Lui P P Y
Headquarter, Hospital Authority, Hong Kong SAR, China.
Scand J Med Sci Sports. 2017 Aug;27(8):776-787. doi: 10.1111/sms.12824. Epub 2017 Jan 20.
Chronic tendinopathy is a frequent and disabling musculo-skeletal problem affecting the athletic and general populations. The affected tendon is presented with local tenderness, swelling, and pain which restrict the activity of the individual. Tendon degeneration reduces the mechanical strength and predisposes it to rupture. The pathogenic mechanisms of chronic tendinopathy are not fully understood and several major non-mutually exclusive hypotheses including activation of the hypoxia-apoptosis-pro-inflammatory cytokines cascade, neurovascular ingrowth, increased production of neuromediators, and erroneous stem cell differentiation have been proposed. Many intrinsic and extrinsic risk/causative factors can predispose to the development of tendinopathy. Among them, diabetes mellitus is an important risk/causative factor. This review aims to appraise the current literature on the epidemiology and pathology of tendinopathy in diabetic patients. Systematic reviews were done to summarize the literature on (a) the association between diabetes mellitus and tendinopathy/tendon tears, (b) the pathological changes in tendon under diabetic or hyperglycemic conditions, and (c) the effects of diabetes mellitus or hyperglycemia on the outcomes of tendon healing. The potential mechanisms of diabetes mellitus in causing and exacerbating tendinopathy with reference to the major non-mutually exclusive hypotheses of the pathogenic mechanisms of chronic tendinopathy as reported in the literature are also discussed. Potential strategies for the management of tendinopathy in diabetic patients are presented.
慢性肌腱病是一种常见且致残的肌肉骨骼问题，影响运动员和普通人群。受影响的肌腱会出现局部压痛、肿胀和疼痛，限制个体活动。肌腱退变会降低机械强度并使其易于破裂。慢性肌腱病的发病机制尚未完全明确，已提出了几种主要的、并非相互排斥的假说，包括缺氧-凋亡-促炎细胞因子级联反应的激活、神经血管长入、神经介质产生增加以及干细胞分化错误。许多内在和外在的风险/致病因素都可能导致肌腱病的发生。其中，糖尿病是一个重要的风险/致病因素。本综述旨在评估当前关于糖尿病患者肌腱病流行病学和病理学的文献。进行了系统评价以总结关于以下方面的文献：（a）糖尿病与肌腱病/肌腱撕裂之间的关联；（b）糖尿病或高血糖状态下肌腱的病理变化；（c）糖尿病或高血糖对肌腱愈合结果的影响。还讨论了糖尿病导致和加重肌腱病的潜在机制，参考了文献中报道的慢性肌腱病发病机制的主要非相互排斥假说。并提出了糖尿病患者肌腱病管理的潜在策略。
