同型半胱氨酸与糖尿病周围神经病变的关系

目的:了解血浆同型半胱氨酸(Hcy)与2型糖尿病周围神经病变间的关系及叶酸对Hcy水平的影响和对糖尿病周围神经病变的防治作用.方法:24只糖尿病KKAy小鼠分为3组:糖尿病诱发饮食组(KA组);高蛋氨酸饮食组(KB组);喂养高蛋氨酸饮食的基础上加用叶酸组(KC组).16只C57小鼠为正常对照组,分为2组:糖尿病诱发饮食组(CA组);高蛋氨酸饮食组(CB组).测定血糖、体重、血浆HCY、叶酸浓度,并观察光镜下及电镜下坐骨神经结构变化.结果:糖尿病小鼠喂饲蛋氨酸后出现高Hcy血症,对照组无此改变.糖尿病小鼠的坐骨神经出现不同程度的缺血性改变,且与Hcy水平相关.叶酸可减轻坐骨神经损害的程度.结论:高同型半胱氨酸为糖尿病微血管病变的危险因素,叶酸可起到干预作用.     

同型半胱氨酸与糖尿病周围神经病变的关系

目的：了解血浆同型半胱氨酸(Hcy)与2型糖尿病周围神经病变间的关系及叶酸对Hcy水平的影响和对糖尿病周围神经病变的防治作用。方法：24只糖尿病KKAy小鼠分为3组：糖尿病诱发饮食组(KA组)；高蛋氨酸饮食组(KB组)；喂养高蛋氨酸饮食的基础上加用叶酸组(Kc组)。16只C57小鼠为正常对照组，分为2组：糖尿病诱发饮食组(CA组)；高蛋氨酸饮食组(CB组)。测定血糖、体重、血浆HCY、叶酸浓度，并观察光镜下及电镜下坐骨神经结构变化。结果：糖尿病小鼠喂饲蛋氨酸后出现高Hcy血症，对照组无此改变。糖尿病小鼠的坐骨神经出现不同程度的缺血性改变，且与Hcy水平相关。叶酸可减轻坐骨神经损害的程度。结论：高同型半胱氨酸为糖尿病微血管病变的危险因素，叶酸可起到干预作用。     

Autonomic disturbances in relation to sensorimotor peripheral neuropathy in diabetes mellitus

Summary Thirty patients with diabetes mellitus were investigated. Twenty-seven had clinical signs of a symmetrical sensory or sensorimotor polyneuropathy. Features of autonomic dysfunction were found in 17 patients. Nerve conduction was studied in the femoral, deep peroneal, saphenous, sural and sensory and motor fibres of the posterior tibial nerves. The postural heart rate response was tested in all of the 30 patients.There was only a weak correlation between autonomic disturbances and sensorimotor polyneuropathy, based either on clinical or on electrophysiological results. Thus a multifactorial causation is suspected.

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Zusammenfassung Bei 30 Patienten mit einem Diabetes mellitus wurden der N. femoralis, N. peronaeus, der motorische und sensible Anteil des N. tibialis, der N. suralis und der N. saphenus neurographisch untersucht. Ferner wurde bei allen Patienten qualitativ die Änderung der Herzfrequenz nach Lagewechsel bestimmt. Klinische Symptome einer distal betonten, symmetrischen sensibelmotorischen Polyneuropathie fanden sich bei 27 Patienten, 17 Patienten klagten über Störungen des autonomen Nervensystems. Ein pathologisches Verhalten der Änderung der Herzfrequenz nach Lagewechsel bestand bei 6 Patienten. Sowohl klinisch als auch elektrophysiologisch war nur eine schwache Korrelation zwischen autonomen Störungen und sensibel-motorischen Ausfällen zu beobachten.

     

Cardiovascular autonomic neuropathy in patients with type 2 diabetes with and without sensorimotor polyneuropathy

Background and Aims

Cardiovascular autonomic neuropathy (CAN) in patients with diabetes is associated with poor prognosis. We aimed to assess signs of CAN and autonomic symptoms and to investigate the impact of sensorimotor neuropathy on CAN by examining type 2 diabetes patients with (DPN [distal sensorimotor polyneuropathy]) and without distal sensorimotor polyneuropathy (noDPN) and healthy controls (HC). Secondarily, we aimed to describe the characteristics of patients with CAN.

Methods

A population of 374 subjects from a previously described cohort of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) were included. Subjects were examined with the Vagus™ device for the diagnosis of CAN, where two or more abnormal cardiovascular autonomic reflex tests indicate definite CAN. Autonomic symptoms were assessed with Composite Autonomic Symptom Score 31 (COMPASS 31) questionnaire. DPN was defined according to the Toronto consensus panel definition.

