Oxidative stress and diabetic neuropathy: a new understanding of an old problem.
Oxidative stress and diabetic neuropathy: a new understanding of an old problem.
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DOI：
10.1172/jci17862
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发表时间：
2003-02
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影响因子：
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通讯作者：
E. Feldman
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文献类型：
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作者：
E. Feldman
糖尿病在西方世界已达到流行病的程度。在美国，有 1700 万人患有糖尿病，占总人口的 6% 以上 (1)。糖尿病的发病率和死亡率是由于大血管和微血管并发症的发生造成的 (2)。糖尿病患者的大血管并发症（包括心肌梗塞、中风和大血管周围血管疾病）的发生率是糖尿病患者的 2 至 4 倍。大血管并发症的潜在共同因素是糖尿病加速动脉粥样硬化形成的能力。动脉粥样硬化是血管对损伤的多因素反应。糖尿病中常见的胰岛素抵抗和血脂水平升高是动脉粥样硬化损伤的主要诱因 (3)。糖尿病动脉内皮也更容易发生动脉粥样硬化损伤，这可能是由于内皮一氧化氮（已知具有抗动脉粥样硬化作用）的产生减少以及纤溶酶原激活剂抑制剂-1 (PAI-1) 的产生增加 (4)。虽然大血管并发症在糖尿病患者中很常见，但糖尿病特有的微血管并发症最终将影响几乎所有糖尿病患者。糖尿病视网膜病变是美国成人失明的最常见原因。 90% 的糖尿病患者在发病后 15 年内出现视网膜病变的证据，每年报告大约 25,000 例新的糖尿病相关失明病例 (5)。在美国，糖尿病也是肾衰竭的主要原因，占每年新发病例的 40% (6)。超过一半的糖尿病患者会出现神经病变，神经逐渐恶化，导致周围神经和自主神经功能障碍。因此，糖尿病神经病变是非创伤性截肢和自主神经衰竭的最常见原因 (7, 8)。患有神经病变的糖尿病患者一生中有 15% 的机会接受一次或多次截肢 (9)。
Diabetes has reached epidemic proportions in the Western world. In the United States, 17 million individuals have diabetes, greater than 6% of the population (1). The morbidity and mortality of diabetes is due to the development of both macrovascular and microvascular complications (2). Macrovascular complications including myocardial infarction, stroke, and large vessel peripheral vascular disease are 2 to 4 times more prevalent in individuals with diabetes. The underlying common factor in macrovascular complications is the ability of the diabetic condition to accelerate atherogenesis. Atherogenesis is a multifactorial response of vessels to injury; both insulin resistance and elevated lipid levels, common in diabetes, are primary triggers of atherogenic injury (3). The endothelium in diabetic arteries is also more prone to atherogenic injury, likely due to decreased production of endothelial nitric oxide, known to be antiatherogenic, and increased production of plasminogen activator inhibitor-1 (PAI-1) (4). While macro-vascular complications are common among diabetics, diabetes-specific microvascular complications will eventually affect nearly all individuals with diabetes. Diabetic retinopathy is the most common cause of adult blindness in the United States. Ninety percent of diabetics present evidence of retinopathy within 15 years of disease onset and approximately 25,000 new cases of diabetes-related blindness are reported per year (5). Diabetes is also the leading cause of renal failure in the United States, accounting for 40% of new cases each year (6). Greater than half of all patients with diabetes develop neuropathy, a progressive deterioration of nerves resulting in peripheral and autonomic nerve dysfunction. As a result, diabetic neuropathy is the most common cause of nontraumatic amputations and autonomic failure (7, 8). In his or her lifetime, a diabetic patient with neuropathy has a 15% chance of undergoing one or more amputations (9).