College of Basic Medicine, Guangxi Medical University, Nanning, China.
Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China.
Folia Neuropathol. 2023;61(2):153-162. doi: 10.5114/fn.2023.126609.
The aim of the study was to investigate the pathogenesis of diabetic peripheral neuropathy (DPN) and the value of fibrinogen (FIB) in the early diagnosis of DPN.
A total of 121 patients with type 2 diabetes mellitus (T2DM) and DPN hospitalized in the Endocrinology Department of the 923 Hospital of the People's Liberation Army of China were randomly selected between May and October 2020 and divided into a T2DM asymptomatic (no peripheral neuropathy-related symptoms) group (66 cases) and a T2DM symptomatic group (55 cases) according to the presence or absence of clinical neurological symptoms and signs. Forty healthy volunteers were selected as a normal control group. In addition to plasma FIB and nerve electrophysiological tests, all included subjects were electrophysiologically tested for nerve conduction velocity (NCV), terminal motor latency (DML), sensory nerve action potential (SNAP) amplitude, and compound muscle action potential (CMAP) amplitude.
Compared with the control group, NCV was slowed down in T2DM patients, DML was prolonged, and the amplitude of CMAP and SNAP were decreased. Compared with asymptomatic T2DM patients, symptomatic patients had slower NCV, longer DML, lower CMAP amplitude of median nerve, ulnar nerve and tibial nerve, and significantly lower SNAP amplitude of median nerve and ulnar nerve. CMAP amplitudes were decreased, and median and ulnar nerve SNAP amplitudes were also significantly decreased ( p < 0.05). The plasma FIB concentration of asymptomatic patients with T2DM was higher than that of the control group, and the plasma FIB concentration of symptomatic patients with T2DM was higher than that of asymptomatic patients with T2DM ( p < 0.01). The NCV and DML of asymptomatic patients with T2DM slowed down and prolonged as the FIB level increased; the NCV of T2DM symptomatic patients also slowed down as FIB increased, and median and ulnar nerve DML increased as FIB increased. There was no correlation between NCV and DML and the plasma FIB level in the control group. SNAP amplitudes of symptomatic and asymptomatic patients with T2DM decreased as plasma FIB increased, while CMAP amplitudes of the tibial nerve and the T2DM symptomatic ulnar nerve decreased as FIB increased in the control group.
FIB may be a contributing factor for diabetic neuropathy and could be used as an indicator in the early screening and diagnosis of peripheral neuropathy in patients with T2DM.
本研究旨在探讨糖尿病周围神经病变（DPN）的发病机制及纤维蛋白原（FIB）在 DPN 早期诊断中的价值。
2020 年 5 月至 10 月，随机选取解放军第 923 医院内分泌科收治的 121 例 2 型糖尿病（T2DM）合并 DPN 患者，根据是否存在临床神经症状和体征分为 T2DM 无症状（无周围神经病变相关症状）组（66 例）和 T2DM 有症状组（55 例）。另选取 40 名健康志愿者作为正常对照组。除检测血浆 FIB 和神经电生理外，所有入选者均行神经传导速度（NCV）、运动神经末端潜伏期（DML）、感觉神经动作电位（SNAP）振幅和复合肌肉动作电位（CMAP）振幅的电生理检查。
与对照组相比，T2DM 患者的 NCV 减慢，DML 延长，正中神经、尺神经和胫神经的 CMAP 和 SNAP 振幅降低。与无症状 T2DM 患者相比，有症状患者的 NCV 更慢，DML 更长，正中神经、尺神经和胫神经的 CMAP 振幅更低，正中神经和尺神经的 SNAP 振幅更低。CMAP 振幅降低，正中神经和尺神经的 SNAP 振幅也明显降低（均 P<0.05）。无症状 T2DM 患者的血浆 FIB 浓度高于对照组，有症状 T2DM 患者的血浆 FIB 浓度高于无症状 T2DM 患者（均 P<0.01）。随着 FIB 水平的升高，无症状 T2DM 患者的 NCV 和 DML 减慢和延长；随着 FIB 的增加，T2DM 有症状患者的 NCV 也减慢，正中神经和尺神经的 DML 随着 FIB 的增加而增加。对照组中 NCV 和 DML 与血浆 FIB 水平无相关性。随着血浆 FIB 的增加，T2DM 有症状和无症状患者的 SNAP 振幅降低，而对照组中 T2DM 有症状的尺神经和胫神经的 CMAP 振幅随着 FIB 的增加而降低。
FIB 可能是糖尿病神经病变的一个致病因素，可作为 T2DM 患者周围神经病变早期筛查和诊断的指标。
