Vascular risk factors and diabetic neuropathy
Vascular risk factors and diabetic neuropathy
复制标题
DOI：
10.1056/nejmoa032782
复制
发表时间：
2005-01-27
影响因子：
158.5
通讯作者：
Fuller, JH
中科院分区：
文献类型：
--
作者：
Tesfaye, S;Chaturvedi, N;Fuller, JH
背景：除了控制血糖外，糖尿病性神经病变没有治疗方法。因此，确定神经病变的潜在可改变的危险因素是至关重要的。我们研究了参与欧洲糖尿病（EURODIAB）前瞻性并发症研究的31个中心的1172例1型糖尿病患者发生远端对称神经病变的危险因素。方法：神经病变在基线（1989年至1991年）和随访（1997年至1999年）进行评估，平均（+/-SD）随访7.3+/-0.6年。标准化方案包括临床评估、定量感觉测试和自主功能测试。在中心实验室测量血脂和脂蛋白、糖化血红蛋白和尿白蛋白排泄率。结果：在随访中，基线时无神经病变的1172例患者中有276例（23.5%）发生了神经病变。神经病变的累积发生率与糖化血红蛋白值和糖尿病病程有关。在对这些因素进行调整后，我们发现较高水平的总脂蛋白、低密度脂蛋白胆固醇和甘油三酯、较高的体重指数、较高的血管性血变因子水平和尿白蛋白排泄率、高血压和吸烟都与神经病变的累积发病率显著相关。在校正其他危险因素和糖尿病并发症后，我们发现糖尿病病程、当前糖化血红蛋白值、随访期间糖化血红蛋白值的变化、体重指数和吸烟与神经病变的发生仍然独立相关。基线时的心血管疾病与神经病变的风险加倍相关，与心血管危险因素无关。结论：这项前瞻性研究表明，除了血糖控制外，神经病变的发生率还与潜在的可改变的心血管危险因素相关，包括甘油三酯水平升高、体重指数、吸烟和高血压。
BACKGROUND:Other than glycemic control, there are no treatments for diabetic neuropathy. Thus, identifying potentially modifiable risk factors for neuropathy is crucial. We studied risk factors for the development of distal symmetric neuropathy in 1172 patients with type 1 diabetes mellitus from 31 centers participating in the European Diabetes (EURODIAB) Prospective Complications Study.METHODS:Neuropathy was assessed at baseline (1989 to 1991) and at follow-up (1997 to 1999), with a mean (+/-SD) follow-up of 7.3+/-0.6 years. A standardized protocol included clinical evaluation, quantitative sensory testing, and autonomic-function tests. Serum lipids and lipoproteins, glycosylated hemoglobin, and the urinary albumin excretion rate were measured in a central laboratory.RESULTS:At follow-up, neuropathy had developed in 276 of 1172 patients without neuropathy at baseline (23.5 percent). The cumulative incidence of neuropathy was related to the glycosylated hemoglobin value and the duration of diabetes. After adjustment for these factors, we found that higher levels of total and low-density lipoprotein cholesterol and triglycerides, a higher body-mass index, higher von Willebrand factor levels and urinary albumin excretion rate, hypertension, and smoking were all significantly associated with the cumulative incidence of neuropathy. After adjustment for other risk factors and diabetic complications, we found that duration of diabetes, current glycosylated hemoglobin value, change in glycosylated hemoglobin value during the follow-up period, body-mass index, and smoking remained independently associated with the incidence of neuropathy. Cardiovascular disease at baseline was associated with double the risk of neuropathy, independent of cardiovascular risk factors.CONCLUSIONS:This prospective study indicates that, apart from glycemic control, the incidence of neuropathy is associated with potentially modifiable cardiovascular risk factors, including a raised triglyceride level, body-mass index, smoking, and hypertension.