Results

Definite CAN was present in 22% with DPN, 7% without DPN and 3% of HC, and 91% of patients with definite CAN had DPN. Patients with DPN and definite CAN reported higher COMPASS 31 scores compared to patients with noDPN (20.0 vs. 8.3, p < 0.001) and no CAN (22.1 vs. 12.3, p = 0.01). CAN was associated with HbA1c and age in a multivariate logistic regression analysis but was not associated with IEFND or triglycerides.

Interpretation

One in five patients with DPN have CAN and specific CAN characteristics may help identify patients at risk for developing this severe diabetic complication. Autonomic symptoms were strongly associated with having both DPN and CAN, but too unspecific for diagnosing CAN.     

Risks for sensorimotor peripheral neuropathy and autonomic neuropathy in non-insulin-dependent diabetes mellitus (NIDDM)

Identification of risk factors for development of diabetic sensorimotor peripheral neuropathy (DSPN) and diabetic autonomic neuropathy (DNA) may help to prevent or modify these complications. The ABCD Trial, a prospective study of diabetic complications, has identified risk factors of the presence and staging of peripheral neuropathy based on neurological symptom scores, neurological disability scores, autonomic function testing and quantitative sensory examination. DSPN is independently associated with diabetes duration [odds ratio (OR) = 1.5 per 10 years], body weight (OR = 1.1 per 5 kg), age (OR = 1.8 per 10 years), retinopathy (OR = 2.3), overt albuminuria (OR = 2.5), height (OR = 1.2 per 10 cm), duration of hypertension (OR = 1.1 per 10 years), insulin use (OR = 1.4), and race/ethnicity [African American vs. non-Hispanic white (OR = 0.4) and Hispanic vs. non-Hispanic white (OR = 0.8)]. DAN is independently associated with diabetes duration (OR = 1.2 per 10 years), body weight (OR = 1.1 per 5 kg), glycosylated hemoglobin (OR = 1.1 per 2.5%), overt albuminuria (OR = 1.6), and retinopathy (OR = 1.8). © 1998 John Wiley & Sons, Inc. Muscle Nerve, 21: 72–80, 1998.     

细胞因子与2型糖尿病周围神经病变的相关性研究

目的 观察细胞因子TNF-α、IL-1β和IL-6在2型糖尿病周围神经病变患者的表达并分析其相关性.方法 收集在本院住院治疗的120例2型糖尿病患者及60例正常体检者的病史和临床生化资料,2型糖尿病患者根据有无周围神经病变分成两组:单纯2型糖尿病组与2型糖尿病周围神经病变组.ELISA法分别测定两组患者的细胞因子TNF-α、IL- 1β和IL-6.采用多因素相关分析方法,分析细胞因子与2型糖尿病周围神经病变之间的关系.结果 对照正常组与单纯2型糖尿病组,FBG、PPG、HbAlc、Hs-CRP、TNF-α和IL- 1β在2型糖尿病周围神经病变组表达明显增高,具有统计学意义(P＜0.05).多因素相关分析显示Hs-CRP、TNF-α和HbAlc对2型糖尿病是否合并周围神经病变均有独立作用.结论 免疫炎性反应参与了2型糖尿病周围神经病变的发生.     

Minocycline improves peripheral and autonomic neuropathy in type 2 diabetes: MIND study

Diabetic peripheral neuropathy and diabetic autonomic neuropathy are serious and common complications of diabetes associated with increased risk of mortality and cardiovascular disease. We sought to evaluate the safety and efficacy of minocycline in type 2 diabetic patients with diabetic peripheral and autonomic neuropathy. In a randomized placebo controlled study, 50 outpatients were randomly assigned to receive 100 mg minocycline or placebo. Outcome measures included the vibration perception threshold (VPT), Leeds assessment of neuropathic symptoms and signs (LANSS), Pain Disability Index (PDI), Visual Analog Scale (VAS), beck depression inventory (BDI), health assessment questionnaire (HAQ) and autonomic neuropathy, assessed by cardiovascular reflex tests according to Ewing and peripheral sympathetic autonomic function was assessed by FDA approved Sudoscan. At baseline there were no significant differences between demographic variables and the neuropathy variables in the minocycline and placebo groups. After treatment, VPT significantly improved in the minocycline group as compared to the placebo group. Mean posttreatment scores on the LANSS, PDI and HAQ were significantly lower in the minocycline group compared with the placebo group. However, BDI and VAS significantly (p = 0.01) improved in both minocycline and placebo groups (Table 2). After treatment with minocycline, heart rate (HR) response to standing significantly improved, while there was a borderline significance toward a reduction in HR response to deep breath. These finding indicate that 6-week oral treatment with minocycline is safe, well tolerated and significantly improves peripheral and autonomic neuropathy in type 2 diabetic patients.     

