在糖尿病夏科氏神经关节病中，微血管功能受损与长期的代谢控制及低度炎症过程有关。

In diabetic Charcot neuroarthropathy impaired microvascular function is related to long lasting metabolic control and low grade inflammatory process.

作者信息

Araszkiewicz Aleksandra, Soska Jacek, Borucka Katarzyna, Olszewska Marta, Niedzwiecki Pawel, Wierusz-Wysocka Bogna, Zozulinska-Ziolkiewicz Dorota

机构信息

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland.

出版信息

Microvasc Res. 2015 Sep;101:143-7. doi: 10.1016/j.mvr.2015.07.008. Epub 2015 Aug 1.

DOI:10.1016/j.mvr.2015.07.008

PMID:26239695

Abstract

AIMS

The aim of this study was to assess microvascular function associated with the occurrence of Charcot neuroarthropathy (CN) in patients with diabetes.

METHODS

We evaluated 70 diabetic patients (54 men) with Charcot neuroarthropathy (CN-DM), median age 59 (IQR: 51-62), mean disease duration 16±8years. The control group were 70 subjects with diabetes and without Charcot neuroarthropathy (DM), 54 men, median age 60 (54-62), mean diabetes duration 15±7years. We assessed metabolic control of diabetes, serum C-reactive protein concentration (CRP) and cardiovascular autonomic neuropathy (CAN). We used AGE-Reader to measure skin autofluorescence (AF) associated with accumulation of advanced glycation end products that reflects long lasting metabolic control. Microvascular function was examined by laser Doppler flowmetry (PERIFLUX 5000) with thermal hyperemia (TH) and postocclusive reactive hyperemia (PORH).

RESULTS

CN-DM patients as compared to DM subjects had lower HbA1c level [7.6 (6.6-8.4) vs 8.4 (7.3-9.7)%, p<0.001], lower eGFR [75.9±24.1 vs 86.6±17.8ml/min/1.73m(2), p=0.003], higher CRP serum concentration [3.8 (2.3-10.1) vs 1.9 (0.8-4.4)mg/l, p<0.001] and higher skin autofluorescence [2.8 (2.5-3.1) vs 2.6 (2.3-2.9)AU, p=0.03]. The cardiovascular autonomic neuropathy (CAN) was more frequently diagnosed in CN-DM subjects [59 vs 27%, p<0.001]. The peak flow during thermal hyperemia (THmax) was lower in CN-DM subjects as compared to DM group [156 (93-240) vs 235 (155-300)PU, p=0.001]. We found negative correlation between THmax and CRP concentration (Rs=-0.34, p=0.003), TG concentration (Rs=-0.37, p=0.002) and skin AF (Rs=-0.32, p=0.04) and positive correlation between THmax and HDL cholesterol level (Rs=0.42, p<0.001) in CN-DM patients. There was also a positive correlation between PORHpeak and HDL cholesterol level (Rs=-0.23, p=0.04).

CONCLUSION

Deterioration of microvascular function and autonomic system dysfunction are present in Charcot neuroarthropathy. Impaired microvascular reactivity is associated with worse long lasting metabolic control of diabetes and low grade inflammatory process.

摘要

目的

本研究旨在评估糖尿病患者中与夏科氏神经关节病（CN）发生相关的微血管功能。

方法

我们评估了70例患有夏科氏神经关节病的糖尿病患者（54例男性），年龄中位数为59岁（四分位间距：51 - 62岁），平均病程为16±8年。对照组为70例无夏科氏神经关节病的糖尿病患者，54例男性，年龄中位数为60岁（54 - 62岁），平均糖尿病病程为15±7年。我们评估了糖尿病的代谢控制情况、血清C反应蛋白浓度（CRP）和心血管自主神经病变（CAN）。我们使用AGE-Reader测量与晚期糖基化终末产物积累相关的皮肤自发荧光（AF），其反映长期的代谢控制情况。通过激光多普勒血流仪（PERIFLUX 5000），利用热充血（TH）和阻断后反应性充血（PORH）来检测微血管功能。

结果

与糖尿病患者（DM）相比，CN-DM患者的糖化血红蛋白（HbA1c）水平更低[7.6（6.6 - 8.4）%对8.4（7.3 - 9.7）%，p<0.001]，估算肾小球滤过率（eGFR）更低[75.9±24.1对86.6±17.8ml/min/1.73m²，p = 0.003]，血清CRP浓度更高[3.8（2.3 - 10.1）对1.9（0.8 - 4.4）mg/l，p<0.001]，皮肤自发荧光更高[2.8（2.5 - 3.1）对2.6（2.3 - 2.9）AU，p = 0.03]。心血管自主神经病变（CAN）在CN-DM患者中更常被诊断出来[59%对27%，p<0.001]。与DM组相比，CN-DM患者热充血期间的峰值血流（THmax）更低[156（93 - 240）对235（155 - 300）PU，p = 0.001]。我们发现CN-DM患者中THmax与CRP浓度（Rs = -0.34，p = 0.003）、甘油三酯（TG）浓度（Rs = -0.37，p = 0.002）和皮肤AF（Rs = -0.32，p = 0.04）呈负相关，与高密度脂蛋白胆固醇（HDL）水平呈正相关（Rs = 0.42，p<0.001）。PORHpeak与HDL胆固醇水平之间也存在正相关（Rs = -0.23，p = 0.04）。