The Relationship Between Serum Seluble E-selectin,Transforming Growth Factor-β1 Level And Diabetic Peripheral Neuropathy In Type 2 Diabetes Mellitus Patients

Objective:Type 2 diabetic peripheral neuropathy associated with microcirculatory disorders,metabolic disorders,etc.As many studies have proved,sE-selectin and transforming growth factor-β1(TGF-β1) have a close relationship with microcirculatory disorders.The aim of this study is to investigate the association between serum sE-selectin,TGF-β1 level and type 2 diabetic peripheral neuropathy,and the correlation between sE-selectin,TGF-βland various kinds of factors of diabetic peripheral neuropathy in type 2 diabetes mellitus(T2DM).Methods:65 in-ward patients with T2DM hospitalized in the Second Hospital of Hebei Medicine University from January, 2008 to September,2008.To examine the motor nerve conduction velocity(MCV) and compound muscle action potential amplitude(AMP) of the right median nerve,ulnar nerve and peroneal nerve;to examine the sensory nerve conduction velocity(SCV) and Sensory nerve action potential amplitude(AMP) of the right median nerve conduction,ulnar nerve and the superficial peroneal nerve.According to the degree of the diabetic peripheral neuropathy divide three groups. There are 22 patients(A group) without diabetic peripheral neuropathy,12 males and 10 females,average aged 52.45±12.37 years old;There are 23 patients(B1 group) with light degree of diabetic peripheral neuropathy,12 males and 11 females,average aged 55.78±7.19 years old;There are 20 patients(B₂ group) with critical degreen of diabetic peripheral neuropathy,11 males and 9 females,average aged 57.00±7.79 years old;Normal control(N group) 20 men,11 males and 9 females,average aged 56.20±7.50 years old.Each group in terms of gender and age match on heterogeneous.The diagnosis of T2DM accorded with the new diagnosis criteria of WHO in 1999.Serum sE-selectin,TGF-β1 was determined by ELISA.All the patients detected:systolic blood pressure(SBP),diastolic blood pressure(DBP),glycosylated hemoglobin,triglyceride(TG),cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL),fasting blood glucose(FPG) and 2 hours postprandial blood glucose(PBG).Compared the differences of the common conditions,nerve conduction velocity,and so on in four groups and study the association between sE-selectin,TGF-β1 and diabetic peripheral neuropathy in type 2 diabetes mellitus.Result:1 There was no difference in age,sexuality,among four groups(p＞0.05).2 Compared with N group serum sE-selectin,TGF-β1 level was higher in T2DM group(p＜0.01).Compared with A group serum sE-selectin,TGF-β1 level was higher in T2DM with diabetic peripheral neuropathy groups,but the increased level of TGF-β1 had no statistical significance(P=0.054).The serum sE-selectin level had difference among the four groups(p＜0.01).As the serum TGF-β1 level,there were no difference between N and A group,N and B₂ group,the left groups were different(p＜0.01).3 Compared the MCV,SCV of median nerve,ulnar nerve among the four groups,there was no difference between N and A(p＞0.05),the left groups were difference(p＜0.05).As the SCV of superficial peroneal nerve is concerned,there had difference between B₂ and other groups(p＜0.05),the left groups had no difference(p＜0.05).compared the AMP of the median nerve,ulnar nerve and superficial peroneal nerve,there were different between B₂ and other groups(p＜0.05),the left groups had no difference(p＞0.05).4 Compared the proportion of DN,DR among the A,B₁,B₂ groups,there were no different(p＞0.05).5 Compared with B₂ group,the duration of B₁,A group were shorter(p＜0.05),there was no different between A and B₁ group(p＞0.05);as the glycosylated hemoglobin is concerned, there were no different among the three groups(p＞0.05).6 Compared the fasting blood glucose between B2 group and N,A,B1 grous,there is statistical significance(P＜0.05),there had no significant difference between N group and A,B1,B2 group(P＜0.05);there had no difference between the four groups in height(p＞0.05);compared the SBP between the B₂ group and A group,there is statistical significance(p＜0.01),there was no significant difference between B1 and B2 group(p＞0.05);as the DBP is concerned,there had no significance among the groups(p＞0.05).7 There was a significant difference between N group and A,B1,B2 groups in TC(P＜0.01).the TG level of B2 group was significantly higher than the N,A groups(P＜0.01).the level of LDL in B2 group was lower than N,A,B1 groups, there was statistical significance(P＜0.01).compared the level of HDL there was no significant difference among four groups (P＞0.05).8 In type 2 diabetes mellitus groups,the serum sE-selectin level was positively correlated with diabetic duration(r=0.44, p＜0.01),glycosylated hemoglobin(r=0.38,p＜0.01);and negatively correlated with MMCV(r=-0.528,p＜0.01),UMCV (r=-0.487,p＜0.01),PMCV(r=-0.482,p＜0.01),MSCV(r=-0.544,p＜0.001),USCV(r=-0.488,p＜0.01),SSCV(r=-0.418, p＜0.01);there had no significant correlation with TGFβ1(r= 0.3,p＞0.05);there had no correlation with FPG,SBP,DBP,age, TC,TG,HDL,LDL irrelevant.The serum TGFβ1 level were not relevant with the factors above.Glycosylated hemoglobin were the independent related factors of the serum sE-selectin level(r² =0.138,0.201).Conclusion: 1 Patients with type 2 diabetes mellitus had higher serum sE-selection,TGF-β1 levels,with the degree of peripheral neuropathy aggravated,the serum levels of sE-selectin levels significantly increased,but the serum level of TGF-β1 at heavier neuropathic patients decreased.2 Serum sE-selectin levels was positively correlated with diabetes duration,glycosylated hemoglobin;and negatively correlated with motor nerve conduction velocity,sensory nerve conduction velocity.3 the Serum sE-selectin,TGF-β1 level may benefit the early diagnosis of DPN,sE-selectin may play a role in the complicated pathophysiological process of diabetic peripheral neuropathy,We can take advantage of it to control the progress of diabetic peripheral neuropathy in diabetes patients.