内脏脂肪面积与糖尿病周围神经病变非线性 关系的研究进展

Research Progress on the Non-Linear Relationship between Visceral Fat Area and Diabetic Peripheral Neuropathy

摘要: 糖尿病周围神经病变(DPN)是糖尿病最常见的慢性并发症之一，其发生发展与内脏脂肪堆积密切相关。近年来的证据表明，内脏脂肪面积(VFA)与DPN之间并非简单的线性关系，而是呈现U型、J型或阈值效应等非线性关联模式。本文系统综述了VFA与DPN非线性关系的流行病学证据，重点阐述了慢性低度炎症的阈值激活、胰岛素抵抗与糖脂毒性的双向作用、氧化应激与线粒体功能障碍、神经微血管病变、低VFA状态下的营养不良与肌少症，以及体成分交互与“神经–骨轴”调控等核心病理生理机制。在此基础上，进一步探讨了非线性关系的临床转化价值，包括高危人群风险分层、个体化体成分管理、预测模型优化及骨折风险联合预警，并分析了当前研究的主要局限与未来发展方向。本综述旨在为DPN的精准预防与个体化治疗提供新的理论依据和临床思路。

Abstract: Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, and its occurrence and progression are closely associated with visceral fat accumulation. Recent evidence has demonstrated that the relationship between visceral fat area (VFA) and DPN is not a simple linear correlation, but exhibits non-linear patterns such as U-shaped, J-shaped curves or threshold effects. This paper systematically reviews the epidemiological evidence of the non-linear relationship between VFA and DPN, focusing on the core pathophysiological mechanisms, including threshold activation of chronic low-grade inflammation, bidirectional effects of insulin resistance and glucolipotoxicity, oxidative stress and mitochondrial dysfunction, neuro-microangiopathy, malnutrition and sarcopenia under low VFA conditions, body composition interaction, and regulation of the “nerve-bone axis”. On this basis, we further discuss the clinical translational value of such non-linear relationships, including risk stratification of high-risk populations, individualized body composition management, optimization of predictive models, and combined early warning of fracture risk. We also analyze the main limitations of current studies and future directions. This review aims to provide new theoretical basis and clinical insights for the precise prevention and individualized treatment of DPN.