), and microalbumin/creatinine (MALB/CREA, ACR) were collected. Patients were divided into T2DM with DPN (n=481) and without DPN groups (n=520). Logistic regression analysis was used to evaluate the correlation between PDW and DPN risk. Results The PDW level of T2DM with DPN was significantly higher than that of T2DM without DPN (14.58±2.26 vs 14.20±2.41 fl, P=0.01). Multivariate regression analysis adjusted for age, gender, smoking, alcohol consumption, aspirin use, Course of diabetes, body mass index, blood pressure, FPG, HbA1c, TG, TC, LDL-C, HDL-C, PLT, PCT, MPV, PLCR, ACR showed that PDW levels were independently correlated with DPN. Risk of DPN increased by 11% per unit increase in PDW (OR=1.11, P<0.05) and 29% per standard deviation increase in PDW (OR=1.29, P<0.05). Compared with the first quartile, PDW had a significantly increased risk of DPN at the third (OR=2.43，P=0.01) and fourth (OR=2.01，P<0.05) quartiles. Multi-factor linear regression analysis using DPN as a quantitative indicator showed that PDW levels were negatively correlated with nerve conduction velocity. Conclusion In newly diagnosed T2DM patients, the level of PDW in DPN patients was significantly higher than that in non-DPN patients, and PDW was an independent risk factor for DPN.