Tip 2 Diyabetik Vakalarda Ortalama Trombosit Hacmi (MPV) Düzeyleri İle Diyabetik Periferik Nöropati İlişkisi

Öz

Amaç: Çalışmamızda Tip 2 diyabetli hastalarda, MPV değeriyle, diyabetin mikrovasküler bir komplikasyonu olan nöropati arasındaki ilişkiyi araştırmayı hedefledik.

Materyal ve Metot:Retrospektif çalışmamıza, iç hastalıkları polikliniklerimize başvuran tip 2 diyabetik hasta dosyaları değerlendirilerek, fizik muayene, elektrofizyolojik çalışma verileri, anamnez ve tetkik kayıtları incelenerek, diyabetik nöropatisi olan ve olmayan iki grup diyabetik hasta belirlendi. Bilinen kardiyovasküler, hematolojik, onkolojik hastalık, karaciğer ve böbrek hastalığı, akut veya kronik infeksiyon hastalığı, yakında geçirilmiş travma, cerrahi öyküsü olan vakalar çalışmaya dahil edilmedi. Vakaların istatistiksel değerlendirmesi SPSS 21 yazılım programı ile yapıldı.

Bulgular:Yaşları 31-76 arasında değişen 39'u (25 kadın, 14 erkek) diyabetik periferik nöropatili, 44’ü (27 kadın, 17 erkek) ise nöropatisiz  toplam 83 diyabetik vaka çalışmaya alındı. Nöropatisi olmayan vakaların ortalama yaşları 57,89±8,8 (31-75), A1c % 7,3 (5,5-12,7), açlık kan şekeri 144 mg/dl (80-326), trombosit sayısı 260.800±68,900/mm3, MPV değeri 8,96±0,67 fl (7,6-10,4) idi. Nöropatik vakaların ortalama yaşları 56,54±8,4 (37-76), A1c % 8,3 (5,6-14,4), açlık kan şekeri 184 (100-432) mg/dl, trombosit sayısı 269.050±74.195/mm3, MPV değeri 9,03 ± 0,75 (7,4-10,5) idi. Gruplar arasında yaş (p=0,482), trombosit sayısı (P=0,601), BKİ (p=0,299), MPV (p=0,596) ve A1c (p=0,076) değerleri açısından anlamlı fark yokken, diyabet yaşı (p=0,002) ve açlık kan şekeri (p=0,04) açısından istatistiksel anlamlı fark mevcuttu. Spearman korelasyon analizinde MPV düzeyi ile nöropati gelişimi arasında istatistiki anlamlılığa ulaşan bir ilişki bulunamadı (p=0,599). 

Sonuç: Tip 2 diyabetli 83 hasta ile yaptığımız çalışmamızda, MPV ile nöropati gelişimi arasında herhangi bir ilişki saptayamadık. Bu ilişkiyi daha iyi aydınlatabilmek için daha fazla vaka ile çok merkezli ve prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• MPV,Diyabetik nöropati,Tip 2 DM

The relationship between diabetic peripheral neuropathy and MPV (Mean Platelet Volume) values in patients with type 2 diabetes mellitus

Abstract

Objective: We aimed at this study to evaluate the relationship between diabetic peripheral neuropathy which is a microvascular complication of diabetes and MPV values in type 2 diabetes mellitus patients.

Material and Method: We investigated the data of type 2 diabetic patients admitted to our internal medicine out-patient clinics retrospectively. The data was divided as two groups (patients with and without diabetic peripheral neuropathy) according to their history, physical examination, laboratory results and electro-physiological study results. The patients with a known cardiovascular, hematological, oncological, hepatic, renal, acute or chronic infectious disease or a recent history of trauma and surgery were excluded from the study. Statistical analysis was studied by SPSS 21 soft-ware statistics programme.

Results: We included 83 diabetic patients that 39 of them were patients with diabetic neuropathy (25 women, 14 men) and 44 (27 women, 17 men) were without diabetic peripheral neuropathy. Their ages were between 31 and 76. While the means of non-neuropathic group for the age was 57,89±8,8 (31-75), A1c   7,3 % (5,5-12,7), fasting plasma glucose 144 mg/dl (80-326), platelet counts  260.800±68,900/mm³, MPV value 8,96±0,67 fl (7,6-10,4); the means of neuropathic group were 56,54±8,4 (37-76) years, 8,3 (5,6-14,4) %, 269.050±74.195/mm³ and 9,03 ± 0,75 (7,4-10,5) fl respectively. There were no statistically significant differences between two groups in terms of age (p=0,482), platelet count (p=0,601), body mass index (p=0,299), MPV (p=0,596) and A1c (p=0,076). But statistically significant differences were found between groups in terms of diabetes age (p=0,002) and fasting plasma glucose (p=0,04). A statistically significant correlation was not found between MPV value and neuropathy existence by Spearman correlation analysis (p=0,599).

