实用老年医学

实用老年医学 ›› 2025, Vol. 39 ›› Issue (12): 1228-1232.doi: 10.3969/j.issn.1003-9198.2025.12.008

• 临床研究 • 上一篇    下一篇

血糖波动与神经损伤标志物联合预测老年糖尿病周围神经病变的临床价值

张海虹, 葛飞, 于红梅   

  1. 226600 江苏省南通市,扬州大学医学院海安临床学院(海安市中医院)老年病科(张海虹,于红梅);
    214043 江苏省无锡市,无锡市第二人民医院中医科(葛飞)
  • 收稿日期:2025-05-27 发布日期:2025-12-26
  • 通讯作者: 葛飞,Email:ha9099@163.com
  • 基金资助:
    江苏省卫生健康委医学科研项目(Z2022048)

Predictive value of glucose fluctuation combined with nerve injury markers for peripheral neuropathy in elderly patients with type 2 diabetes mellitus

ZHANG Haihong, GE Fei, YU Hongmei   

  1. Department of Geriatrics, Haian Clinical College, Yangzhou University Medical College (Hai′an City Traditional Chinese Medicine Hospital), Nantong 226600, China (ZHANG Haihong, YU Hongmei);
    Department of Chinese Traditional Medicine, the Second People’s Hospital of Wuxi, Wuxi 214043, China (GE Fei)
  • Received:2025-05-27 Published:2025-12-26
  • Contact: GE Fei, Email:ha9099@163.com

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摘要： 目的 探讨血糖波动参数与神经损伤标志物对老年T2DM患者并发糖尿病周围神经病变(DPN)的联合预测价值。 方法 采用病例对照研究设计,选取2021年4月至2024年9月在海安市中医院就诊的老年T2DM合并DPN患者158例为病例组,另选取院内同期接受治疗的无DPN的老年T2DM患者158例作为对照组。收集并比较2组的临床资料,采用多因素logistic回归分析筛选DPN的独立影响因素,并在此基础上构建风险预测模型。 结果 病例组HbA1c、日间血糖波动幅度(DMMG)、髓鞘碱性蛋白(MBP)水平高于对照组(P＜0.05),葡萄糖目标范围内时间(TIR)低于对照组(P＜0.05)。多因素logistic回归分析显示,HbA1c(OR=3.340,95%CI:1.499～7.441)、DMMG(OR=3.725,95%CI:1.672～8.298)、MBP(OR=4.166,95%CI:1.869～9.277)是老年T2DM患者并发DPN的独立危险因素,TIR(OR=0.334,95%CI:0.150～0.745)是保护因素。基于上述指标构建的风险预测模型,其ROC曲线下面积为0.783(95%CI:0.686～0.880),灵敏度为85.01%,特异度为76.93%。 结论 HbA1c、DMMG、MBP、TIR与老年T2DM患者DPN的发生密切相关,四者联合构建的预测模型具有较好的判别效能,可为早期识别高危人群提供参考。

关键词: 老年人, 2型糖尿病, 周围神经病变, 影响因素, 预测模型

Abstract: Objective To explore the clinical value of glucose fluctuation combined with nerve injury markers in predicting peripheral neuropathy in the elderly patients with type 2 diabetes mellitus (T2DM). Methods In this case-control study, 158 elderly T2DM patients with peripheral neuropathy (case group) and 158 elderly T2DM patients without peripheral neuropathy (control group) were selected from Hai’an Traditional Chinese Medicine Hospital from April 2021 to September 2024. The clinical data of the two groups were compared, and the independent influencing factors for peripheral neuropathy in elderly T2DM patients were analyzed by logistic regression analysis, and a risk prediction model was subsequently constructed. Results The levels of glycosylated hemoglobin (HbA1c), diurnal maximum-minimum glucose (DMMG), and myelin basic protein (MBP) were significantly higher, while the time in range (TIR) was significantly lower in the case group compared to the control group (all P<0.05). Multivariate logistic regression analysis showed that HbA1c (OR=3.340, 95%CI: 1.499－7.441), DMMG (OR=3.725, 95%CI: 1.672－8.298), and MBP (OR=4.166, 95%CI: 1.869－9.277) were risk factors for peripheral neuropathy in elderly T2DM patients (P <0.05), while TIR (OR=0.334, 95%CI: 0.150－0.745) was a protective factor (P<0.05). The risk prediction model integrating these four factors achieved an area under the receiver operating characteristic (AUC) curve of 0.783 (95%CI: 0.686－0.880), with a sensitivity of 85.01%, and a specificity of 76.93%. Conclusions HbA1c, DMMG, MBP, and TIR are related to the occurrence of peripheral neuropathy in elderly T2DM patients. The prediction model combining these indicators demonstrates good discriminatory ability and may aid in the early identification of high-risk individuals.

Key words: aged, type 2 diabetes mellitus, peripheral neuropathy, risk factor, risk model

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