Diyabetik Polinöropati Şiddeti İle Serum Aterojenite İndeks İlişkisinin Değerlendirilmesi

Öz

Amaç: Diyabet Mellitus (DM) dünya çapında en yaygın metabolik hastalıklardan biridir. DM’nin en sık görülen komplikasyonu diyabetik nöropati (DN), özellikle diyabetik polinöropatidir (DPN). Biz bu çalışmada serum lipid değerlerinin DPN şiddeti üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Hastanesi Elektrofizyoloji Laboratuvarına 2016-2019 tarihleri arasında başvuran ve yapılan elektromiyografi (EMG) incelemesinde diyabetik polinöropati tanısı konulan hastalar retrospektif olarak incelendi. DPN şiddeti elektrofizyolojik olarak hafif, orta, ağır olmak üzere sınıflandırıldı Bulgular: Çalışmamıza diyabetik polinöropati saptanan 131 hasta dahil edildi. Hastaların 68’i kadın 63’ü erkekti. Hastaların yaş ortalaması 64,34±10,9 olarak saptandı. Elektromiyografi sonucunda 131 hastadan 55’inde ağır derecede, 65’inde orta derecede, 11’inde hafif derecede diyabetik polinöropati saptanmıştır. Diyabetik polinöropati şiddeti ile açlık kan şekeri arasında anlamlı farklılık saptandı (p=0,041). Hba1c ve Trigliserid değeri arttıkça diyabetik polinöropati şiddetinin arttığı gözlendi ancak istatistiksel olarak anlamlı değildi. DPN olan ve olmayan hastalar karşılaştırıldığında Trigliserid / HDL kolesterol (TG/HDL-K) oranı yüksek saptanırken (p=0,035), DPN şiddeti açısından değerlendirildiğinde TG/HDL-K oranının ağır şiddette olanlarda yüksek olduğu izlendi, ancak istatistiksel olarak anlamlı saptanmadı. Sonuç: Açlık kan şekeri, Hba1c kontrolü, lipid profilinin düzenlenmesi özellikle DPN den korunma açısından önemlidir. Hasta sayısının yüksek olduğu prospektif planlanmış çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Diyabetik polinöropati
• Serum aterojenite indeks (TG/HDL-K oranı)
• Açlık kan şekeri
• Hba1c

Evaluation of the Relationship Between Severity of Diabetic Polyneuropathy and Atherogenic Index of Plasma

Öz

Aim: Type 2 Diabetes Mellitus is one of the most common metabolic diseases worldwide seen. The most frequent complication of DM is diabetic neuropathy, especially diabetic polyneuropathy. In this study, we aimed to evaluate the effect of serum lipid values on severity of DPN. Material and Methods: Demographic data; including duration of illness and medications of patients with DM diagnosis who applied to Electrophysiology laboratory of Zonguldak Bülent Ecevit University Health Practice and Research Hospital, in between 2016-2019 were recorded. Severity of DPN was electrophysiologically classified as mild, moderate, and high. Results: 131 patients with DPN were included in our study. 68 of the patients were female and 63 were male. The mean age of patients with PNP was determined as 64.34±10.9. It is determined according to the EMG results that of the 131 patients, 55 of them were highly, 65 of them were moderately, and 11 of them were mildly DPN. There was a significant relationship between the severity of DPN and fasting blood glucose (p =0.041). It was observed that as the hba1c and triglyceride levels increased, the severity of DPN increased, but it was not statistically significant. In our study, the risk of developing diabetic PNP was higher in patients with low HDL, high TG/HDL-C ratio. When evaluated in terms of DPN severity, it was observed that the TG / HDL- C ratio was higher in patients with high severity, but it was not statistically significant. Conclusion: Fasting blood sugar, Hba1c control, regulation of lipid profile are particularly necessary for protection of DPN. Prospectively planned studies with a high number of patients are needed.

Anahtar Kelimeler

• diabetic polyneuropathy
• Atherogenic index of plasma (TG/ HDL-C)
• Hba1c
• Fasting blood sugar

