Mediators of diabetic neuropathy: is hyperglycemia the only culprit?
Mediators of diabetic neuropathy: is hyperglycemia the only culprit?
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DOI：
10.1097/med.0000000000000320
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发表时间：
2017-04
期刊：
影响因子：
--
通讯作者：
Feldman EL
中科院分区：
文献类型：
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作者：
Grisold A;Callaghan BC;Feldman EL
糖尿病周围神经病变 (DPN) 是 1 型和 2 型糖尿病（T1DM、T2DM）的一种非常常见的致残并发症。大型临床研究支持这样的观点：除了高血糖之外，代谢综合征 (MetS) 的组成部分可能是 DPN 发病机制的基础，尤其是在 T2DM 中。本综述将提供支持 MetS 及其各个组成部分作为神经病发生的潜在病因的证据。除了血糖控制不佳和糖尿病持续时间外，MetS 的组成部分（例如血脂异常、肥胖和高血压）可能对 DPN 的患病率产生重要影响。肥胖和糖尿病前期有最多的数据支持其在神经病变中的作用，而高血压和血脂异常的结果则更为复杂。非代谢因素，如遗传易感性、年龄、身高、性别、吸烟和饮酒，也被强调为周围神经病变的潜在危险因素，尽管这些因素对 DPN 的确切贡献仍不清楚。 DPN是一种慢性致残性疾病，准确识别和修改DPN危险因素对于临床管理具有重要意义。最近的数据支持 MetS 成分和其他危险因素在 DPN 发展中的作用，为治疗开发提供了高血糖之外的新目标。
Diabetic peripheral neuropathy (DPN) is a disabling, highly prevalent complication of both type 1 and type 2 diabetes mellitus (T1DM, T2DM). Large clinical studies support the concept that, in addition to hyperglycemia, components of the metabolic syndrome (MetS) may underlie the pathogenesis of DPN, especially in T2DM. This review will present the evidence supporting the MetS and its individual components as potential causal factors for the development of neuropathy. In addition to poor glycemic control and duration of diabetes, components of MetS such as dyslipidemia, obesity, and hypertension, may have an important impact on the prevalence of DPN. Obesity and prediabetes have the most data to support their role in neuropathy, whereas hypertension and dyslipidemia have more mixed results. Non-metabolic factors, such as genetic susceptibility, age, height, gender, smoking, and alcohol, have also been highlighted as potential risk factors in peripheral neuropathy, although the exact contribution of these factors to DPN remains unknown. DPN is a chronic and disabling disease, and the accurate identification and modification of DPN risk factors is important for clinical management. Recent data support a role for components of the MetS and other risk factors in the development of DPN, offering novel targets beyond hyperglycemia for therapeutic development.