Conclusion: We did not found any correlation between MPV value and neuropathy development in these 83 type 2 diabetic patients in our study. We think that to clarify this relationship certainly, we need a prospective, multi-centered study with a bigger cohort.

Keywords

• DM,Diabetic neuropathy,MPV

References

1. 1. Boulton AJ, Vinik AI, Arezzo JC, et al. American Diabetes Association: Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care, 2005, 28: 956–962. [PubMed]
2. 2. Liu Y, Liu SX, Cai Y, et al. : Effects of combined aerobic and resistance training on the glycolipid metabolism and inflammation levels in type 2 diabetes mellitus. J Phys Ther Sci, 2015, 27: 2365–2371.[PMC free article] [PubMed]
3. 3. Norgaz T, Hobikoglu G, Aksu H, et al. The relationship between preprocedural platelet size and subsequent in-stent restenosis Acta Cardiol 2004;59:391-395
4. 4 Hekimsoy Z, Payzin B, Ornek T, Kandogan G. Mean platelet volume in Type 2 Diabetic patients. J Diabetes Complications 2004;18:173-6.
5. 5. Varol E, Akcay S, Ozaydin M, Erdogan D, Dogan A, Altinbas A. Mean platelet volume is associated with insulin resistance in non-obese, nondiabetic patients with coronary artery disease. J Cardiol 2010;56:154-8
6. 6. Varol E, Akcay S, Icli A, et al. Mean platelet volume in patients with prehypertension and hypertension. Clin Hemorheol Microcirc 2010;45:67-72.
7. 7. Coban E, Afacan B. The effect of rosuvastatin treatment on the mean platelet volume in patients with uncontrolled primary dyslipidemia with hypolipidemic diet treatment. Platelets 2008;19:111-4.
8. 8. Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects. Singapore Med J. 2008;49:114–116. [PubMed]

9. 9. Callaghan BC, Price RS, Chen KS, et al. : The importance of rare subtypes in diagnosis and treatment of peripheral neuropathy: a review. JAMA Neurol, 2015, 72: 1510–1518. [PMC free article] [PubMed]
10. 10. Han D: Retrogression of nervous fibers according to the age of patients with Diabetes Mellitus (DM). J Phys Ther Sci, 2013, 25: 1063–1066. [PMC free article] [PubMed]
11. 11. Schreiber, A. K., Nones, C. F., Reis, R. C., Chichorro, J. G., & Cunha, J. M. (2015). Diabetic neuropathic pain: Physiopathology and treatment. World journal of diabetes, 6(3), 432-44.
12. 12. El Haouari M, Rosado JA. Platelet signalling abnormalities in patients with type 2 diabetes mellitus: a review. Blood Cells Mol Dis. 2008;41:119–123. [PubMed]
13. 13. Reardon W, Ross RJM, Sweeny MG. Diyabetes mellitus associated with a patogenic point mutation in mitocondrial DNA. Lancet. 1992; 340: 1376-9.
14. 14. Yıldırım Ş, Kalkan İH, Yılmazer TT, Tüzün D, Suher M. Tip 2 Diabetes Mellituslu Olgularda Hipertansiyon ve Diabetik Mikrovasküler komplikasyonlarla Ortalama Trombosit Hacmi İlişkisi. M N Dahili Tıp Bilimleri 2008;3:14-8.
15. 15.Papanas N1, Symeonidis G, Maltezos E, Mavridis G, Karavageli E, Vosnakidis T, Lakasas G. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets. 2004 Dec;15(8):475-8
16. 16. N. Papanas1, G. Mavrıdıs2, E. Karavagelı, et al. Peripheral neuropathy is associated with increased mean trombosit volume in type 2 Diyabetic patients. Trombosits. 2005; 16 (8): 498–9.
17. 17. Al-Salman RA, Al-Basri HA, Al-Sayyad AS, Hearnshaw HM. Prevalence and risk factors of albuminuria in Type 2 diabetes in Bahrain. J Endocrinol Invest 2009;32:746-51.
18. 18. Zhang HX, Jia LL, Hou XH, et al. Prevalence of and risk factors associated with diabetic retinopathy in pre-diabetic and diabetic population in Shanghai community. Zhonghua Yi Xue Za Zhi 2009;89:1749-52