Aoki Y, Yazaki K, Shirotori K, Yanagisawa Y, Oguchi H, Kiyosawa K, Furuta S
Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Diabetologia. 1993 Jan;36(1):79-83. doi: 10.1007/BF00399098.
Limited joint mobility seen in diabetes mellitus is thought to be the result of stiffening of periarticular connective tissue, which is presumably derived from increased cross-linking of collagen related to advanced glycation end products. In this study the extent of the stiffening of connective tissue was measured by the passive extension angle of the metacarpophalangeal joints in 205 elderly diabetic patients. Association with diabetic nephropathy, with which advanced glycation end products have recently been demonstrated to increase, and metabolic abnormalities were also considered. The angle of the metacarpophalangeal joints was significantly correlated with age (r = -0.24, p < 0.01), and was significantly smaller in men than in women (p < 0.01). The angle demonstrated a decrease in association with diabetic retinopathy and nephropathy, and only the association with nephropathy was significant (p < 0.05). The angle was weakly, but significantly, correlated with serum thiobarbituric acid reactants as a measure of lipid peroxides (r = -0.15, p < 0.05), triglyceride (r = -0.20, p < 0.01) and HDL cholesterol (r = 0.19, p < 0.01), but not with blood glucose (r = 0.02), HbA1c (r = 0.06) or duration of diabetes (r = -0.05). In addition, the angle in 14 non-diabetic patients on haemodialysis was significantly (p < 0.05) smaller than that in age- and sex-matched normal subjects. Thus, it was indicated that the stiffening of connective tissue was associated with diabetic nephropathy, serum lipid peroxide and dyslipidaemia. Stiffening of connective tissue seems to be more affected by oxidative stress than non-enzymatic glycation per se.(ABSTRACT TRUNCATED AT 250 WORDS)
糖尿病中出现的关节活动受限被认为是关节周围结缔组织硬化的结果，这种硬化可能源于与晚期糖基化终产物相关的胶原蛋白交联增加。在本研究中，通过测量205例老年糖尿病患者掌指关节的被动伸展角度来评估结缔组织的硬化程度。还考虑了与糖尿病肾病（最近已证明晚期糖基化终产物在其中增加）以及代谢异常的关联。掌指关节角度与年龄显著相关（r = -0.24，p < 0.01），男性角度显著小于女性（p < 0.01）。该角度与糖尿病视网膜病变和肾病相关且呈下降趋势，仅与肾病的关联具有统计学意义（p < 0.05）。该角度与作为脂质过氧化指标的血清硫代巴比妥酸反应物呈弱但显著的相关性（r = -0.15，p < 0.05），与甘油三酯（r = -0.20，p < 0.01）和高密度脂蛋白胆固醇（r = 0.19，p < 0.01）相关，但与血糖（r = 0.02）、糖化血红蛋白（r = 0.06）或糖尿病病程（r = -0.05）无关。此外，14例接受血液透析的非糖尿病患者的角度显著（p < 0.05）小于年龄和性别匹配的正常受试者。因此，表明结缔组织硬化与糖尿病肾病、血清脂质过氧化和血脂异常有关。结缔组织硬化似乎比非酶糖基化本身更受氧化应激的影响。（摘要截短至250字）
