Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida 32608, USA.
J Clin Endocrinol Metab. 2013 Feb;98(2):466-73. doi: 10.1210/jc.2012-3776. Epub 2013 Jan 11.
The discovery of limited joint mobility (LJM) as the earliest clinically apparent complication of diabetes in children and adolescents nearly 40 years ago provided insights into the mechanism of diabetes complications.
LJM, due to periarticular connective tissue thickening and stiffness, varied from single joint involvement bilaterally to obvious hand deformity and limitation of movement of the spine. Thick, tight, waxy skin was apparent with more severe changes; biopsy indicated thickening of the dermis and epidermis with accumulation of collagen and loss of skin appendages. Substantial growth impairment was associated with all levels of LJM. Risk for microvascular disease over a 16-year period was actuarially increased nearly 4-fold by the presence of LJM. Long-term glycemic control influenced the onset of LJM; for every unit increase in average glycated hemoglobin from onset there was a 46% increase in the risk of LJM. Between 1976-78 and 1998, the prevalence of LJM decreased from 30 to 7%, and the portion with moderate to severe changes decreased from 33 to 14%, with the disappearance of severely affected individuals. Furthermore, growth data markedly improved for those with and without LJM; 30% without LJM and 77% with LJM had been less than the 25th percentile for height, whereas the more contemporary group had 22% without LJM and 33% with LJM in this quartile.
The elucidation of LJM as a novel and informative early complication of pediatric diabetes has provided insights into the evolution of the severe long-term complications of diabetes. The marked decrease in the frequency of LJM and statural deficit in children and youth with diabetes in the 20 years between the late 1970s and 1990s can be attributed to improved metabolic control of children and adolescents. The prevalence of LJM in a population may serve as a measure of quality of diabetes control.
近 40 年前，人们发现儿童和青少年糖尿病的最早临床明显并发症是关节活动度受限（LJM），这使人们深入了解了糖尿病并发症的发病机制。
由于关节周围结缔组织增厚和僵硬，LJM 从单侧单关节受累到明显的手部畸形和脊柱运动受限不等。病情较重时，皮肤会变得又厚又紧，像蜡一样；活检显示真皮和表皮增厚，胶原堆积，皮肤附属物丢失。严重的 LJM 会导致显著的生长障碍。16 年内，LJM 使微血管病变的风险增加近 4 倍。长期血糖控制会影响 LJM 的发病；糖化血红蛋白每增加 1 个单位，LJM 的风险就会增加 46%。1976-78 年至 1998 年，LJM 的患病率从 30%降至 7%，中度至重度病变的比例从 33%降至 14%，严重受累者消失。此外，有和无 LJM 患者的生长数据明显改善；30%无 LJM 和 77%有 LJM 的患者身高低于第 25 百分位数，而较近期的患者中，无 LJM 的有 22%，有 LJM 的有 33%处于第 25 百分位数以下。
LJM 作为儿童糖尿病的一种新型且具有信息意义的早期并发症，为了解糖尿病严重长期并发症的演变提供了线索。在 20 世纪 70 年代末至 90 年代期间，儿童和青少年糖尿病患者 LJM 发生频率和身高不足的明显减少，可归因于儿童和青少年代谢控制的改善。人群中 LJM 的患病率可作为衡量糖尿病控制质量的指标。
