Корелација меѓу плазма-концентрациите на тумор-некротичниот фактор алфа и степенот на оштетување на периферните нерви кај дијабетес мелитус тип 2

Abstract

Introduction: Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes mellitus. DPN denotes that presences of people with diabetes have symptoms and / or signs of peripheral nerve damage, excluding all other causes of neuropathy. In the first years of diabetes, neuropathies develops about 5-10% of the patients, and after 20 years the duration of diabetes is thought to be about 60-70% of the patients develop some of the forms of diabetic peripheral neuropathy. The pathophysiology of DPN has not been fully clarified yet, since diabetes causes a functional deficiency of nitric monoxide, the activation of alternative metabolic pathways, the accumulation of end products of glycation, oxidative stress, and inflammation by activating pro-inflammatory molecules. Chronic hyperglycaemia leads to increased secretion of tumor necrosis factor-alpha (TNF-α), with consequent development of micro and macroangiopathy, damage of nerve fibers and local demyelination. Research goals: The main goal of the study is to determine the connection of TNF-α with the degree and severity of a neurogenic lesion in diabetic peripheral neuropathy. Material and Methods: In the study, the total number of 80 examinees, men and women, were divided into two groups: an examined group (n = 50) consisting of subjects with symptomatology of DPN, between the ages from 30 to 80 and a control group (n = 30 ) of healthy subjects, aged from 18 to 45 years. It was performed a clinical and neurological examination for the examinees from the investigated group, and the severity of the clinical picture and the degree of damage to the peripheral nerves were assessed using the Diabetic neuropathy symptom score (DNS scale) and electrophysiological investigations-electroneurography and electromyography. From all subjects in the study (n = 80) blood samples were taken to determine the concentration of TNF-α by the ELISA method. Results: The average value of the TNF-α blood plasma sample of the test group (n = 50) was 8.24 ± 2.899 pg / ml, while the control group (n = 30) was 4.36 ± 2.622 pg /ml <0.0001). Based on the clinical presentation in the investigated group (n = 50), four forms of DPN were registered: 29 examinees (58%) had senso-motor peripheral neuropathy, sensory neuropathy had 11 examinees (22%), senso- motor and autonomic neuropathy manifested 6 subjects (12%), while 4 subjects (8%) had cranial neuritis. Regarding the DNS connection, the score with the type of DPN found a statically significant difference at the level p = 0.0244. Regarding the DNS connection, the score with the type of DPN found a statically significant difference at the level p = 0.0244. Regarding the linear association of the concentration of TNF-α with the peripheral nerve conduction velocity in the investigated group, no statistical significance of the Pearson correlation coefficient r was detected in any of the motor and sensory nerves conduction velocity. Conclusion: Higher concentrations of TNF-α were detected in patients with DPN compared to healthy subjects. The clinical type of DPN influenced the concentrations of TNF-α in a sample of blood plasma, especially in the subjects with autonomic nervous system and cranial nerve involvement. These respondents also had higher DNS score values. DNS score, and thus the clinical picture does not depend on the average values of the motor and sensory velocities of peripheral nerve conduction, nor of the type of neurogenic lesion. Also, no DNS score was found with the average duration of diabetes mellitus, nor with the sex and age of the examinees.