Kaynakça

1. Referans1. Fitri A, Sjahrir H, Bachtiar A, Ichwan M, Fitri FI, Rambe AS. Predictive Model of Diabetic Polyneuropathy Severity Based on Vitamin D Level. Open access Macedonian journal of medical sciences 2019 ;7(16): 2626.
2. Referans2. Vinik AI, Nevoret ML, Casellini C, Parson H. Diabetic neuropathy. Endocrinology and Metabolism Clinics 2013; 42(4):747-87.
3. Referans3. Stino AM, Smith AG. Peripheral neuropathy in prediabetes and the metabolic syndrome. Journal of diabetes investigation 2017; 8(5):646-55.
4. Referans4. Soheilykhah S, Rashidi M, Dehghan F, Shojaoddiny-Ardekani A, Rahimi-saghand S. Prevalence of peripheral neuropathy in diabetic patients. Iranian Journal of Diabetes and Obesity 2013; 5(3):107-13.
5. Referans5. Kakrani AL, Gokhale VS, Vohra KV, Chaudhary N. Clinical and nerve conduction study correlation in patients of diabetic neuropathy. J Assoc Physicians India 2014 ;62(1):24-27
6. Referans6. Miric DJ, Kisic BM, Filipovic-Danic S, Grbic R, Dragojevic I, Miric MB,Puhalo-Sladoje D. Xanthine oxidase activity in type 2 diabetes mellitus patients with and without diabetic peripheral neuropathy. Journal of diabetes research 2016. Article ID 4370490, 7 pages.
7. Referans7. Vukojević Z, Pekmezović T, Nikolić A, Perić S, Basta I, Marjanović I, Lavrnić D. Correlation of clinical and neurophysiological findings with healthrelated quality of life in patients with diabetic polyneuropathy. Vojnosanitetski pregled 2014; 71(9), 833-838.
8. Referans8. Pençe HH, Aktaş HŞ. Diyabetik Nöropatisi Olan Kişilerde Monosit/HDL Kolesterol Oranı ile Kardiyovasküler Risk Arasındaki İlişki. Online Türk Sağlık Bilimleri Dergisi 2019; 4(4): 526-538.

9. Referans9. Yıldırım A, Avcı HK, Güngen BD, Yağız O, Saçak Ş, Polat H. Tip 2 Diyabetes Mellitus Tanılı Hastalarda HbA1c Seviyesi ile Distal Simetrik Polinöropati Şiddeti Arasındaki İlişki. Istanbul Medical Journal 2014; 15(3): 175-177.
10. Referans10. Abougalambou SS, Abougalambou AS. Explorative study on diabetes neuropathy among type II diabetic patients in Universiti Sains Malaysia Hospital. Diabetes Metab Syndr 2012; 6: 167-72.
11. Referans11. Ivan T, Vera B. Glycemic control is related to the electrophysiolgy severity of diabetic peripheral sensorimotor polyneuropathy. Diabetes care 1998; 21: 1749-52.
12. Referans12. Joy KNI, Hasan AH, Islam MR, Kalam F, Kabir ML, Habib M, Mohammad QD. Glycemic Control and Clinico-Electrophysiological Severity of Diabetic Polyneuropathy. Journal of National Institute of Neurosciences Bangladesh 2019; 5(2): 177-184.
13. Referans13. Abdelsadek SE, El Saghier EO, Raheem SIA. Serum 25 (OH) vitamin D level and its relation to diabetic peripheral neuropathy in Egyptian patients with type 2 diabetes mellitus. The Egyptian journal of neurology, psychiatry and neurosurgery 2018; 54(1): 36.
14. Referans14. Atmaca M, Dilek İ, Atmaca B, Dülger AC, Taşdemir E. Yeni Tanı Tip 2 Diabetes Mellituslu Hastalarda Mikrovasküler Komplikasyonların Görülme Sıklığı. Van Tıp Dergisi 2010; 17(4):124-130.
15. Referans15. Katulanda P, Ranasinghe R, Jayawardena R, Constantine GR, Sheriff MHR and Matthews DR. The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country. Diabetology Metabolic Syndrome 2012;4(21):78-86.
16. Referans16. .Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A; KORA Study Group. Prevalence of polyneuropathy in pre-diabetes and diabetes is associated with abdominal obesity and macroangiopathy: the MONICA/KORA Augsburg Surveys S2 and S3. Diabetes Care 2008; 31: 464-469.
17. Referans17. Mao F, Zhu X, Liu S, Qiao X, Zheng H, Lu B, Li, Y. Age as an Independent Risk Factor for Diabetic Peripheral Neuropathy in Chinese Patients with Type 2 Diabetes. Aging and disease 2019; 10(3): 592-600.
18. Referans18. Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Current diabetes reports 2019; 19(10), 86.
19. Referans19. Babic N, Valjevac A, Zaciragic A, Avdagic N, Zukic S, Hasic S. The Triglyceride/HDL Ratio and Triglyceride Glucose Index as Predictors of Glycemic Control in Patients with Diabetes Mellitus Type 2. Medical Archives 2019; 73(3): 163-168.
20. Referans20. Söğüt E, Avcı E, Üstüner F, Arıkan E. Serum aterojenite indeksi olarak (TG/HDL-K) oranının değerlendirilmesi. Türk Klinik Biyokimya Derg. 2006; 4: 1-8.
21. Referans21. Li Z, Huang Q, Sun L, Bao T, Dai Z. Atherogenic index in type 2 diabetes and its relationship with chronic microvascular complications. International journal of endocrinology 2018; Article ID 1765835, 9 pages.