Correlation Between The Accumulation Of Skin Glycosylation End Products And The Development Of Type 2 Diabetic Peripheral Neuropathy And TCM Syndromes

Objective: To study the skin glycosylation end products cumulants with type 2 diabetes peripheral neuropathy in development and the correlation of TCM syndrome types,assess the skin ages terminal product accumulated in the diagnostic value and clinical significance of diabetic peripheral neuropathy,to guide the diagnosis and treatment of diabetic peripheral neuropathy and data support.Methods: 560 inpatients(T2DM group)with type 2 diabetes who were admitted to the affiliated hospital of chengdu university of traditional Chinese medicine(sichuan hospital of traditional Chinese medicine)from May 2016 to June 2018 were selected.The diagnostic criteria of western medicine refer to the diagnostic criteria of type 2 diabetes proposed by the world health organization(WHO)in 1999.The guidelines for the prevention and treatment of diabetes mellitus published by the Chinese medical association in 2007 and the guiding principles for the clinical research of new drugs of Chinese medicine were used as the reference criteria for TCM symptom score and TCM syndrome differentiation in this study.560 patients with type 2 diabetes were divided into DPN group and non-dpn group according to the clinical diagnostic criteria recommended by the 2010 ADA diabetes medical treatment standards.According to the grading criteria of diabetic neuropathy formulated by p.j.dwyck,it was further divided into grade 0(i.e.,non-dpn group,diabetic non-neuropathy group).Stage1(early): asymptomatic neuropathy;Stage 2(middle stage): neuropathic symptoms,but no neurological involvement;Grade 3(advanced): neuropathic symptoms and functional involvement.The accumulations of skin glycosylation end products were measured,and other general information of hospitalized patients as well as relevant examination indexes were collected.SPSS 20.0 statistical software was used for data statistical analysis.Quantitative data with mean ±standard deviation(X?±S),data to normality test,meet the needs of normal distribution data,using the single factor analysis of variance.For those that do not meet the normal distribution,such as qualitative data(such as gender,smoking history,drinking history,etc.)and TCM syndrome classification,non-parametric tests such as chi-square test are used.Pearson or Spearman correlation analysis was used to analyze the correlation between AGE cumulants and laboratory indexes.ROC curves were used to assess the sensitivity and specificity of AGEs accumulation in the diagnosis of diabetic peripheral neuropathy(DPN).Compare the correlation between AGEs and DPN multi-check grading;To analyze and compare the correlation between AGEs level and TCM syndrome classification in type 2 diabetic peripheral neuropathy patients.P < 0.05 was considered statistically significant,while P < 0.01 was considered statistically significant.Pearson or Spearman correlation analysis was used to analyze the correlation between AGE cumulants and laboratory indexes.ROC curves were used to assess the sensitivity and specificity of AGEs accumulation in the diagnosis of diabetic peripheral neuropathy(DPN).The correlation between AGEs and DPN test grades was compared.To analyze and compare the correlation between AGEs level and TCM syndrome classification in type 2 diabetic peripheral neuropathy patients.P < 0.05 was considered statistically significant,while P < 0.01 was considered statistically significant.Result :1.The difference analysis of various indexes among different DPN(1)Compare AGEs between different DPNS :With the increase of DPN severity,the AGEs accumulation and the four risk assessment values(cardiovascular risk value,glycine reticulum lesion risk value,neuropathy risk value,and glycine nephropathy risk value)showed an increasing trend,especially the AGEs change showed a linear relationship.(2)Comparison of general data between different DPNS:With the increase of DPN severity,age,disease course,TCM symptom score,TCSS score,inflammatory index(NLR,CRP),renal function index(CysC,Hcy,Cr,ACR,a microglobulin,uric microalbumin,uric transferrin,uric immunoglobulin)all showed an increasing trend.Islet function(insulin 1-2h after meal),eGFR and lymphocyte count showed a decreasing trend.In addition,although there was no significant statistical difference in calcium ion concentration and insulin level 3h after meals,the statistical charts showed a trend of gradual decline.2 Correlation analysis of skin AGEs accumulation and other indicators :Correlation analysis: the skin which cumulant and general information(age,duration,systolic blood pressure),the related parameters of renal function,blood uric acid,Cr,CysC,Hcy,ACR,urine trace albumin,a microglobulin,urinary transferrin,urine immune globulin),inflammatory index(white blood cells,neutrophils,leaching ratio,CRP),four major complications risk value(value at risk of cardiovascular disease,risk value,sugar disease risk of neuropathy,kidney variable value at risk),TCM symptom scores,TCSS score was positively related to relationship significance(P < 0.01 or 0.05)(positive)correlation coefficient;Islet function(fasting and glucose tolerance test 1-3h insulin,HOMAIR),BMI,lymphocytes,eGFR were negatively correlated(P<0.01 or 0.05)(correlation coefficient was negative).3.Correlation analysis between DPN severity and DPN detection grading :There was a good positive correlation between different degrees of neuropathy grading and the degree of vibration sensation threshold,current threshold and TCSS grading.4.Analysis of the diagnostic value of skin AGEs accumulation in DPN(1)AGEs comparisons between DPN correlation check grades :There were significant differences in the AGEs between different vibration threshold grades,between the normal group and the weakened group,and between TCSS grading of different degrees(P<0.01).With the increase of VPT,the accumulator of AGEs increased gradually.The AGEs accumulation in the CPT normal group was smaller than that in the reduced group.The more severe the TCSS lesion,the higher the AGEs accumulation.(2)Sensitivity and specificity of AGEs :Combined with ROC curve and curve coordinates,the maximum exponential of AGEs cumulant is 0.440,corresponding AGEs cumulant value is 77.65,corresponding sensitivity is 0.731,and specificity is 0.709.The maximum density index of the risk value of neuropathy was 0.385,the corresponding risk value of neuropathy was 66.25,the corresponding sensitivity was 0.676,and the specificity was 0.709.5.Study on TCM syndrome type of DPN:(1)It was found that age,course of disease and gender were different in different TCM syndromes of diabetic peripheral neuropathy.(2)There is a certain difference in TCM syndrome types between different DPN grades.(3)The AGEs accumulation of qi deficiency and blood stasis,Yin deficiency and blood stasis,phlegm and dampness blocking collaterals was significantly lower than that of liver and kidney deficiency(P<0.05 or P<0.01).Conclusion: Skin AGEs plays an important role in the development of diabetic peripheral neuropathy,and can be used as an important indicator for the diagnosis and evaluation of diabetic neuropathy.It can provide some reference for TCM syndrome differentiation and treatment of DPN.Noninvasive detection system for skin glycosylation end products has the advantages of noninvasive,rapid and low cost,and it is of great significance and value to actively promote and apply the system.