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目的 探讨老年 2型糖尿病 (DM)患者周围神经病变 (DPN)与血清抗神经节苷脂 (GS)抗体之间的关系。 方法 受试者分为 3组 ,DPN组 32例 ,DM组 2 5例 ,对照组 30例。采用美国NicoletVikingⅣ型肌电图仪测定神经传导速度 ,固相酶免法测定各组抗GSIgM抗体、抗GSIgG抗体 ,同时测定白细胞介素 1β(IL 1β)、白细胞介素 2 (IL 2 )、肿瘤坏死因子 (TNF α)、糖化血红蛋白 (HbA1C)、一氧化氮 (NO)。 结果 DPN组患者抗GSIgM抗体、抗GSIgG抗体的阳性率分别为 6 5 6 %和 34 4% ,显著高于DM组及对照组 (P <0 0 1)。DPN组抗GSIgM抗体与糖尿病神经病变临床分级 (DPNC)、HbA1C、IL 1β、TNF α和NO呈显著正相关 ,而与病程及IL 2呈显著负相关 ;抗GSIgG抗体与DPNC呈显著正相关。逐步回归分析 ,对抗GSIgM抗体有显著作用的因素依次为DPNC、NO、IL 1β ,对抗GSIgG抗体有显著作用的因素为DPNC。 结论 抗GS抗体的检测可作为了解DPN自身免疫介导损伤的一项免疫学指标 ,对DPN的诊断及病情的判断有参考价值。
Objective To investigate the relationship between peripheral neuropathy (DPN) and serum anti-ganglioside (GS) antibody in elderly patients with type 2 diabetes mellitus (DM). Methods The subjects were divided into three groups: 32 cases in DPN group, 25 cases in DM group and 30 cases in control group. NicoletViking Ⅳ electromyography was used to measure the nerve conduction velocity. The anti-GSIgM and anti-GSIgG antibodies of each group were measured by enzyme-linked immunosorbent assay. The levels of IL-1β, IL 2, Necrosis factor (TNFα), HbA1C, NO. Results The positive rates of anti-GSIgM antibody and anti-GSIgG antibody in patients with DPN were 65.6% and 34.4%, respectively, which were significantly higher than those in DM group and control group (P <0.01). The anti-GSIgM antibody in DPN group was significantly and positively correlated with diabetic nephropathy clinical grade (DPNC), HbA1C, IL1β, TNFα and NO, but negatively correlated with the course of disease and IL2. Anti-GSIgG antibody was positively correlated with DPNC. Stepwise regression analysis showed that DPNC, NO and IL 1β were the most effective anti-GSIgM antibodies and DPNC was the most effective anti-GSIgG antibody. Conclusion The detection of anti-GS antibody can be used as an immunological index to understand the autoimmune-mediated damage of DPN, which has reference value for the diagnosis of DPN and the judgment of disease.