Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Diabetes Metab Res Rev. 2023 Oct;39(7):e3679. doi: 10.1002/dmrr.3679. Epub 2023 Jun 20.
Increasing numbers of reports link vitamin D deficiency to diabetic peripheral neuropathy (DPN), yet evidence regarding neurological deficits and electromyogram is scarce. The present multi-centre study sought to investigate these associations based on objective quantifications.
Information on DPN-related symptoms, signs, all diabetic microvascular complications, and nerve conduction abilities (quantified by nerve conduction amplitude and velocity, F-wave minimum latency (FML) of peripheral nerves) were collected from a derivation cohort of 1192 patients with type 2 diabetes (T2D). Correlation, regression analysis, and restricted cubic splines (RCS) were used to explore linear and non-linear relationships between vitamin D and DPN, which were validated in an external cohort of 223 patients.
Patients with DPN showed lower levels of vitamin D than those without DPN; patients with vitamin D deficiency (<30 nmol/L) tended to suffer more DPN-related neurological deficits (paraesthesia, prickling, abnormal temperature, ankle hyporeflexia, and distal pall hypoesthesia correlating with MNSI-exam score (Y = -0.005306X + 2.105, P = 0.048). Worse nerve conduction abilities (decreased motor nerve amplitude, sensory nerve amplitude, motor nerve velocity, and increased FML) were also observed in these patients. Vitamin D had a significant threshold association with DPN (adjusted OR = 4.136, P = 0.003; RCS P for non-linearity = 0.003) and correlates with other microvascular complications (diabetic retinopathy and diabetic nephropathy).
Vitamin D is associated with the conduction ability of peripheral nerves and may have a nerve- and threshold-selective relationship with the prevalence and severity of DPN among patients with T2D.
越来越多的报告将维生素 D 缺乏与糖尿病周围神经病变（DPN）联系起来，但关于神经功能缺损和肌电图的证据很少。本多中心研究旨在基于客观量化来研究这些关联。
从 1192 例 2 型糖尿病（T2D）患者的衍生队列中收集与 DPN 相关的症状、体征、所有糖尿病微血管并发症以及神经传导能力（通过神经传导幅度和速度、周围神经 F 波最小潜伏期（FML）进行量化）的信息。使用相关、回归分析和限制性立方样条（RCS）来探索维生素 D 与 DPN 之间的线性和非线性关系，并在 223 例患者的外部队列中进行验证。
有 DPN 的患者维生素 D 水平低于没有 DPN 的患者；维生素 D 缺乏症（<30nmol/L）的患者更容易出现与 DPN 相关的神经功能缺损（感觉异常、刺痛、异常温度、踝反射减弱和远端跖感觉减退，与 MNSI 检查评分相关（Y=-0.005306X+2.105，P=0.048）。这些患者的神经传导能力也较差（运动神经幅度、感觉神经幅度、运动神经速度降低，FML 增加）。维生素 D 与 DPN 存在显著的阈值关联（调整后的 OR=4.136，P=0.003；RCS 非线性 P 值=0.003），并与其他微血管并发症（糖尿病视网膜病变和糖尿病肾病）相关。
维生素 D 与周围神经的传导能力相关，并且与 T2D 患者 DPN 的患病率和严重程度可能具有神经和阈值选择性关系。
