Musial Diego Castro, Ajita Maria Eduarda, Bomfim Guilherme Henrique Souza
Hospital Evangélico de Londrina, Londrina 86015-900, PR, Brazil.
Department of Medicine, Pontifícia Universidade Católica do Paraná, Londrina 86067-000, PR, Brazil.
Med Sci (Basel). 2024 Dec 24;13(1):1. doi: 10.3390/medsci13010001.
Diabetes mellitus (DM) is a global health concern with a rising incidence, particularly in aging populations and those with a genetic predisposition. Over time, DM contributes to various complications, including nephropathy, retinopathy, peripheral arterial disease (PAD), and neuropathy. Among these, diabetic neuropathy and PAD stand out due to their high prevalence and significant impact on patients' quality of life. Diabetic distal symmetric polyneuropathy, the most common form of diabetic neuropathy, is driven by neuroinflammation stemming from prolonged hyperglycemia. Simultaneously, hyperglycemia significantly increases the risk of PAD, a condition further exacerbated by factors like smoking, age, and sedentary lifestyles. PAD frequently manifests as claudication, a debilitating symptom marked by pain and cramping during physical activity, which limits mobility and worsens patients' outcomes. Cilostazol, a phosphodiesterase-3 inhibitor, has proven effective in managing intermittent claudication in PAD by improving walking distances and enhancing blood flow. Recent studies have also explored its potential benefits for diabetic neuropathy. Cilostazol's mechanisms include vasodilation, platelet inhibition, and increased cyclic adenosine monophosphate (cAMP) levels, which may contribute to improved neurological outcomes. However, variability in the clinical evidence due to inconsistent treatment protocols highlights the need for further investigation. This review explores cilostazol's mechanisms of action and therapeutic applications for managing neuropathy and PAD in diabetic patients, aiming to provide insights into its potential as a dual-purpose pharmacological agent in this high-risk population.
糖尿病（DM）是一个全球性的健康问题，其发病率不断上升，在老年人群和有遗传易感性的人群中尤为明显。随着时间的推移，糖尿病会引发各种并发症，包括肾病、视网膜病变、外周动脉疾病（PAD）和神经病变。其中，糖尿病神经病变和PAD因其高患病率以及对患者生活质量的重大影响而格外突出。糖尿病远端对称性多发性神经病变是糖尿病神经病变最常见的形式，由长期高血糖引发的神经炎症所致。同时，高血糖显著增加了PAD的风险，吸烟、年龄和久坐不动的生活方式等因素会进一步加剧这种情况。PAD常表现为间歇性跛行，这是一种使人虚弱的症状，在体力活动时会出现疼痛和抽筋，限制了活动能力并恶化患者的预后。西洛他唑是一种磷酸二酯酶-3抑制剂，已被证明通过增加步行距离和改善血流来有效治疗PAD中的间歇性跛行。最近的研究还探讨了其对糖尿病神经病变的潜在益处。西洛他唑的作用机制包括血管舒张、血小板抑制以及增加环磷酸腺苷（cAMP）水平，这可能有助于改善神经学预后。然而，由于治疗方案不一致导致临床证据存在差异，这凸显了进一步研究的必要性。本综述探讨了西洛他唑在治疗糖尿病患者神经病变和PAD方面的作用机制及治疗应用，旨在深入了解其在这一高危人群中作为两用药物的潜力。
