Diabetes：糖尿病神经病变的潜在生物标志物

近日，新南威尔士大学研究人员发表论文证实：新发现的生物标志物可能最终有助于糖尿病的新治疗方法诞生。

研究人员表示：糖尿病患者病变的早期诊断和识别一直是个难题。据估计高达50％的糖尿病患者出现神经损伤。

研究人员对比分析研究了无神经病变的糖尿病患者和有神经病变糖尿病患者之间的神经兴奋性，结果发现神经病变糖尿病患者并没有出现不可逆的神经损伤，但在临床症状出现前仍可表现出兴奋异常。

这项研究由新南威尔士大学医学博士Cindy Lin带领，并发表在Diabetes杂志上。

Matthew Kiernan教授说：这项研究可能会导致新的治疗手段用于治疗糖尿病周围神经病变患者早期症状。

doi:10.2337/db11-1509
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Progressive Axonal Dysfunction Precedes Development of Neuropathy in Type 2 Diabetes

Jia-Ying Sung, Susanna B. Park, Ya-Ting Liu, Natalie Kwai, Ria Arnold, Arun V. Krishnan and Cindy S.-Y. Lin

To evaluate the development of diabetic neuropathy, the current study examined changes in peripheral axonal function. Nerve excitability techniques were undertaken in 108 type 2 diabetic patients with nerve conduction studies (NCS), HbA_1c levels, and total neuropathy score (TNS). Patients were categorized into two cohorts: patients with diabetes without neuropathy (DWN group [n = 56]) and patients with diabetes with neuropathy (DN group [n = 52]) and further into severity grade 0 (TNS 0–1 [n = 35]), grade 1 (TNS 2–8 [n = 42]), and grade 2/3 (TNS 9–24 [n = 31]). Results revealed that the DWN group had a significantly increased threshold, prolonged latency, and changes in excitability parameters compared with age-matched control subjects. Patients with neuropathy demonstrated significant alteration in recovery cycle parameters and depolarizing threshold electrotonus. Within the DWN cohort, there were significant correlations between HbA_1c level and latency and subexcitability, whereas the estimated glomerular filtration rate correlated with superexcitability in patients with neuropathy. Furthermore, excitability parameters became progressively more abnormal with increasing clinical severity. These results suggest a spectrum of excitability abnormalities in patients with diabetes and that early axonal dysfunction may be detected prior to the development of neuropathy. As progressive changes in excitability parameters correlated to neuropathy severity, excitability testing may provide a biomarker of the early development and severity of diabetic neuropathy, providing insights into the pathophysiological mechanisms producing axonal dysfunction.