Medial arterial calcification and diabetic neuropathy
- 23 Downloads
- 6 Citations
Summary
The aim of this study was to detect linear arterial calcification (Mönckeberg’s sclerosis) localized in feet, ankles, legs, knees and hands in an attempt to correlate the extent of calcification with the presence and severity of autonomic neuropathy as well as with microangiopathy (proliferative retinopathy, proteinuria >200 mg/die) and peripheral neuropathy. Typical linear calcification were observed in 37 out of 41 (90.2%) patients with autonomic neuropathy and in none of those without autonomic neuropathy (p<0.001). These 37 patients were divided into two subgroups by cluster analysis: Subgroup A, including 18 subjects with calcification length ranging from 8 to 26 cm and moderate autonomic neuropathy, and Subgroup B, including 19 subjects with calcification length between 58 and 126 cm and severe autonomic neuropathy (p<0.0001 by Spearman’s test). No difference in the length of arterial calcification was detected between patients with proteinuria >200 mg/24h and/or proliferative retinopathy and patients without these complications. A possible relationship between arterial calcification and peripheral neuropathy is difficult to evaluate; in fact, the majority of subjects having autonomic neuropathy had peripheral neuropathy, too. Vice versa, around 10% of patients without peripheral neuropathy but with autonomic neuropathy did not have Mönckeberg’s sclerosis. Autonomic neuropathy is the principal factor responsible for calcification of the arterial media, and in addition the severity of the neuropathy, rather than the patient’s age or the known disease duration seems to determine the extent of calcification.
Key-words
Autonomic neuropathy Mönckenberg’s sclerosisPreview
Unable to display preview. Download preview PDF.
References
- 1.Amos R. S., Wright V.: Mönckeberg’s arteriosclerosis and metabolic bone diseases — Lancetii, 248–249, 1980.CrossRefGoogle Scholar
- 2.Armely M. F.: Denervation of ciliary muscle and iris sphincter following resection of the ciliary ganglion — Trans. Amer. Ophthalmol. Soc.66, 475–501, 1968.Google Scholar
- 3.Bellavere F., Bosello G., Fedele D., Cardone C., Ferri M.: Diagnosis and management of diabetic autonomic neuropathy — Brit. med. J.287, 61, 1983.Google Scholar
- 4.Bevan R. D., Tsuru H.: Long term denervation of vascular smooth muscle causes not only functional but structural change — Blood Vessels16, 109–112, 1979.PubMedGoogle Scholar
- 5.Boulton A. M. G., Scarpello J. H. B., Ward J. D.: Venous oxygenation in the diabetic neuropathic foot: evidence of arteriovenous shunting? — Diabetologia22, 6–8, 1982.PubMedCrossRefGoogle Scholar
- 6.Bowen B. D., Koenig E. C., Viele A.: A study of the lower extremities in diabetes as compared with non-diabetic subjects from the standpoint of X-ray findings, with particular reference to the relationship of arteriosclerosis and diabetes — Bull. Buffalo Gen. Hosp.2, 35–41, 1924.Google Scholar
- 7.Bradford M. M.: A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein dye binding — Analyt. Biochem.72, 248–257, 1986.CrossRefGoogle Scholar
- 8.Christiansen N. J.: Muscle blood flow measured by xenon and vascular calcification in diabetics — Acta med. scand.183, 449–454, 1968.CrossRefGoogle Scholar
- 9.Edmonds M. E., Morrison N., Laws J. W., Watkins P. J.: Medial arterial calcification and diabetic neuropathy — Brit. med. J.284, 928–930, 1982.CrossRefGoogle Scholar
- 10.Edmonds M. E., Roberts V. C., Watkins P. J.: Blood flow in the diabetic neuropathic foot — Diabetologia22, 6–8, 1982.CrossRefGoogle Scholar
- 11.Ewing D. J., Martyn C. N., Young R. J., Clarke B. F.: The value of cardiovascular autonomic function test: 10 years experience in diabetes — Diabet. Care8, 491–498, 1985.CrossRefGoogle Scholar
- 12.Ferrier T. M.: Radiologically demonstrable arterial calcification in diabetes mellitus — Aust. Ann. Med.13, 222–226, 1967.Google Scholar
- 13.Frank R. N.: Diabetic retinopathy: current concepts of evaluation and treatment. In:Watkins P. J. (Ed.): Long-term Complications of Diabetes. W. B. Saunders Ltd., London, 1986; p. 933–969.Google Scholar
- 14.Katzeff H. L., Savage P. J., Barelay-White B., Nagulesparan M., Bennett P. H.: C-peptide measurement in the differentiation of Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus — Diabetologia28, 264–268, 1985.PubMedCrossRefGoogle Scholar
- 15.Kerper A. H., Collier W. D.: Pathological changes in arteries following partial denervation — Proc. Soc. exp. Biol. (N.Y.)24, 492–494, 1926.Google Scholar
- 16.Lie J. T.: The structure of the normal vascular system and its reactive changes. In:Jurgens J. L., Spittel J. A., Foxenbun J. A. II (Eds): Peripheral Vascular Disease. W. B. Saunders Ltd., London, 1980; pp. 51–81.Google Scholar
- 17.Mönckeberg J. G.: Über die reine Mediaverklekung der Extremitatenarterien und ihr Verhalten zür Arteriosklerose — Virchows Arch. (path. Anat.)171, 141–167, 1903.CrossRefGoogle Scholar
- 18.Morgan A. J.: Mineralized deposits in the thoracic aorta of aged rats: ultrastructural and electron probe X-ray microanalysis study — Exp. Gerontol.5, 563–573, 1980.CrossRefGoogle Scholar
- 19.Parfitt A. M.: Soft-tissue calcification in uremia — Arch. intern. Med.124, 544–556, 1969.PubMedCrossRefGoogle Scholar
- 20.Ricordi L., Rossi M., Marti G., Finardi G., Fratino P., Bernardi L.: Hypertension in diabetes: an additional factor determining autonomic neuropathy? — Diabet. Nutr. Metabol.2, 269–275, 1989.Google Scholar
- 21.Rose C. A., Blackburn H.: Cardiovascular survey methods. WHO Monograph Series 56, Geneva, 1968.Google Scholar
- 22.Rotar J.: The autonomic nervous system. Akademia Kiadó, Budapest, 1966.Google Scholar
- 23.Silbert S., Lippman H. I., Gordon E.: Mönckeberg’s arteriosclerosis — J. Amer. med. Ass.151, 191–210, 1953.Google Scholar
- 24.Sinha S., Munichoodappa C. S., Kozak G. P.: Neuroarthropathy (Charcot joints) in diabetes mellitus — Medicine (Baltimore)51, 191–210, 1982.Google Scholar
- 25.Snedecor G. W., Cochran W. G.: Statistical methods. 6th Ed., Iowa State University Press, Ames/IA, 1974.Google Scholar
- 26.Spallone V., Tomei E., Spartera C., Sideri G., Bolea A., Laglia P., Petrassi C., Savina A., Menzinger G.: Sclerosi di Mönckeberg ed alterazioni di flusso nella neuropatia diabetica — G. ital. Diabetol6, 13–20, 1986.Google Scholar
- 27.Stickland M. H., Perkins C. M., Wales J. K.: The measurement of hemoglobin A1c by isoelectric focusing in diabetic patients — Diabetologia22, 315–317, 1982.PubMedCrossRefGoogle Scholar
- 28.WHO Expert Committee: Arterial hypertension. World Health Organization Technical Report Series 628, World Health Organization, Geneva, 1978.Google Scholar