糖尿病神経障害と心, 脳, 下肢のマクロアンギオパチーの関係

Abstract

To investigate the relationship between micro- and macroangiopathy (MA) in type-2 diabetes, the prevalence and clinical characteristics of macroangiopathy were studied in subjects with peripheral and autonomic neuropathy. These complications were assessed in 829 diabetic patients on the basis of both clinical findings and non-invasive examinations. The prevalence of peripheral neuropathy (PN) and autonomic neuropathy (AN) was 45.5% and 27.6%, respectively. 21.1% of the subjects were complicated with both PN and AN. The prevalence of ischemic heart disease (IHD), cerebral infarction (CI), and arteriosclerosis obliterans (ASO) in subjects with neuropathy, especially complicated with both PN and AN, was significantly higher than in the subjects without neuropathy. Aging, duration of diabetes, HbAlc levels, high systolic blood pressure, and uremia were common risk factors for both PN and AN. In addition, smoking was associated with PN, and reduced concentrations of HDL-C with AN. These risk factors were also related with MA. Multivariate analysis indicated that AN could be an independent risk factor for all MA, on the other hand, PN was indicated for IHD and ASO. These data suggest that diabetic neuropathy is closely correlated with MA of the heart, brain and lower legs. Glycemic control, other risk factor management and evaluation of systemic MA using a non-invasive approach are important for subjects with neuropathy, especially for subjects complicated with both PN and AN.