Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida, Malta.
Postgrad Med J. 2011 Oct;87(1032):658-63. doi: 10.1136/pgmj.2010.104216.
Distal peripheral neuropathy (DPN) is a troublesome complication of diabetes mellitus (DM). The factors associated with the disease are still incompletely understood. The purpose of this study was to investigate factors associated with vibration perception threshold (VPT) as a marker of DPN in a type 2 diabetic population with advanced microvascular disease.
The study included 203 diabetic patients (117 male, 86 female) with proliferative diabetic retinopathy. Subjects were investigated by questionnaires, clinical examinations, blood and urine sampling, and review of medical records in the period from November 2008 through April 2009. Presence of DPN was defined as VPT ≥25 V.
The mean (±SD) age was 65.2 (±9.9) years and median (IQR) diabetes duration was 18 (10-25) years. Forty-six per cent of subjects were found to have DPN, defined as a VPT ≥25 V by neurothesiometer testing. Prevalence of DPN was found to be associated with age (p=0.038), male gender (p=0.046), low haemoglobin (p<0.001), high erythrocyte sedimentation rate (p=0.03), uric acid values (p=0.034), and peripheral vascular disease (PVD) (p=0.003) in univariate analysis. Multivariate logistic regression analysis revealed male gender (OR 5.52; p<0.001) and low haemoglobin values (B=-0.58; p<0.001) to be independent predictors of VPT ≥25 V in subjects with proliferative retinopathy, while linear regression analysis revealed male gender (p<0.001), haemoglobin (p=0.001), age (p=0.04), and PVD (p=0.001) to be significant predictors of VPT.
This study reports a novel independent association of DPN with low haemoglobin values. In the study population with type 2 DM and proliferative retinopathy, DPN was also independently associated with male gender, age, and PVD. Further studies are needed to confirm the association with low haemoglobin and identify the underlying mechanism.
远端周围神经病变（DPN）是糖尿病（DM）的一种麻烦的并发症。与该疾病相关的因素仍不完全清楚。本研究的目的是调查与振动感觉阈值（VPT）相关的因素，作为 2 型糖尿病伴微血管病变患者的 DPN 标志物。
该研究纳入了 203 名患有增殖性糖尿病视网膜病变的糖尿病患者（男性 117 名，女性 86 名）。在 2008 年 11 月至 2009 年 4 月期间，通过问卷调查、临床检查、血液和尿液采样以及病历回顾对受试者进行了调查。DPN 的存在定义为 VPT≥25V。
平均（±SD）年龄为 65.2（±9.9）岁，中位数（IQR）糖尿病病程为 18（10-25）年。46%的受试者被发现患有 DPN，通过神经感觉计测试 VPT≥25V。在单变量分析中，DPN 的患病率与年龄（p=0.038）、男性（p=0.046）、低血红蛋白（p<0.001）、高红细胞沉降率（p=0.03）、尿酸值（p=0.034）和外周血管疾病（PVD）（p=0.003）有关。多变量逻辑回归分析显示，男性（OR 5.52；p<0.001）和低血红蛋白值（B=-0.58；p<0.001）是增殖性视网膜病变患者 VPT≥25V 的独立预测因素，而线性回归分析显示男性（p<0.001）、血红蛋白（p=0.001）、年龄（p=0.04）和 PVD（p=0.001）是 VPT 的显著预测因素。
本研究报告了 DPN 与低血红蛋白值之间的新的独立关联。在患有 2 型糖尿病和增殖性视网膜病变的研究人群中，DPN 还与男性、年龄和 PVD 独立相关。需要进一步的研究来证实与低血红蛋白的关联并确定潜在的机制。
