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糖尿病与外周动脉疾病。

Diabetes mellitus and peripheral artery disease.

作者信息

Takahara Mitsuyoshi

机构信息

Department of Laboratory Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita City, Osaka 565-0871 Japan.

出版信息

Diabetol Int. 2025 Jan 3;16(1):7-12. doi: 10.1007/s13340-024-00785-8. eCollection 2025 Jan.

Abstract

Atherosclerotic peripheral artery disease (PAD), that is, arteriosclerosis obliterans, is pathologically rooted in atherosclerosis, similar to other cardiovascular diseases. In addition to smoking, hypertension, and dyslipidemia, diabetes mellitus is a major risk factor. People with diabetes mellitus have an elevated risk of developing PAD. PAD in turn increases the risk of diabetic foot ulcers and gangrene in the population. Rest pain, nonhealing ulcers, and gangrene associated with chronic ischemia are known as chronic limb-threatening ischemia (CLTI). This article gives an overview of the link between atherosclerotic PAD, particularly CLTI, and diabetes mellitus. First, the clinical impact of CLTI among patients with diabetes mellitus is presented. Second, its clinical features, including prognosis, comorbidity, occurrence, and seasonality, are mentioned. The clinical management of CLTI is also discussed. Diabetes mellitus has notable clinical impact on CLTI and vice versa. CLTI has different clinical features from those of other atherosclerotic cardiovascular diseases. Its clinical profile also differs between individuals with both diabetes mellitus and CLTI and general people with diabetes mellitus. There is considerable room for improvement in CLTI treatment and management. Clinical measures taken before revascularization, including CLTI risk assessment, prompt diagnosis, and expedited referral to vascular specialists, may enhance CLTI outcomes. Further research is warranted to obtain more evidence.

摘要

动脉粥样硬化性外周动脉疾病(PAD),即闭塞性动脉硬化,在病理上源于动脉粥样硬化,与其他心血管疾病相似。除吸烟、高血压和血脂异常外,糖尿病也是一个主要危险因素。糖尿病患者发生PAD的风险升高。PAD反过来又增加了人群中糖尿病足溃疡和坏疽的风险。与慢性缺血相关的静息痛、不愈合溃疡和坏疽被称为慢性肢体威胁性缺血(CLTI)。本文概述了动脉粥样硬化性PAD,尤其是CLTI与糖尿病之间的联系。首先,介绍了CLTI在糖尿病患者中的临床影响。其次,提到了其临床特征,包括预后、合并症、发生率和季节性。还讨论了CLTI的临床管理。糖尿病对CLTI有显著的临床影响,反之亦然。CLTI具有与其他动脉粥样硬化性心血管疾病不同的临床特征。其临床特征在糖尿病合并CLTI患者和普通糖尿病患者之间也有所不同。CLTI的治疗和管理有很大的改进空间。血管重建术前采取的临床措施,包括CLTI风险评估、及时诊断和加快转诊至血管专科医生,可能会改善CLTI的治疗效果。有必要进行进一步的研究以获得更多证据。

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