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关注糖尿病足:糖尿病眼病与下肢伤口愈合之间的联系。

Keeping an eye on the diabetic foot: The connection between diabetic eye disease and wound healing in the lower extremity.

作者信息

Ramsey David J, Kwan James T, Sharma Arjun

机构信息

Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States.

Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States.

出版信息

World J Diabetes. 2022 Dec 15;13(12):1035-1048. doi: 10.4239/wjd.v13.i12.1035.

Abstract

Diabetic eye disease is strongly associated with the development of diabetic foot ulcers (DFUs). DFUs are a common and significant complication of diabetes mellitus (DM) that arise from a combination of micro- and macrovascular compromise. Hyperglycemia and associated metabolic dysfunction in DM lead to impaired wound healing, immune dysregulation, peripheral vascular disease, and diabetic neuropathy that predisposes the lower extremities to repetitive injury and progressive tissue damage that may ultimately necessitate amputation. Diabetic retinopathy (DR) is caused by cumulative damage to the retinal mic-rovasculature from hyperglycemia and other diabetes-associated factors. The severity of DR is closely associated with the development of DFUs and the need for lower extremity revascularization procedures and/or amputation. Like the lower extremity, the eye may also suffer end-organ damage from macrovascular compromise in the form of cranial neuropathies that impair its motility, cause optic neuropathy, or result in partial or complete blindness. Additionally, poor perfusion of the eye can cause ischemic retinopathy leading to the development of proliferative diabetic retinopathy or neovascular glaucoma, both serious, vision-threatening conditions. Finally, diabetic corneal ulcers and DFUs share many aspects of impaired wound healing resulting from neurovascular, sensory, and immunologic compromise. Notably, alterations in serum biomarkers, such as hemoglobin A1c, ceruloplasmin, creatinine, low-density lipoprotein, and high-density lipoprotein, are associated with both DR and DFUs. Monitoring these parameters can aid in prognosticating long-term outcomes and shed light on shared pathogenic mechanisms that lead to end-organ damage. The frequent co-occurrence of diabetic eye and foot problems mandate that patients affected by either condition undergo reciprocal comprehensive eye and foot evaluations in addition to optimizing diabetes management.

摘要

糖尿病眼病与糖尿病足溃疡(DFU)的发生密切相关。DFU是糖尿病(DM)常见且严重的并发症,由微血管和大血管受损共同引起。DM中的高血糖及相关代谢功能障碍导致伤口愈合受损、免疫失调、外周血管疾病和糖尿病神经病变,使下肢易受重复性损伤和进行性组织损伤,最终可能需要截肢。糖尿病视网膜病变(DR)是由高血糖和其他糖尿病相关因素对视网膜微血管的累积损伤所致。DR的严重程度与DFU的发生以及下肢血管重建手术和/或截肢的需求密切相关。与下肢一样,眼睛也可能因大血管受损而遭受终末器官损害,表现为影响眼球运动的颅神经病变、导致视神经病变或引起部分或完全失明。此外,眼部灌注不足可导致缺血性视网膜病变,进而发展为增殖性糖尿病视网膜病变或新生血管性青光眼,这两种都是严重的、威胁视力的疾病。最后,糖尿病角膜溃疡和DFU在神经血管、感觉和免疫功能受损导致的伤口愈合受损方面有许多共同之处。值得注意的是,血清生物标志物如糖化血红蛋白、铜蓝蛋白、肌酐、低密度脂蛋白和高密度脂蛋白的改变与DR和DFU均有关联。监测这些参数有助于预测长期预后,并揭示导致终末器官损害的共同致病机制。糖尿病眼部和足部问题经常同时出现,这就要求受其中任何一种疾病影响的患者除了优化糖尿病管理外,还需接受相互的全面眼部和足部评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8de/9791566/c2d5ff7f527f/WJD-13-1035-g001.jpg

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