Advanced diabetic neuropathy: A point of no return?
Advanced diabetic neuropathy: A point of no return?
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DOI：
10.1900/rds.2006.3.143
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发表时间：
2006-09-01
影响因子：
--
通讯作者：
Boucek, Petr
中科院分区：
文献类型：
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作者：
Boucek, Petr
糖尿病周围神经病变是长期糖尿病最常见的并发症，经常导致临床显著的并发症，如疼痛、足部溃疡和截肢。在其自然过程中，它从最初的功能变化发展到晚期的、难以逆转的结构变化。基于代谢和血管因素，人们提出了各种相互关联的糖尿病神经病变发病概念，这些概念大多源于长期高血糖。这些发病机制已经在一些实验和临床试验中得到了明确的定位。这篇综述总结了现有的主要形态学数据，这些数据主要来自旨在阻止糖尿病神经病变进展或实现逆转的干预措施，包括通过胰腺或胰岛移植恢复正常血糖，通过醛糖还原酶抑制剂阻断多元醇途径，通过使用抗氧化剂减轻氧化应激或纠正必需脂肪酸代谢异常。不幸的是，到目前为止，没有基于致病因素的治疗显示出明确的积极作用，因此，早期建立最佳血糖控制仍然是预防或阻止糖尿病神经病变进展的唯一有效措施。显然需要采用客观可重复参数的进一步实验和临床研究。新的无创或微创方法，如角膜共聚焦显微镜或表皮神经纤维计数，可能是客观评估神经损伤和监测治疗效果的潜在有用工具。
Diabetic peripheral neuropathy is the most common complication of long-standing diabetes mellitus which frequently results in clinically significant morbidities e.g. pain, foot ulcers and amputations. During its natural course it progresses from initial functional changes to late, poorly reversible, structural changes. Various interconnected pathogenetic concepts of diabetic neuropathy have been proposed based on metabolic and vascular factors, mostly derived from long-term hyperglycemia. These pathogenetic mechanisms have been targeted in several experimental and clinical trials. This review summarizes available, mainly morphological data from interventions designed to halt the progression or achieve the reversal of established diabetic neuropathy, which include the recovery of normoglycemia by pancreas or islet transplantation, polyol pathway blockade by aldose reductase inhibitors, mitigation of oxidative stress by the use of antioxidants or correction of abnormalities in essential fatty acid metabolism. Unfortunately, to date, no treatment based on pathogenic considerations has shown clear positive effects and thus early institution of optimal glycemic control remains the only available measure with proven efficacy in preventing or halting progression of diabetic neuropathy. Further experimental and clinical research employing objective reproducible parameters is clearly needed. Novel noninvasive or minimally invasive methods e.g. corneal confocal microscopy or epidermal nerve fiber counts may represent potentially useful instruments for the objective assessment of nerve damage and monitoring of treatment effects.