Study The Relationship Between Anti-ganglioside Antibody And Diabetic Peripheral Neuropathy Based On Immune Mechanism

Introduction In the whole course of diabetes,there are many chronic complications.In the chronic complications,diabetic peripheral neuropathy(DPN)is one of the most common complications,about 50-60% of the total incidence(1).Diabetic peripheral neuropathy is a very serious disease,mainly for the symmetry of the distal limb numbness,some patients will be irritating pain,including spontaneous pain,hyperalgesia(mild irritation caused by severe pain)and hyperalgesia(Harmless such as light or touch can also cause significant pain),tendon reflexes weakened,myasthenia,hypoesthesia,etc,which affect the quality of life of patients(2).The foot has a protective mechanism due to pain avoidance,and the sensory disorder caused by nerve damage will weaken the protection mechanism,leading to foot injury,ulcers refractory,and even amputation,it can affect the patient's life(3).However,the specific pathogenesis of diabetic peripheral neuropathy has not yet fully elucidated.Part of the theoretical mechanism has become the focus of discussion on oxidative stress-mediated neuronal and peripheral glial cell damage,oxidative stress also activates other pathways that can initiate direct or indirect initiation and increase the production of inflammatory mediators.Inflammatory factors damaging the neuronal due to antigen exposure,the further occurrence of immune-mediated vicious cycle,together lead to the occurrence and development of diabetic peripheral neuropathy(4).There is also a lack of effective clinical treatment,a significant impact on the lives of people with diabetes and quality of life.Further study of its mechanism is important for finding effective therapeutic targets.Part One Selection of diagnostic methods for diabetic peripheral neuropathy1.Aims To study the incidence of peripheral neuropathy in diabetes and its clinical levels.2.Methods The subjects were divided into three groups: normal control group(NC group)with 101 healthy individuals;diabetes mellitus without peripheral neuropathy group(DM group)with 87 patients;DPN group with 178 cases.American Nicolet Viking IV electromyography(EMG)was applied to detect nerve conduction velocity(NCV).3.Results Motor nerve conduction velocity(MCV),sensory nerve conduction velocity(SCV)of DNC group were significantly lower than those of NC group and DM group(P < 0.05).3.1 Diabetic peripheral neuropathy clinical levels(DPNC)(6): Level 1(DPNC1): 2 NCV abnormalities and diabetic neuropathy score(DNS)? 12;Level 2(DPNC2): 3 to 4 NCV abnormalities and DNS ?29 points;Level 3(DPNC3): ? 5 or more NCV abnormalities and DNS ? 46 points.3.2 MNSI score < 12 points in the DM group,NCV abnormal rate was 20.69%.3.3 Motor nerve conduction velocity(MCV)and sensory nerve conduction velocity(SCV)in DPN group were significantly lower than in NC group and DM group(P <0.05).The MCV of the median nerve,ulnar nerve and peroneal nerve in DM group was significantly lower than that in NC group(P <0.05).4.Conclusion We can diagnose diabetic peripheral neuropathy more accuracy and early with electromyography and Michigan neuropathy screening scale.With the prolonged course of diabetes,the incidence and severity of diabetic peripheral neuropathy increased gradually.Part Two Study on the correlation between anti-ganglioside antibody(anti-GS-AB)and TNF-?,PAI-1,CRP in diabetic peripheral neuropathy1.Aims To investigate the associations of serum anti-ganglioside antibodies(anti-GS-ab),serum plasminogen activator inhibitor-1(PAI-1),tumor necrosis factor-?(TNF-?),C reactive protein(CRP)in diabetic peripheral neuropathy(DPN).2.Methods Enzyme linked immunosorbent assay(ELISA)was used to determine the levels of anti-GS-Ig G-ab,PAI-1 and TNF-?;immunoturbidimetry was employed to measure the CRP levels.3.Results 3.1 Pairwise comparisons among diabetic peripheral neuropathy clinical levels(DPNC)were statistically significant(P < 0.05),and the level of anti-GS-ab was positively related with DPNC.3.2 There were statistically significant in PAI-1,TNF-?,CRP levels between DPN group and DM or NC groups(both P < 0.05).3.3 The positive rate of anti-GS-Ig M-ab was positively correlated with the levels of PAI-1,TNF-? and CRP.3.4 The levels of PAI-1,TNF-? and CRP were positively correlated with course of disease,diabetic foot,glycosylated hemoglobin,fasting blood glucose,total cholesterol and triglyceride(P <0.05).4.Conclusion Anti-GS-ab,PAI-1,TNF-?,CRP levels were associated with DPN development and progression,which could be regard as important reference indicators for the diagnosis of DPN and prediction of disease progression.