Hayden Melvin R, Tyagi Suresh C
Department of Family and Community Medicine, University of Missouri, Columbia, MO 65020, USA.
Med Sci Monit. 2004 Dec;10(12):RA291-307.
Diabetic polyneuropathy (DPN) is the most common complication of diabetes and may frequently be the presenting symptom in type 2 diabetes mellitus (T2DM). Metabolic syndrome and T2DM are associated with multiple metabolic toxicities. These substrate toxicities support the formation of reactive oxygen species (ROS), which are so damaging to cells, tissues and organs and play an important role in the development of multiple diabetic complications. The importance of redox stress (ROS) and their effect on the neuronal unit are discussed. There are at least 5 major pathways involved in the development of DPN: metabolic, vascular, immunologic-autoimmune, neurohormonal growth factor deficiency, and extracellular matrix neuronal unit remodeling. Each of these five pathways are reviewed and related to neural redox stress and the role of ROS. The identification of the toxic substrates (A-FLIGHT acronym), earlier diagnosis of T2DM at the stage of impaired glucose tolerance or impaired fasting glucose, and aggressive global risk reduction with the use of a simple RAAS acronym will assist the clinician in slowing the natural progressive history, and possibly preventing the complications associated with DPN. The pain, foot ulceration, limb loss, organ dysfunction, and the associated morbidity and financial burden all contribute to the need for a better understanding of DPN and the role of redox stress and global risk reduction.
糖尿病性多发性神经病变（DPN）是糖尿病最常见的并发症，且在2型糖尿病（T2DM）中常为首发症状。代谢综合征和T2DM与多种代谢毒性相关。这些底物毒性促进活性氧（ROS）的形成，ROS对细胞、组织和器官具有极大损害，并在多种糖尿病并发症的发生发展中起重要作用。本文讨论了氧化还原应激（ROS）的重要性及其对神经单元的影响。DPN的发生发展至少涉及5条主要途径：代谢、血管、免疫-自身免疫、神经激素生长因子缺乏以及细胞外基质神经单元重塑。对这五条途径分别进行了综述，并阐述了它们与神经氧化还原应激及ROS作用的关系。识别毒性底物（A-FLIGHT首字母缩写），在糖耐量受损或空腹血糖受损阶段早期诊断T2DM，以及使用简单的RAAS首字母缩写进行积极的全面风险降低，将有助于临床医生减缓自然进展病程，并可能预防与DPN相关的并发症。疼痛、足部溃疡、肢体缺失、器官功能障碍以及相关的发病率和经济负担，都促使人们需要更好地了解DPN以及氧化还原应激的作用和全面风险降低。
