血清缺氧诱导因子-1α、髓鞘碱性蛋白和超敏C反应蛋白在糖尿病周围神经病变中的变化及临床意义

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摘要目的检测糖尿病周围神经病变患者血清缺氧诱导因子-1α（HIF-1α）、髓鞘碱性蛋白（MBP）、超敏C反应蛋白（hs-CRP）和氧化应激反应水平，分析其相关性。方法选择2015年7月~2016年7月在新疆医科大学第五附属医院（以下简称“我院”）接受治疗的糖尿病周围神经病变患者90例为研究组，选择同期在我院体检的年龄、性别相匹配的健康人群80名为对照组。检测两组一般生化指标、血清HIF-1α、MBP、hs-CRP及超氧化物歧化酶（SOD）、还原型谷胱甘肽（GSH）、丙二醛（MDA）氧化应激指标水平。糖尿病周围神经病变发生的影响因素采用多因素Logistic回归分析。研究组患者血清HIF-1α、MBP、hs-CRP与SOD、GSH、MDA的相关性分析采用Spearman相关性检验。结果研究组总胆固醇（TC）、三酰甘油（TG）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）水平均明显高于对照组（P ﹤ 0.05）。研究组血清HIF-1α、MBP、hs-CRP水平均明显高于对照组，差异有统计学意义（P ﹤ 0.05）。研究组血清SOD、GSH水平均明显低于对照组（P < 0.05），MDA水平明显高于对照组（P < 0.05）。多因素Logistic分析表明，年龄、糖尿病病程、TC、TG、FPG、HbA1c、FINS、HIF-1α、MBP、hs-CRP、MDA是糖尿病周围神经病变发生的独立危险因素（P < 0.05），SOD、GSH是糖尿病周围神经病变的保护性因素（P < 0.05）。Spearman相关检验分析显示，研究组血清HIF-1α、MBP、hs-CRP均与MDA水平呈正相关（r=0.547、0.624、0.685，P ＜ 0.05），均与SOD、GSH水平呈负相关（r=-0.565、-0.583、-0.592，r=-0.492、-0.551、-0.572，均P ＜ 0.05）。结论血清HIF-1α、MBP、hs-CRP水平的上升和氧化应激反应均参与糖尿病周围神经病变的发生及发展，可能成为临床辅助诊断糖尿病周围神经病变患者的生物指标，为临床干预治疗提供理论依据。

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	张丽罗荔陆春晖张洁王敏哲

关键词 ：糖尿病周围神经病变, 缺氧诱导因子-1&alpha, 髓鞘碱性蛋白, 超敏C反应蛋白, 氧化应激反应

Abstract：Objective To detect the levels of serum hypoxia inducible factor-1α (HIF-1α), myelin basic protein (MBP), high sensitive C reactive protein (hs-CRP) and oxidative stress response in patients with diabetic peripheral neuropathy, and analyze the correlation among them. Methods 90 cases of patients with diabetic peripheral neuropathy treated in the Fifth Atfiliated Hospital of Xinjiang Medical University ("our hospital" for short) from July 2015 to July 2016 were selected as the study group. 80 healthy cases matched by age and gender in our hospital at the same time were selected as the control group. General biochemical indexes, levls of serum HIF-1α, MBP, hs-CRP, oxidative stress levels of super oxide dismutase (SOD), reduced glutathione (GSH), and malonaldehyde (MDA) were detected and compared between the two gorups. The multivariate Logistic regression analysis was used to analyze the influence factors of diabetic peripheral neuropathy. Spearman correlation test was used to analyze the correlation among serum HIF-1α, MBP, hs-CRP and SOD, GSH, MDA in the study group. Results The levels of total cholesterol (TC), triglyceride (TG), fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS) in the study group were significantly higher than those in the control group (P < 0.05). The levers of serum HIF-1α, MBP and hs-CRP in the study group were significantly higher than those in the control group, the differences were statistically significant (P < 0.05). The levels of serum SOD and GSH in the study group were significantly lower than those in the control group (P < 0.05), and the serum MDA level in the study group was significantly higher than that in the control group (P < 0.05). The multivariate Logistic regression analysis showed that age, duration of diabetes, TC, TG, FPG, HbA1c, FINS, MBP, hs-CRP, HIF-1α, MDA were independent risk factors of diabetic peripheral neuropathy (P < 0.05), SOD and GSH were protective factors of diabetic peripheral neuropathy (P < 0.05). Spearman correlation analysis showed that serum HIF-1α, MBP and hs-CRP in study group were positively correlated with MDA level (r=0.547, 0.624, 0.685, P < 0.05), and which were negatively correlated with SOD and GSH levels (r=-0.565, -0.583, -0.592, r=-0.492, -0.551, -0.572, P < 0.05). Conclusion The higher levels of serum HIF-1α, MBP and hs-CRP levels and oxidative stress are involved in the occurrence and development of diabetic peripheral neuropathy, which can be taken as clinical diagnostic bio-markers in patients with diabetic peripheral neuropathy, and provide theoretical basises for clinical intervention.

Key words： Diabetic peripheral neuropathy HIF-1α MBP hs-CRP Oxidative stress

基金资助:新疆维吾尔自治区自然科学基金（2016D01C241）；
新疆医科大学科研创新基金项目（XYDCX2015112）。

通讯作者: 王敏哲（1966-），女，主任医师，副教授，主要从事内分泌疾病研究。

引用本文:

张丽罗荔陆春晖张洁王敏哲. 血清缺氧诱导因子-1α、髓鞘碱性蛋白和超敏C反应蛋白在糖尿病周围神经病变中的变化及临床意义[J]. 中国医药导报, 2017, 14(15): 174-178.
ZHANG Li LUO Li LU Chunhui ZHANG Jie WANG Minzhe. Changes and clinical significance of HIF-1α, MBP and hs-CRP in patients with diabetic peripheral neuropathy. 中国医药导报, 2017, 14(15): 174-178.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I15/174

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