Correlation Between Serum Gastrin-17 Level And Peripheral Autonomic Neuropathy In Patients With Type 2 Diabetes Mellitus

ObjectiveIncreasing evidence suggest that gut may also play a key role in the pathogenesis of type 2 diabetes which may be related to both the intestinal microbiological profile and patterns of gut hormones secretion.Intestinal milieu regulates the secretion of hormones such as GLP-1,gastrin,somatostatin and so on,all of which importantly influence metabolism in general and in particular glucose metabolism.In recent years,the relationship between gastrin and diabetes has gradually attracted the attention.In fetal life,the predominant site of gastrin expression is the developing pancreatic islets,not the stomach.Pancreatic gastrin expression is transient and is promptly suppressed after birth.This period of pancreatic gastrin expression coincides with a time of rapid pancreatic development.In addition,scholars have found that gastrin-17 is closely related to diabetic autonomic neuropathy involving the gastrointestinal tract,cardiovascular system and kidney.Gastrin-17 is involved in the development of diabetic gastroparesis.However,there is no study report the relationship between gastrin-17 and diabetic peripheral autonomic neuropathy.This study to investigate the relationship between serum gastrin-17 level and peripheral autonomic neuropathy in patients with type 2 diabetes mellitus,in order to provide theoretical basis for the diagnosis,prevention and evaluation of diabetic peripheral autonomic neuropathy.Subjects and methodsA total of 287 patients with type 2 diabetes mellitus admitted to our department were enrolled in this study.The conductivity analyzer SUDOSCAN was used to measure the electrical skin conductivity(ESC)as an index for detecting peripheral autonomic function.All the patients were divided into three groups according to the sweat function: The mean value of both hands(HESC)and the mean value of feet(FESC)conductivity were>60?S for 114 patients with normal peripheral autonomic nerves(NPAN group),and 40?S<HESC or FESC?60?S for 92 patients with moderate peripheral autonomic neuropathy(MPAN group),and HESC or FESC?40?S for 81 patients with severe peripheral autonomic neuropathy(SPAN group).The level of gastrin-17,the clinical biochemical indicators and the results of SUDOSCAN detection were compared among the three groups.Results(1)There was no significant difference in sex,body mass index,diastolic blood pressure,creatinine,fasting blood glucose,fasting C-peptide,glycosylated hemoglobin,Triglyceride,Total cholesterol,High-density lipoprotein cholesterol,Low-density lipoprotein cholesterol and Very low-density lipoprotein cholesterol among the three groups.The age,course of disease,systolic blood pressure and uric acid in autonomic peripheral neuropathy group were significantly higher than those in normal peripheral autonomic nerves group.The level of serum gastrin-17 in SPAN group was significantly higher than those in MPAN group and NPAN group(P<0.01).The level of gastrin-17 in the three groups were 2.32(1.38,5.27)pmol/L,2.86(1.50,5.09)pmol/L and 6.21(2.59,10.93)pmol/L respectively.The marginal rising and rising rate of gastrin-17 in SPAN group were higher than those in MPAN group and NPAN group,while the marginal rising rate of gastrin-17 in MPAN group was higher than that in NPAN group(P<0.05).There was no significant difference in the level of gastrin-17,the marginal rising and rising rate of gastrin-17 between the younger group and the older group(P>0.05).(2)Spearman correlation analysis showed that FESC and HESC were negatively correlated with disease course,age and gastrin-17,and FESC was negatively correlated with uric acid and systolic blood pressure(P<0.05).FASYM was positively correlated with age,gastrin-17 and systolic blood pressure,and HASYM was positively correlated with the disease course and gastrin-17.In general,gastrin-17 level was negatively correlated with FESC and HESC(r=-0.261,-0.309),and positively correlated with FASYM and HASYM(r=0.193,0.140)(P<0.05).(3)Multivariate stepwise linear regression analysis showed that the course of disease and gastrin-17 were the common influencing factors for FESC and HESC,systolic blood pressure and uric acid were the influencing factors for FESC.Conclusion(1)The level of serum gastrin-17 in diabetic patients with peripheral autonomic neuropathy tends to increase,but significantly increased only in severe peripheral autonomic neuropathy group,so the value of serum gastrin-17 in screening early peripheral autonomic neuropathy is limited.(2)The level of serum gastrin-17 increases significantly in patients with severe peripheral autonomic neuropathy,which can be used as one of the screening methods.Similarly,the level of gastrin-17 in diabetic patients complicated with severe peripheral autonomic neuropathy is affected,so it is necessary to pay attention to the disorder of gastrointestinal hormones and the disturbance of gastrointestinal function in clinical.(3)The abnormal increase of serum gastrin-17 level may be involved in the occurrence and development of peripheral autonomic neuropathy in patients with diabetes,which needs to provide appropriate treatments.