| Objective:To explore the correlation between brachial ankle pulse wave velocity(Brachial ankle Pulse Wave Velocity,baPWV)and the risk of diabetic peripheral neuropathy(Diabetic Peripheral Neuropathy,DPN)in patients with type 2 diabetes mellitus,in order to provide a new theoretical basis for baPWV to predict the risk of DPN.Methods:A total of 205 patients with type 2 diabetes who were hospitalized in Endocrine Department of Northern Jianfsu People’s Hospital from July 2019 to August2020 were selected.All patients met the diagnostic criteria of type 2 diabetes proposed by the World Health Organization diabetes expert committee in 1999:fasting blood glucose≥7.0 mmol/L,or 2h blood glucose≥11.1 mmol/L,or had typical symptoms of diabetes with random blood glucose≥11.1%.The patients with tumor,cachexia,stress state,acute complications of diabetes,diabetic foot,other diseases of nervous system,peripheral vascular occlusion and ankle brachial index(ABI)less than 0.9 or more than1.3 were excluded.Diagnostic criteria of DPN:symptoms of nervous system lesions after diagnosis of diabetes,such as numbness of limbs,ant walking,tingling and crawling sensation of insects,and 2 or more abnormalities in 5 neuropathy-related examinations including 10g nylon test,sensory threshold measurement,ankle reflex test,warm and cool sensation test and nerve conduction velocity measurement.General data of patients were collected:age,gender,course of disease,drug and insulin use,smoking history,drinking history,past disease history,family genetic disease history;height,weight,systolic blood pressure,diastolic blood pressure,body mass index of patients were measured;laboratory indexes of patients were detected:fasting blood glucose,2h blood glucose,glycosylated hemoglobin,fasting C peptide,2h blood glucose C-peptide,blood lipid,uric acid and so on;morning urine was collected to determine microalbuminuria.BaPWV was measured by the same endocrinologist using the automatic arteriosclerosis detector.According to the measured baPWV,the patients were divided into three groups:T1 group(966-1473cm/s),T2 group(1474-1763cm/s),T3 group(1764-2442cm/s).Statistical software SPSS 25.0 was used to analyze the differences of clinical data between the two groups.The measurement indexes were compared by analysis of variance or Kruskal Wallis H test and chi square test were used to compare the difference of DPN prevalence among the three groups.Chi square test was used to compare the prevalence between the two groups.Binary logistic regression was used to analyze the correlation between baPWV and DPN prevalence.P<0.05showed that the difference was statistically significant.Result:1.There were significant differences in age,course of disease,systolic blood pressure,insulin use history,antihypertensive drug use history,smoking history among the three groups(P<0.05),but no significant differences in gender,body mass index,diastolic blood pressure,drinking history,hypoglycemic drug use history among the three groups(P>0.05).Age,course of disease,systolic blood pressure,history of insulin use,antihypertensive drug use and smoking history increased significantly with the increase of baPWV.2.There were significant differences in fasting blood glucose,2 h blood glucose,glycosylated hemoglobin,microalbumin,triglyceride,high density lipoprotein among the three groups(P<0.05),but there were no significant differences in fasting C peptide,2 h C peptide,cholesterol,low density lipoprotein and uric acid among the three groups(P>0.05).The levels of fasting blood glucose,2 h blood glucose,glycosylated hemoglobin,microalbumin and triglyceride increased significantly with the increase of baPWV,and the levels of high density lipoprotein decreased with the increase of baPWV.3.The prevalence of DPN in T1,T2 and T3 groups was 26.1%(18/69),77.9%(53/68)and 97.1%(66/68),respectively.The prevalence of DPN gradually increased with the increase of baPWV value.The overall mean of data among the three groups was statistically significant(x ~2=83.49,P<0.001),and the difference between any two groups was statistically significant(P<0.001).4.Age,course of disease,systolic blood pressure,fasting blood glucose,2h blood glucose,glycosylated hemoglobin,microalbuminuria,triglyceride,high density lipoprotein,baPWV,history of insulin use,history of antihypertensive drugs use,smoking history and other independent variables were included in the binary logistic regression model.The results showed that the risk of DPN was related to age(OR=1.078,P=0.034),course of disease(OR=1.391,P=0.000),fasting blood glucose(OR=4.495,P=0.003),baPWV(OR=1.003,P=0.045)were significantly positively correlated,P<0.05.Age,course of disease,fasting blood glucose and baPWV were independent risk factors for DPN.5.With DPN as the dependent variable and baPWV as the independent variable,a regression model was established to gradually correct the confounding factors.Model 1did not adjust for confounding factors,model 2 adjusted for glycosylated hemoglobin,fasting blood glucose,2-hour blood glucose,triglyceride and cholesterol,and model 3further adjusted for systolic blood pressure,diastolic blood pressure,age,course of disease and smoking history on the basis of model 2.The trend of the three statistical models was P<0.05.The results showed that there was a significant dose-response relationship between the risk of DPN and baPWV The degree of risk is obviously increased.Conclusion:1.In type 2 diabetic patients with normal ABI,the risk of DPN increased with age,course of disease,fasting blood glucose and baPWV;2.There is a significant correlation between high baPWV and DPN.The increase of baPWV is an independent risk factor for DPN.BaPWV detection can predict the risk of DPN in type 2 diabetic patients with normal ABI. |
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