Jiang Tianyuan, Wang Dandan, Chai Ruoting, Hu Yanyun, Zhu Liying, Fang Fang, Li Na, Wan Chunling, Liu Fang
Department of Endocrinology and Metabolism, School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China.
Diabetes Metab Res Rev. 2025 May;41(4):e70042. doi: 10.1002/dmrr.70042.
The diagnosis of diabetic peripheral neuropathy (DPN) remains challenging because of the lack of objective biomarkers. In this study, we explored the niacin-induced skin flushing response (NSFR) as a novel diagnostic biomarker for DPN on the basis of its association with microangiopathy.
We recruited 114 patients with type 2 diabetes (51 with DPN, 59 without DPN, and 4 with unclear neuropathy status) and 91 healthy controls. Peripheral neuropathy was assessed through clinical symptoms and signs, vibration threshold testing and electromyography. NSFR was measured using a six-chamber sandwich patch and six concentrations of aqueous methyl nicotinate. Demographic and clinical data were collected via questionnaires and medical records.
The NSFR was significantly lower in patients with type 2 diabetes than in healthy controls (1613 ± 1130.1 vs. 2494.6 ± 1071.9, p < 0.001) and was further reduced in DPN patients than in those without DPN (1105.4 ± 950.93 vs. 2063.7 ± 1119.3, p < 0.001). The association between the NSFR and the risk of developing DPN remained significant after adjusting for potential confounding factors (OR 0.848, 95% CI 0.757-0.949; p = 0.004). A nomogram illustrated the role of the NSFR in predicting DPN occurrence. The ROC curve for the NSFR had an AUC of 0.740, with 72.55% sensitivity and 66.10% specificity. For the combined model, the AUC improved to 0.898, with 89.58% sensitivity and 78.85% specificity. Decision curve analysis confirmed the practical clinical value of the NSFR for predicting DPN risk.
NSFR is significantly associated with the risk of developing peripheral neuropathy in diabetic patients and shows promise as a diagnostic tool for DPN.
由于缺乏客观的生物标志物，糖尿病周围神经病变（DPN）的诊断仍然具有挑战性。在本研究中，我们基于烟酸诱导的皮肤潮红反应（NSFR）与微血管病变的关联，探讨其作为DPN的一种新型诊断生物标志物。
我们招募了114例2型糖尿病患者（51例患有DPN，59例未患DPN，4例神经病变状态不明）和91名健康对照者。通过临床症状和体征、振动阈值测试和肌电图评估周围神经病变。使用六腔夹心贴片和六种浓度的烟酸甲酯水溶液测量NSFR。通过问卷和病历收集人口统计学和临床数据。
2型糖尿病患者的NSFR显著低于健康对照者（1613±1130.1对2494.6±1071.9，p<0.001），DPN患者的NSFR比未患DPN的患者进一步降低（1105.4±950.93对2063.7±1119.3，p<0.001）。在调整潜在混杂因素后，NSFR与发生DPN风险之间的关联仍然显著（OR 0.848，95%CI 0.757 - 0.949；p = 0.004）。列线图说明了NSFR在预测DPN发生中的作用。NSFR的ROC曲线AUC为0.740，敏感性为72.55%，特异性为66.10%。对于联合模型，AUC提高到0.898，敏感性为89.58%，特异性为78.85%。决策曲线分析证实了NSFR在预测DPN风险方面的实际临床价值。
NSFR与糖尿病患者发生周围神经病变的风险显著相关，有望成为DPN的诊断工具。
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