摘要
目的探讨血清胆碱酯酶(ChE)水平与2型糖尿病(T2DM)患者周围神经功能的相关性。方法为横断面研究。选取2021年1月至2023年12月在南通市第一人民医院内分泌科就诊的T2DM患者作为研究对象。收集研究对象身高、体重并计算体重指数(BMI),检测其空腹血糖和空腹胰岛素并计算稳态模型评估胰岛素抵抗指数(HOMA-IR),收集其糖化血红蛋白(HbA1c)和ChE,收集其神经功能参数[包括四肢周围神经(正中神经、尺神经、腓总神经、腓浅神经、胫神经和腓肠神经)的潜伏期、波幅和传导速度]并计算周围神经潜伏期、波幅和传导速度的复合Z分数。按照ChE四分位数水平将研究对象分为Q_(1)组(血清ChE为3690~7680 U/L)、Q_(2)组(血清ChE为7690~9020 U/L)、Q_(3)组(血清ChE为9030~10350 U/L)和Q_(4)组(血清ChE为10360~16110 U/L)4组。采用线性多项式对比的单因素方差分析、Jonckheere-Terpstra检验和线性相关的卡方检验法检验相关指标随着血清ChE四分位数分组的水平升高而变化的趋势,采用Pearson相关分析法来检验血清ChE水平与相关指标之间的相关性。采用多因素线性回归分析法分析血清ChE水平是否为T2DM患者周围神经功能(神经潜伏期、波幅和传导速度)的独立影响因素。结果共纳入659例T2DM患者,其中Q_(1)组165例,Q_(2)组166例,Q_(3)组164例,Q_(4)组164例。从Q_(1)、Q_(2)、Q_(3)至Q_(4)组,周围神经潜伏期复合Z分数呈现下降趋势(F=20.402,趋势检验P<0.001),而神经波幅复合Z分数和传导速度复合Z分数均呈现升高趋势(F值分别为78.929和49.018,趋势检验P均<0.001)。单因素分析结果显示,血清ChE水平与周围神经潜伏期复合Z分数呈负相关(r=-0.190,P<0.001),与神经波幅复合Z分数和传导速度复合Z分数均呈正相关(r值分别为0.318和0.278,P均<0.001)。通过多因素线性回归分析校正了BMI、HOMA-IR和HbA1c等临床指标后,血清ChE升高仍然是神经潜伏期复合Z分数(β=-0.093,t=-2.166,P=0.031)下降的独立影响因素,是波幅复合Z分数(β=0.210,t=4.963,P<0.001)和传导速度复合Z分数(β=0.152,t=3.508,P<0.001)升高的独立影响因素。结论血清ChE水平升高与T2DM患者周围神经潜伏期缩短、波幅和传导速度升高密切相关。
Objective To investigate the relationship between serum cholinesterase(ChE)levels and peripheral nerve function in patients with type 2 diabetes mellitus(T2DM).Methods This was a cross-sectional study.T2DM patients were recruited for this study at the Department of Endocrinology of Nantong First People's Hospital between January 2021 and December 2023.The height and weight of the subjects were collected to calculate body mass index(BMI);fasting glucose and insulin levels were measured to calculate homeostasis model assessment of insulin resistance(HOMA-IR);glycated hemoglobin A 1c(HbA 1c)and ChE levels were measured;and peripheral nerve function parameters,including the latency,amplitude and conduction velocity of the peripheral nerves(median nerve,ulnar nerve,common peroneal nerve,superficial peroneal nerve,tibial nerve and sural nerve)of the extremities were evaluated.The composite Z-scores of latency,amplitude and conduction velocity of the peripheral nerve were calculated.All subjects were divided into four subgroups according to the quartiles of serum ChE levels:group Q 1(range of ChE,3690-7680 U/L),group Q 2(range of ChE,7690-9020 U/L),group Q 3(range of ChE,9030-10350 U/L),and group Q 4(range of ChE,10360-16110 U/L).One-way analysis of variance with linear polynomial contrasts,the Jonckheere-Terpstra test,or the chi-squared test with linear-by-linear association was used to analyze the trend of clinical data as quartiles of serum ChE levels increased.Pearson's correlation analysis was used to analyze the relationship between ChE and relevant clinical variables,and multivariate linear regression analysis was used to analyze whether ChE was an independent factor for peripheral nerve function(latency,amplitude and conduction velocity).Results A total of 659 T2DM patients were recruited,with 165 patients in group Q 1,166 patients in group Q 2,164 patients in group Q 3 and 164 patients in group Q 4.From Q 1,Q 2,Q 3 to Q 4 of the ChE,the composite Z-scores of nerve latency gradually decreased(F=20.402,P for trend<0.001),while the composite Z-scores of nerve amplitude and conduction velocity increased gradually(F=78.929 and 49.018,respectively;all P for trend<0.001).Pearson's correlation analysis revealed that the serum ChE levels were negatively correlated with the composite Z-scores of nerve latency(r=-0.190,P<0.001)and were positively correlated with the composite Z-scores of nerve amplitude and conduction velocity(r=0.318 and 0.278,respectively;all P<0.001).After adjusting for BMI,HOMA-IR,HbA 1c and other clinical variables via multivariate linear regression analysis,increased serum ChE levels were independently associated with decreased composite Z-scores of nerve latency(β=-0.093,t=-2.166,P=0.031)and increased composite Z-scores of nerve amplitude(β=0.210,t=4.963,P<0.001)and conduction velocity(β=0.152,t=3.508,P<0.001).Conclusion Increased serum ChE levels were associated with decreased nerve latency and increased nerve amplitude and conduction velocity in patients with T2DM.
作者
徐峰
薛峰
王春华
赵丽华
宁莉燕
段程伟
张冬梅
王雪琴
苏建彬
Xu Feng;Xue Feng;Wang Chunhua;Zhao Lihua;Ning Liyan;Duan Chengwei;Zhang Dongmei;Wang Xueqin;Su Jianbin(Department of Endocrinology,Second Affiliated Hospital of Nantong University,First People's Hospital of Nantong,Nantong 226001,China;Department of General Medicine,People's Hospital of Dongtai,Dongtai 224200,China;Department of Administration,Second Affiliated Hospital of Nantong University,First People's Hospital of Nantong,Nantong 226001,China;Medical Research Center,Second Affiliated Hospital of Nantong University,First People's Hospital of Nantong,Nantong 226001,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2024年第12期1361-1369,共9页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
江苏省卫生健康委员会科研项目(Z2022058)
南通市科技局科研项目(MS12019019,JC12022045,MS2023083)。
关键词
糖尿病
2型
糖尿病周围神经病变
胆碱酯酶
神经功能
Diabetes mellitus,type 2
Diabetic peripheral neuropathy
Cholinesterase
Nerve function
