Zeng Jing, Xu Yalin, Shi Yao, Jiang Chenyin
Department of Neurology, Zhongshan Traditional Chinese Medicine Hospital, Zhongshan, 528400, China.
Department of Rehabilitation, Department of Rehabilitation Second people's Hospital of Jiangmen, Jiangmen, Guangdong 529030, China.
Clin Neurol Neurosurg. 2018 Mar;166:136-140. doi: 10.1016/j.clineuro.2018.01.031. Epub 2018 Jan 31.
Prediabetes involves people with glucose-metabolism impairment, and is related to different diabetic complications, like peripheral neuropathy. We aimed to explore the relationship among inflammatory (tumor necrosis factor alpha [TNFα]) and antiinflammatory (interleukin 10 [IL10]) cytokines as well as neuropathy of very distal-sensory-nerves in Chinese patients with prediabetes/diabetes.
In the present study, 55 patients having prediabetes, 55 patients having type 2 diabetes mellitus (DM), and 48 controls were included. TNFα, HbA1c, and IL10 plasma levels were measured. Electrodiagnosis was conducted on dorsal-sural/medial-plantar sensory nerve, that is most distal feet sensory-nerves.
Nerve conduction test (NCT) irregularities of dorsal-sural/medial-plantar sensory nerve were considerably greater in patients with prediabetes or diabetes. The means of TNFα levels demonstrated a significant increase in patients with diabetes when compared to prediabetes patients as well as controls showed a significant decrease in patients with prediabetes and diabetes contrasted with controls. No significant contrast with respect to serum biomarkers among patients having regular as well as irregular medial-plantar/dorsal-sural NCT was noted. Critical correlationship among TNFα as well as HbA1c with symptoms severity as well as disability while negative correlations of IL10 with neuropathy severity was noted. Biomarker levels of TNFα, IL10, and HbA1c were noted to differ significantly among patients without/with neuropathy.
All in all, the proinflammatory phase appears to start from initial pre-clinical phases, sometime prior to advancement of diabetes. The higher neuropathy frequency in patients with prediabetes indicates conceivable causative impact; although, the prospective part of inflammation in pathogenetics of peripheral neuropathy requires more elucidation.
糖尿病前期涉及糖代谢受损人群，且与不同的糖尿病并发症相关，如周围神经病变。我们旨在探讨中国糖尿病前期/糖尿病患者中炎症性（肿瘤坏死因子α [TNFα]）和抗炎性（白细胞介素10 [IL10]）细胞因子与极远端感觉神经的神经病变之间的关系。
在本研究中，纳入了55例糖尿病前期患者、55例2型糖尿病（DM）患者和48例对照。检测了TNFα、糖化血红蛋白（HbA1c）和IL10的血浆水平。对足背外侧/足底内侧感觉神经（即足部最远端的感觉神经）进行了电诊断。
糖尿病前期或糖尿病患者足背外侧/足底内侧感觉神经的神经传导测试（NCT）异常明显更多。与糖尿病前期患者相比，糖尿病患者的TNFα水平均值显著升高，而与对照组相比，糖尿病前期和糖尿病患者的TNFα水平均值显著降低。在足底内侧/足背外侧NCT正常和异常的患者之间，未发现血清生物标志物有显著差异。注意到TNFα以及HbA1c与症状严重程度和残疾之间存在显著相关性，而IL10与神经病变严重程度呈负相关。在无/有神经病变的患者中，TNFα、IL10和HbA1c的生物标志物水平存在显著差异。
总而言之，促炎阶段似乎从糖尿病前期的初始临床前期阶段就开始了，有时早于糖尿病的进展。糖尿病前期患者中较高的神经病变发生率表明可能存在因果影响；尽管如此，炎症在周围神经病变发病机制中的前瞻性作用仍需要更多阐释。
