The Relationship Between Toll-like Receptor4and Painfull Dabetic Neuropathy

ObjectiveToll-like receptor family (TLRs) as pattern recognition receptors, plays an role in theimmune response and inflammation, in recent years more and more attention in the studyof neuropathic pain, with the Toll-like receptor4(TLR4) study on the majority. Tumornecrosis factor-α (TNF-α) has also been confirmed that play an important role in thepathological pain.The aim of this study is to analyze the clinical significance of TLR4and TNF-α by exploring the relationships among the serum level of TLR4、TNF-α andpainful diabetic neuoropathy(PDN).MethodsScreening the patients with type2diabetes mellitus, who were hospitalized indepartment of endocrinology of Second Artillery General Hospital from March to October2013. The diagnosis of patients with diabetic peripheral neuropathy accorded with thediagnostic criteria of the2009general practitioners developed by the branch of ChineseMedical Association endocrine metabolism of diabetic peripheral neuropathy (DPN).Refering to Ziegler standard diagnosis of diabetic painful neuropathy,54cases of diabeticperipheral neuropathy patients were divided into2groups:(1) simple group of diabeticperipheral neuropathy (simple DPN group):32cases;(2) group of diabetic painfulneuropathy (PDN group):22cases.Normal control(NC group) has30cases. First of all,measure the subjects of groups,such as height, weight, and calculate the BMI, bloodpressure, and detect glycosylated hemoglobin (HbA1C), blood biochemical,and others ofgeneral clinical parameters, each group were treated with determination of the serumconcentrations of TLR4and TNF-α, using statistical software SPSS to analyze the changesand their significance in PDN.Results1.Comparison of clinical data Compared with the NC group, the group of diabeticperipheral neuropathy (DPN and simple PDN group) age, SBP, BMI, HbA1C, FBP, TG, LDL-C differences there was statistically significant difference (P<0.05),there were nosignificant difference in DBP and TC (P>0.05). Between simple DPN and PDN groups,there were no significant difference in age, BMI, diabetes course, SBP, DBP, TC, LDL-C(P>0.05), differences are statistically significant in TG, HbA1C and FPG (P<0.05).Eachgroup in terms of age match on heterogeneous(P>0.05).2. The serum levels of TLR4of NC group,simple DPN group and PDN group are:0.58±0.154ng/ml±0.122ng/ml,0.97and1.03±0.262ng/ml.There were a statisticallysignificant difference in the serum levels of TLR4(P<0.01) between the group of diabeticperipheral neuropathy (DPN group and simple PDN group) and NC group.Camparedsimple DPN group with PDN group,there were no significant difference in the serum levelsof TLR4(P>0.05).3. The serum levels of TNF-α of NC group,simple DPN group and PDN group are:1.20±0.115pg/ml、1.47±0.077pg/ml、1.57±0.160pg/ml.There were a statisticallysignificant difference in the serum levels of TNF-α (P<0.01) between the group of diabeticperipheral neuropathy (DPN group and simple PDN group) and NC group.Camparedsimple DPN group with PDN group,there were no significant difference in the serum levelsof TNF-α (P<0.01).4.In diabetic peripheral neuropathy (DPN group and simple PDN group), the serumlevel of TLR4was positively correlated with HbA1C(r=0.333，P<0.05)、TNF-α(r=0.650，P<0.01)；the serum level of TNF-α was positively correlated with TG(r=0.303，P<0.05)、TLR4(r=0.650，P<0.01).Conclusions1.Compared with NC group,the serum level of TLR4in the diabetic neuropathy group(DPN group and simple PDN group) was a statistically significantdifference(P<0.01).Suggesting that TLR4may play a role in diabetic peripheralneuropathy.2. There were a statistically significant difference in the serum levels of TNF-α(P<0.01) between the group of diabetic peripheral neuropathy (DPN group and simplePDN group) and NC group.Campared simple DPN group with PDN group,there were alsosignificant difference in the serum levels of TNF-α (P<0.01). Tip that TNF-α may play animportant role in peripheral nerve injury-induced pathological pain. 3. TNF-α was positively correlated with TLR4,and this prompted that TLR4mightpromote to product and release of the inflammatory cytokines TNF-α through relatedsignal transduction pathways, then mediate that diabetic neuropathy pain occurs, to providenew ideas for clinical treatment.