Whether coagulation dysfunction influences the onset and progression of diabetic peripheral neuropathy: A multicenter study in middle-aged and aged patients with type 2 diabetes

IF 4.8 1区医学 Q1 NEUROSCIENCES CNS Neuroscience & Therapeutics Pub Date : 2024-09-11 DOI:10.1111/cns.70040

Jiali Xie, Xinyue Yu, Luowei Chen, Yifan Cheng, Kezheng Li, Mengwan Song, Yinuo Chen, Fei Feng, Yunlei Cai, Shuting Tong, Yuqin Qian, Yiting Xu, Haiqin Zhang, Junjie Yang, Zirui Xu, Can Cui, Huan Yu, Binbin Deng

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Abstract

Background

Nearly half of patients with diabetes experience diabetic peripheral neuropathy (DPN), resulting in a mere 53% survival rate within 3 years. Aberrations in coagulation function have been implicated in the pathogenesis of microvascular complications, prompting the need for a thorough investigation into its role as a contributing factor in the development and progression of DPN.

Methods

Data were gathered from 1211 type 2 diabetes patients admitted to five centers from September 2018 to October 2022 in China. DPN was evaluated by symptoms and electromyography. Motor and sensory nerve conduction velocity (NCV) was appraised and the NCV sum score was calculated for the median, ulnar, and peroneal motor or sensory nerves.

Results

Patients with DPN exhibited alterations in coagulation function. (i) Specifically, they exhibited prolonged thrombin time (p = 0.012), elevated fibrinogen (p < 0.001), and shortened activated partial thromboplastin time (APTT; p = 0.026) when compared to the control group. (ii) After accounting for potential confounders in linear regression, fibrinogen, and D-dimer were negatively related to the motor NCV, motor amplitude values, and mean velocity and amplitude. Also, fibrinogen was associated with higher Michigan neuropathy screening instrument (MNSI) scores (β 0.140; p = 0.001). This result of fibrinogen can be validated in the validation cohort with 317 diabetic patients. (iii) Fibrinogen was independently associated with the risk of DPN (OR 1.172; p = 0.035). In the total age group, DPN occurred at a slower rate until the predicted fibrinogen level reached around 3.75 g/L, after which the risk sharply escalated.

Conclusions

Coagulation function is warranted to be concerned in patients with type 2 diabetes to predict and prevent the occurrence of DPN in clinical practice.

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凝血功能障碍是否会影响糖尿病周围神经病变的发生和发展：一项针对中老年 2 型糖尿病患者的多中心研究

背景近一半的糖尿病患者会出现糖尿病周围神经病变（DPN），3 年内的存活率仅为 53%。凝血功能异常与微血管并发症的发病机制有关，因此有必要对凝血功能异常在 DPN 发生和发展过程中的作用进行深入研究。方法收集2018年9月至2022年10月中国5个中心收治的1211例2型糖尿病患者的数据。通过症状和肌电图对DPN进行评估。评估运动神经和感觉神经传导速度（NCV），并计算正中神经、尺神经和腓运动神经或感觉神经的NCV总分。结果 DPN 患者的凝血功能发生了改变。(i) 具体而言，与对照组相比，他们的凝血酶时间延长（p = 0.012），纤维蛋白原升高（p < 0.001），活化部分凝血活酶时间缩短（APTT; p = 0.026）。(ii) 在线性回归中考虑了潜在的混杂因素后，纤维蛋白原和 D-二聚体与运动 NCV、运动振幅值、平均速度和振幅呈负相关。此外，纤维蛋白原与较高的密歇根神经病变筛查工具（MNSI）评分相关（β 0.140; p = 0.001）。纤维蛋白原的这一结果可在由 317 名糖尿病患者组成的验证队列中得到验证。(iii) 纤维蛋白原与 DPN 风险独立相关（OR 1.172；p = 0.035）。在所有年龄组中，DPN 的发生率较低，直到预测纤维蛋白原水平达到 3.75 g/L 左右，之后风险急剧上升。结论临床实践中应关注 2 型糖尿病患者的凝血功能，以预测和预防 DPN 的发生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.