Gentile S, Bizzarro A, Marmo R, de Bellis A, Orlando C
Istituto di Medicina Generale e Metodologia Clinica, I Facoltà di Medicina, Università di Napoli, Italy.
Acta Diabetol Lat. 1990 Jul-Sep;27(3):243-53. doi: 10.1007/BF02581336.
The aim of this study was to detect linear arterial calcification (Mönckeberg's sclerosis) localized in feet, ankles, legs, knees and hands in an attempt to correlate the extent of calcification with the presence and severity of autonomic neuropathy as well as with microangiopathy (proliferative retinopathy, proteinuria greater than 200 mg/die) and peripheral neuropathy. Typical linear calcification were observed in 37 out of 41 (90.2%) patients with autonomic neuropathy and in none of those without autonomic neuropathy (p less than 0.001). These 37 patients were divided into two subgroups by cluster analysis: Subgroup A, including 18 subjects with calcification length ranging from 8 to 26 cm and moderate autonomic neuropathy, and Subgroup B, including 19 subjects with calcification length between 58 and 126 cm and severe autonomic neuropathy (p less than 0.0001 by Spearman's test). No difference in the length of arterial calcification was detected between patients with proteinuria greater than 200 mg/24h and/or proliferative retinopathy and patients without these complications. A possible relationship between arterial calcification and peripheral neuropathy is difficult to evaluate; in fact, the majority of subjects having autonomic neuropathy had peripheral neuropathy, too. Vice versa, around 10% of patients without peripheral neuropathy but with autonomic neuropathy did not have Mönckeberg's sclerosis. Autonomic neuropathy is the principal factor responsible for calcification of the arterial media, and in addition the severity of the neuropathy, rather than the patient's age or the known disease duration seems to determine the extent of calcification.
本研究旨在检测足部、脚踝、腿部、膝盖和手部的线性动脉钙化（蒙克贝格硬化症），试图将钙化程度与自主神经病变的存在及严重程度、微血管病变（增殖性视网膜病变、蛋白尿大于200mg/日）以及周围神经病变相关联。41例自主神经病变患者中有37例（90.2%）观察到典型的线性钙化，而无自主神经病变的患者中无一例出现（p<0.001）。通过聚类分析将这37例患者分为两个亚组：A组，包括18名钙化长度为8至26cm且伴有中度自主神经病变的受试者；B组，包括19名钙化长度在58至126cm之间且伴有严重自主神经病变的受试者（Spearman检验p<0.0001）。蛋白尿大于200mg/24小时和/或患有增殖性视网膜病变的患者与无这些并发症的患者在动脉钙化长度上未检测到差异。动脉钙化与周围神经病变之间的可能关系难以评估；事实上，大多数患有自主神经病变的受试者也患有周围神经病变。反之，约10%没有周围神经病变但患有自主神经病变的患者没有蒙克贝格硬化症。自主神经病变是动脉中层钙化的主要因素，此外，神经病变的严重程度而非患者年龄或已知病程似乎决定了钙化程度。
