The Relationship Between Neutrophil-lymphocyte Ratio And Diabetic Peripheral Neuropathy In Type 2 Diabetes Mellitus

Background and Objective Diabetic peripheral neuropathy is a chronic and disabling disease,and the accurate identification and early intervention is important for clinical management.Recent data support a role for components of inflammation in the presence and development of DPN.Several studies have suggested that neutrophil-lymphocyte ratio,a stable and effective inflammation markers,which has a significant correlation with diabetes mellitus and its complications.But evidence is scarce concerning the possible association between NLR and DPN in type 2 diabetes mellitus.This paper is aimed at exploring the relationship between the level of peripheral blood neutrophil-lymphocyte ratio and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus.Methods Object: This study is a retrospective investigation,included 239 participants with type 2 diabetes(average age 58.30±11.39,male/female: 143/96),excluded other neuropathy and severe complications of patients.There is a total of 100 patients with DPN,and 139 patients without DPN.Data collection: Collect patients' generally information,peripheral blood leukocyte count,neutrophil count,lymphocyte count,glycosylated hemoglobin(Hb A1c),fasting plasma glucose,blood lipid,microalbuminuria,urinary albumin creatinine ratio,glomerular filtration rate and other biochemical indicators.Nerve conduction studies(NCS): A total of patients were measured the motor nerve conduction latentperiod(MLAT),amplitude(MAMP)and velocity(MCV)of median nerve,ulnar nerve,tibial nerve and phil total nerve,and the sural nerve conduction latentperiod(SLAT),amplitude(SAMP)and velocity(SCV)of median nerve,ulnar nerve,phil shallow nerve and sural nerve.Statistical analysis: SPSS 21.0 software was used for statistical analysis of research data.Results 1.Characteristics of the subjects with and without diabetic peripheral neuropathy The DPN group had a greater NLR,neutrophil count,duration of diabetes,fasting plasma glucose,glycated hemoglobin,height,weight,systolic blood pressure,microalbuminuria,urinary albumin to creatinine ratio and the patients with diabetic retinopathy,diabetic nephropathy,hypertension when compared to the NDPN group(p<0.05 or p<0.001).Lymphocyte count,hemoglobin,serum calcium,serum sodium,serum albumin of DPN group were lower than those of NDPN group(p<0.05 or p<0.001).Gender,age,body mass index,diastolic blood pressure,white blood cell count,mean platelet volume,mononuclear cell count,blood lipid,potassium,urea nitrogen,creatinine,glomerular filtration rate and uric acid were comparable between the two groups(p>0.05).2.The influence of NLR levels on the detection of DPN,DN and DR,and the reaching standard rate of glycemic control Between group P0?NLR?P25,P25<NLR?P50,P50<NLR?P75 and group P75<NLR?P100,the detection rate of DPN and DN gradually rose(P=0.000).And the detection rate of DR in different groups have significant difference(P<0.05).While the reaching standard rate of Hb A1 c in different groups has no significant difference(P > 0.05).3.Spearmon Correlation analysis between NLR and nerve conduction function NLR was positively correlated with the MLAT of median nerve,ulnar nerve(below elbow-wrist,up elbow-below elbow),tibial nerve and common peroneal nerve(below fibula capitulum-ankle,up fibula capitulum-below fibula capitulum)(P<0.05 or P<0.001).And it was negatively correlated with MAMP of median nerve,ulnar nerve,tibial nerve and common peroneal nerve(P<0.05 or P<0.001).Also negatively correlated with MCV of median nerve,ulnar nerve(wrist-ADM,below elbow-wrist), tibial nerve and common peroneal nerve(P<0.05 or P<0.001).But there was no statistical correlation of NLR and ulnar nerve(wrist-ADM)MLAT,common peroneal nerve(ankle-EDB)MLAT and ulnar nerve(up-below elbow)MCV(p>0.05).NLR was positively correlated with the SLAT of median nerve and sural nerve(P<0.05 or P<0.001).And it was negatively correlated with SAMP and SCV of median nerve,ulnar nerve,sural nerve,phil shallow nerve(P<0.05 or P<0.001).However,NLR wasn't correlated with the SLAT of ulnar nerve and phil shallow nerve(p>0.05).4.The risk analysis about NLR and type 2 diabetes peripheral neuropathy Binary logistic regression analysis showed that NLR(OR= 1.984,95%CI:1.302-3.024,P=0.001),diabetic retinopathy(OR= 3.484,95%CI : 1.583-7.665,P=0.002),diabetic nephropathy(OR= 3.155,95%CI:1.368-7.276,P=0.007),heigh(OR= 1.076,95%CI:1.030-1.124,P=0.001)were risk factors for DPN.And serum sodium(OR= 0.854,95%CI:0.767-0.950,P=0.004)was protect factor for DPN.5.ROC curve about using NLR predict DPN Based on the receiver operating characteristic curve,use of the NLR as an indicator for diabetes patients with peripheral neuropathy diagnosis was projected to be 2.1225,and yielded a sensitivity and specificity of 58% and 73.4%,respectively,with an area under the curve of 0.679(95%CI:0.609-0.749,P=0.000).Conclusions NLR is closely associated with the detection of DPN in patients with T2 DM.There is an correlation between NLR and nerve conduction function.Moreover,NLR is one of the independently risk factors of DPN.NLR has a certain significance for the forecast of DPN,and the best predict boundary value is NLR = 2.1225.