The significance of neutrophil/lympocyte ratio and platelet/lymphocyte ratio in predicting diabetic polyneuropathy and neuropathic pain severity as inflammatory factors

Ideggyogy Sz. 2023 Nov 30;76(11-12):408-414. doi: 10.18071/isz.76.0408.


Background and purpose: <p>Neuropathic pain may appear as one of the first symptoms that take the patient to the physician in type 2 diabetes, which can be asymptomatic for years. Although it is accepted that diabetes is a trigger for vascular inflammation, it has been suggested that inflammation itself may trigger diabetes. In our study, we aimed to investigate the relationship between diabetic polyneuropathy and neuropathic pain and inflammatory markers.</p>.

Methods: <p>The study included 44 healthy controls, 46 diabetic patients with normal electroneuromyography (ENMG) and 44 diabetic patients with polyneuropathy detected in ENMG. Sedimentation, C-reactive protein (CRP), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLO) and mean platelet volume (MPV) values were recorded in the sera of the patients. The Douleur Neuropathic 4 (DNP4) Questions was used to evaluate the presence of neuropathic pain in the patients, and the Visual Analogue Scale (VAS) was used to evaluate the severity of pain.</p>.

Results: <p>NLR, CRP, sedimentation levels were statistically significantly higher in the DMP+ and DMP&ndash; patient groups compared to the control group. PLO and MPV levels were significantly higher in the DMP+ patient group compared to both the DMP&ndash; patient group and the control group.&nbsp;<br>The means of VAS and DN4 scores were statistically significantly higher in the DMP+ patient group than in the DMP&ndash; patient group. In the DMP&ndash; patient group, the NLR levels of those with neuropathic pain according to the DN4 scale were statistically significantly higher than those without neuropathic pain.</p>.

Conclusion: <p>Diabetic neuropathy is one of the common complications of diabetes, affecting about half of patients. Our study shows that NLR, PLO, MPV values can be used as parameters to help us make an easy and fast diagnosis in diabetic polyneuropathy. However, their reliability in the diagnosis of diabetic polyneuropathy should be evaluated with studies to be conducted with larger patient and control groups.</p>.

Background and purpose: <p>A neuropathi&aacute;s f&aacute;jdalom az egyik első t&uuml;net lehet, ami orvoshoz viszi a beteget 2-es típus&uacute; cukorbetegs&eacute;gben, ami &eacute;vekig t&uuml;netmentes lehet. B&aacute;r elfogadott, hogy a cukorbetegs&eacute;g &eacute;rrendszeri gyullad&aacute;st kiv&aacute;lt&oacute; t&eacute;nyező, felmer&uuml;lt, hogy maga a gyullad&aacute;s is kiv&aacute;lthatja a cukorbetegs&eacute;get. Tanulm&aacute;nyunkban a diabeteses polyneuropathia &eacute;s a neuropathi&aacute;s f&aacute;jdalom, valamint a gyullad&aacute;sos markerek k&ouml;z&ouml;tti kapcsolat vizsg&aacute;lat&aacute;t tűzt&uuml;k ki c&eacute;lul.</p>.

Methods: <p>A vizsg&aacute;latba 44 eg&eacute;szs&eacute;ges kontroll, 46 diabeteses beteg norm&aacute;lis elek&shy;troneuromiogr&aacute;fi&aacute;s (ENMG) lelettel &eacute;s 44, ENMG-vel kimutatott polyneuropathi&aacute;s diabeteses beteg ker&uuml;lt bevon&aacute;sra. A betegek sz&eacute;rum&aacute;b&oacute;l a szediment&aacute;ci&oacute;, a C-reaktív feh&eacute;rje (CRP), a neutrophil-lymphocyta ar&aacute;ny (NLR), a thrombocyta-lymphocyta ar&aacute;ny (PLO) &eacute;s az &aacute;tlagos thrombocyta-t&eacute;rfogat (MPV) &eacute;rt&eacute;keit r&ouml;gzített&uuml;k. A betegekn&eacute;l a neu&shy;ropathi&aacute;s f&aacute;jdalom jelenl&eacute;t&eacute;nek &eacute;rt&eacute;ke&shy;l&eacute;s&eacute;re a Douleur Neuropathic 4 (DNP4) K&eacute;r&shy;dő&shy;ívet haszn&aacute;ltuk, míg a f&aacute;jdalom s&uacute;lyoss&aacute;g&aacute;nak &eacute;rt&eacute;kel&eacute;s&eacute;re a vizu&aacute;lis anal&oacute;g sk&aacute;l&aacute;t (VAS).</p>.

Results: <p>Az NLR, a CRP &eacute;s a s&uuml;llyed&eacute;s szintje statisztikailag szignifik&aacute;nsan magasabb volt a DMP+ &eacute;s a DMP&ndash; betegcsoportban, mint a kontrollcsoportban. A PLO- &eacute;s MPV-szintek szignifik&aacute;nsan magasabbak voltak a DMP+ betegcsoportban mind a DMP&ndash; betegcsoporthoz, mind a kontrollcsoporthoz k&eacute;pest.&nbsp;<br>A VAS- &eacute;s a DN4-pontsz&aacute;mok k&ouml;z&eacute;p&eacute;rt&eacute;kei statisztikailag szignifik&aacute;nsan magasabbak voltak a DMP+ betegcsoportban, mint a DMP&ndash; betegcsoportban. A DMP&ndash; betegcsoportban a DN4-sk&aacute;la szerint neuropathi&aacute;s f&aacute;jdalomban szenvedők NLR-szintje statisztikailag szignifik&aacute;nsan magasabb volt, mint a neuropathi&aacute;s f&aacute;jdalomban nem szenvedők&eacute;.</p>.

Conclusion: <p>A diabeteses neuropathia a cukorbetegs&eacute;g egyik gyakori sz&ouml;vődm&eacute;nye, a betegek mintegy fel&eacute;t &eacute;rinti. Vizsg&aacute;latunk azt mutatja, hogy az NLR-, PLO- &eacute;s MPV-&eacute;r&shy;t&eacute;kek segíts&eacute;g&eacute;vel k&ouml;nnyen &eacute;s gyorsan fel&shy;&aacute;llíthat&oacute; a diabeteses polyneuropathia diagn&oacute;zisa. Mindazon&aacute;ltal, ezen &eacute;rt&eacute;kek meg&shy;bízhat&oacute;s&aacute;g&aacute;t a diabeteses poly&shy;neu&shy;ro&shy;pathia diagn&oacute;zis&aacute;ban nagyobb beteg- &eacute;s kont&shy;rollcsoportokon elv&eacute;gzendő vizsg&aacute;latokkal kell &eacute;rt&eacute;kelni.</p>.

Keywords: diabetic peripheral neuropathy; neuropathic pain; neutrophil- lymphocyte ratio (NLR); platelet-lymphocyte ratio (PLO).

MeSH terms

  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism
  • Diabetes Mellitus, Type 2* / complications
  • Diabetic Neuropathies* / diagnosis
  • Diabetic Neuropathies* / etiology
  • Humans
  • Inflammation / complications
  • Lymphocytes
  • Neuralgia* / diagnosis
  • Neuralgia* / etiology
  • Neutrophils
  • Reproducibility of Results


  • C-Reactive Protein