性激素结合球蛋白与2型糖尿病周围神经病变的相关性研究

Correlation between sex hormone-binding globulin and peripheral europathy in type 2 diabetes mellitus

摘要:

目的：探究性激素结合球蛋白（sex hormone-binding globulin，SHBG）与2型糖尿病（type 2 diabetes mellitus，T2DM）周围神经病变（diabetic peripheral neuropathy，DPN）的相关性。方法：收集2014年1月至2017年1月本院收治的T2DM组患者238例，分别分为单纯T2DM组（n=96）和DPN组（n=142），DPN组根据多伦多评分系统（Toronto clinical scoring system，TCSS）再分为轻（n=52）、中（n=48）、重（n=42）3个亚组。分析各组患者的一般临床资料、生化指标、神经电生理指标、血清SHBG及性激素水平，然后采用Pearson分析SHBG水平与DPN相关指标的相关性，最后采用logistic回归法分析DPN的影响因素。结果：与T2DM组相比，DPN组患者的年龄明显增高，体质指数（body mass index，BMI）值则明显下降，差异均具有统计学意义（P<0.05）；与T2DM组相比，DPN组患者的生化指标收缩压（systolic blood pressure，SBP）、甘油三酯（triglyceride，TG）、总胆固醇（total cholesterol，TC）、低密度脂蛋白胆固醇（low density lipoprotein-cholesterol，LDL-C）和血尿酸（blood uric acid，BUA）明显增加，差异均具有统计学意义（P<0.05），而舒张压（diastolic blood pressure，DBP）、空腹血糖（fasting blood-glucose，FPG）、糖化血红蛋白（glycosylated hemoglobin，HbA1c）、高密度脂蛋白胆固醇（high density lipoprotein-cholesterol，HDL-C）、血尿素氮（blood urea ni－trogen，BUN）、谷丙转氨酶（alanine aminotransferase，ALT）、谷草转氨酶（aspartate aminotransferase，AST）、碱性磷酸酶（alkaline phosphatase，ALP）和谷氨酰转肽酶（glutamyl transpeptidase，γ-GT）的变化均无统计学差异（P>0.05）。DPN患者的血清SHBG、总睾酮（testosterone，T）和总雌二醇（estradiol，E2）均明显下降，差异亦具有统计学意义（P<0.05）。另外，与T2DM组相比，DPN组患者的MVC和SCV均明显下降，差异均具有统计学意义（P<0.05）。对DPN的轻、中、重度3个亚组各指标进行两两比较，结果显示随着DPN严重程度的增加，其变化趋势进一步增加，差异亦具有统计学意义（P<0.05）。Pearson相关性分析显示，在DPN患者中SHBG水平与TG、TC、LDL-C和BUA呈现负相关关系（r=-0.562、-0.412、-0.476、-0.854，P<0.05），与MVC和SCV呈现正相关关系（r=0.693、0.782，P<0.05）。logistic回归分析显示，SHBG、SUA、E2和T的水平是影响DPN的危险因素（OR=0.678，95%CI=0.321~1.093；OR=3.237，95%CI=2.671~5.613；OR=1.674，95%CI=1.031~3.012；OR=0.741，95%CI=0.423~0.881，P<0.05）。结论：SHBG水平与DPN相关，SHBG的下降可能是DPN发生发展的危险因素，也可能成为潜在的预测T2DM血管并发症的指标之一。

Abstract:

Objective：To investigate the correlation between sex hormone-binding globulin（SHBG） and diabetic peripheral neuropathy （DPN） in type 2 diabetes mellitus（T2DM）. Methods：A total of 238 patients with T2DM were enrolled in our hospital from January 2014 to January 2017. They were divided into T2DM group（n=96） and DPN group（n=142）. DPN patients were divided into three subgroups including mild（n=52），moderate（n=48） and severe（n=42） according to the Toronto score（TCSS）. The clinical data，bio－chemical indexes，neurophysiological indexes，serum SHBG and sex hormone levels were analyzed，and then the correlation between SHBG level and DPN correlation index was analyzed. Finally，logistic regression analysis was used to analyze the influencing factors of DPN. Results：Compared with those of T2DM group，the age of DPN group was significantly higher，BMI value was significantly decreased，with statistically significant differences（P<0.05）. The levels of systolic blood pressure（SBP），triglyc－eride（TG），total cholesterol（TC），low density lipoprotein-choles－terol（LDL-C） and blood uric acid（BUA） were significantly higher in the DPN group than in T2DM group（P<0.05），while diastolic blood pressure（DBP），fasting blood-glucose（FPG），glycosylated hemoglobin（HbA1c），high density lipoprotein-cholesterol（HDL-C），blood urea nitrogen（BUN），alanine aminotransferase（ALT），aspartate aminotransferase（AST），alkaline phosphatase（ALP） and glutamyl transpeptidase（γ-GT） were not（P>0.05）. The levels of serum SHBG，total testosterone（T） and total estradiol（E2） were sig－nificantly decreased in DPN group（P<0.05）. In addition，the MVC and SCV were significantly decreased in DPN group than in T2DM group（P<0.05，P<0.01）. The difference between the three subgroups of DPN was obvious in above indicators，with the increase of DPN severity（P<0.05）. Pearson correlation analysis showed that there were negative correlation between SHBG level and TG，TC，LDL-C and BUA in DPN patients（r=-0.562，-0.412，-0.476，-0.854，P<0.05），and positively correlated with MVC and SCV（r=0.693，0.782；P<0.05）. Logistic regression analysis showed that the levels of SUA，SHBG，E2 and T were the risk factors of DPN（OR=0.678，95%CI=0.321 to 1.093；OR=3.237，95%CI=2.671 to 5.613；OR=1.674，95%CI=1.031 to 3.012；OR=0.741，95%CI=0.423 to 0.881，P<0.05）. Conclusion：The level of SHBG is related to DPN，and the decrease of SHBG may be a risk factor for the occurrence and development of DPN. It may also be one of the most important predictors of T2DM vascular complications.