2型糖尿病周围神经病变机制研究进展

Research progress of diabetic peripheral neuropathy mechanisms in type 2 diabetes

糖尿病周围神经病变(DPN)是糖尿病患者常见的慢性并发症。2型糖尿病DPN发病机制尚未完全清楚,是由多种因素综合作用的结果。其中,高糖参与的外周神经损伤机制包括线粒体功能障碍及氧化应激、多元醇通路激活、晚期糖基化终产物、硝基化反应、内质网应激等。血脂紊乱的影响机制包括氧化和糖基化低密度脂蛋白、FFA、脂类介质、氧化型胆固醇等。另外,代谢性炎症、胰岛素抵抗、神经滋养血管病变、神经营养因子、外周神经的解剖学特点均参与其中,组成了复杂而相互关联的发病机制。因此,2型糖尿病DPN需要从多靶点进行综合治疗。该文对相关发病机制进行了系统综述。

Diabetic peripheral neuropathy ( DPN ) is a common chronic complication of diabetes. Type 2 diabetes DPN patho-genesis is the result of combined factors, which compose a com-plex and interrelated network. Among the mechanisms of periph-ery nerve damage in type 2 diabetes, hyperglycaemia is the pri-mary concerned factor even with controversy. The glucose-relat-ed mechanisms include mitochondrial dysfunction, oxidative stress, polyol pathway activation, advanced glycation end prod-ucts, nitrative stress, endoplasmic reticulum stress, etc. The effect of dyslipidemia include ox-LDL, glycosylated LDL, free fatty acid, lipid mediators, oxysterols. Metabolic inflammation, insulin resistance, vasa nervorum, neurotrophic factors, anatom-ical features of peripheral nerves are also involved. Therefore, the treatment of type 2 diabetes DPN needs a multi-target com-prehensive treatment. This article systematically reviewed the progress on the pathogenesis.