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

Objective: Diabetic peripheral neuropathy(DPN)caused by type 2 diabetes mellitus(T2DM)is a chronic inflammatory disease and the neutrophil-to-lymphocyte ratio(NLR)is a new inflammatory marker of more concerned in recent years.Previous studies have shown that NLR is closely related to diabetes mellitus and its chronic complications,but there are few studies on NLR and DPN.The aim of this study is to observe the changes of serum NLR levels in DPN patients with different degrees and to speculate its role and significance in order to provide preliminary laboratory evidence and new ideas for the early diagnosis and clinical treatment of DPN.Method: 219 patients with T2 DM from Department of Endocrinology,Affiliated Hospital of Qinghai University from November 2016 to October 2017 were randomly selected and divided into simple DM group(n=106),DPN mild to moderate group(n=67)and DPN severe group(n=46).General information and biochemical indexes were collected.The levels of NLR and other indexes among the three groups were compared and analyzed.The correlation between NLR and the degrees of DPN and other indexes were analyzed.We use SPSS21.0 software to perform the data analysis.Results: 1.There were no significant differences in gender,age,smoking history,ethnic group,BMI,waist circumference and the detection rate of fatty liver among the three groups(P>0.05).The course of the disease in DPN group was longer than that of DM group(P<0.05)and the course of disease was prolonged with the severity of DPN(P<0.05).The detection rate of hypertension was higher in DPN severe group than in DM group(P <0.017).2.There was no significant difference in PLT,PLR,WBC,MC,MPV,PDW,RDW-SD,CRP,hs-CRP and ESR among the three groups(P> 0.05).The differences of NC,LC and NLR among the three groups were statistically significant(P <0.05).With the occurrence and aggravation of DPN,NC gradually increased and LC gradually decreased and there was significant difference among the three groups(P<0.05).NLR is higher in DPN severe group and DPN mild to moderate group than in the DM group,the differences were statistically significant(P<0.05).3.There was no significant difference in FPG,FINS,HOMA-?,TC,HDL-C,LDL-C,UA and ABI among the three groups(P>0.05).The levels of HOMA-IR,TG and Scr in the DPN severe group were significantly higher than those in the DPN mild and moderate group and DM group respectively(P<0.05 or 0.017).The levels of HbA1 c and Cys-c in DPN severe group were significantly higher than those in DM group(P <0.05).The levels of Bun and CIMT in the DPN mild and moderate group and DPN severe group were significantly higher than those in DM group respectively(P<0.05).With the occurrence and aggravation of DPN in T2 DM patients,the value of VPT increased gradually,and the differences among the three groups were statistically significant(P <0.05).4.There was no significant difference in the detection rate of lower extremity atherosclerotic disease(LEAD)and dorsalis pedis artery atherosclerotic plaque among the three groups(P> 0.05).The detection rate of CAS is higher in DPN severe group and DPN mild to moderate group than in DM group,the difference was statistically significant respectively(P <0.017).5.Spearman correlation analysis showed that VPT was significantly correlated with duration,NC,LC,NLR,TG,Bun,Scr,Cys-c and CIMT(P <0.01 or P<0.05).And in addition to the negative correlation with LC(r =-0.344),and the remaining indicators are positively correlated.There was a significant positive correlation between NLR and the duration of DPN,Scr,Cys-c and CIMT(P <0.01 or P <0.05).6.The results of binary multivariate Logistic regression showed that the duration of DPN(P = 0.002),HbA1c(P = 0.033),HOMA-IR(P = 0.038)and Bun(P = 0.025)were the main risk factors for DPN.NC,LC and NLR were not statistically significant in regression analysis(P> 0.05).Conclusion: 1.With the extension of diabetes duration,DPN showed a gradually aggravated trend,the detection rate of hypertension increased.2.With the appearance and aggravation of DPN in type 2 diabetic patients,NC and NLR showed an upward trend while LC showed a downward trend.HOMA-IR,HbA1 c,TG,Bun,Scr,Cys-c and CIMT showed an upward trend.3.DPN was associated with duration of DPN,NC,LC,NLR,HOMA-IR,TG,Bun,Scr,Cys-c and CIMT,and the duration of DPN,HbA1 c,HOMA-IR and Bun were independent risk factors for the occurrence of DPN.