HLA class Ⅱ alleles and risk for peripheral neuropathy in type 2 diabetes patients

The potential impact of human leukocyte antigen (HLA) genotype variations on development of diabetic peripheral neuropathy (DPN) is not well determined. hTis study aimed to identify the association of HLA class II alleles with DPN in type 2 diabetes (T2D) patients. Totally 106 T2D patients, 49 with DPN and 57 without DPN, and 100 ethnic-matched healthy controls were analyzed. Both groups of the patients were matched based on sex, age, body mass index (BMI) and duration of T2D. Polyneuropathy was diagnosed using electrodiagnostic methods. HLA-DRB1 and DQB1 genotyping was performed in all subjects by the polymerase chain reaction with sequence-specific primers (PCR-SSP) method. T2D patients with DPN showed higher frequencies of HLA-DRB1*10 and DRB1*12 alleles compared to control group (P = 0.04). HLA-DQB1*02 allele and HLA-DRB1*07-DQB1*02 haplotype were associated with a decreased risk for developing DPN in T2D patients (P = 0.02 andP = 0.05 respectively). Also, patients with severe neurop-athy showed higher frequencies of DRB1*07 (P = 0.003) and DQB1*02 (P = 0.02) alleles than those with mild-to-moderate form of neuropathy. The distribution of DRB1 and DQB1 alleles and haplotypes were not statistically different between all patients and healthy controls. Our ifndings implicate a possible protective role of HLA-DQB1*02 allele and HLA-DRB1*07-DQB1*02 haplotype against development of peripheral neuropathy in T2D patients. Therefore, variations in HLA genotypes might be used as genetic markers for prediction and potentially management of neuropathy in T2D patients.     

2型糖尿病并发糖尿病周围神经病变与代谢综合征的关系

目的 探讨2型糖尿病(T2DM)并发糖尿病周围神经病变(DPN)与代谢综合征(MS)的关系。方法 选取我院收治的T2DM患者95例,按是否并发MS进行分组,并发MS 45例为研究组,无MS为对照组50例。2组均进行电生理检查、MS相关指标的血液、尿液标本测定,统计2组DPN发生率,比较2组SCV和MCV及MS相关指标水平,并进行影响DPN的多因素Logistic回归分析。结果 研究组DPN发生率为62.22%,对照组为12.00%,差异有统计学意义(P0.01)。2组左右腓神经SCV、MCV比较有显著差异(P0.01)。2组TC、TG、LDL-C比较差异无统计学意义(P0.05),2hINS、UA、HbA1c、CRP、UAER水平比较有明显差异(P0.01)。多因素Logistic回归分析结果显示,HbA1c、UAER、2hINS、CRP等MS相关指标异常均为DPN的危险因素。结论 T2DM并发DPN与MS密切相关,MS相关指标,如HbA1c、UAER、2hINS等水平过高是导致DPN发生的高危因素,故临床在控制血糖的时候应注重患者MS相关指标的检测与调控。     

2型糖尿病并发周围神经病的危险因素及其发病机制探讨

目的 :研究 2型糖尿病合并周围神经病 ( DPN)的危险因素 ,探讨其发病机制。方法 :测定 1 0 6例伴或不伴有周围神经病的 2型糖尿病患者的空腹血糖 ( FBG)、糖化血红蛋白 ( Hb AIC)、甘油三酯 ( TG)、总胆固醇 ( TC)、高密度脂蛋白 -胆固醇 ( HDL-C)、低密度脂蛋白 -胆固醇 ( LDL-C)、脂蛋白 ( a) [Lp( a) ]、载脂蛋白 A( Apo-A)、载脂蛋白 B( Apo-B)以及身高、体重、血压 ,行 Logistic多元逐步回归 ,筛选 DPN的危险因素。结果 :糖尿病病程、身高、舒张压、Hb AIC、TC、Lp( a)是 DPN的独立危险因素 ,Apo-A是 DPN的保护因素。结论 :血糖、血压、血脂控制不良导致 DPN的发生和发展 ,代谢因素和血管因素在其发病机制中起重要作用。     

Electrophysiological findings of peripheral neuropathy in newly diagnosed type II diabetes mellitus

This study was aimed at assessing the electrophysiological signs of peripheral neuropathy in diabetes mellitus (DM) type II patients at diagnosis. Nerve conduction studies (NCS) of median, ulnar, peroneal, tibial and sural nerves were performed in 39 newly diagnosed DM subjects and compared to those of 40 healthy controls. Metabolic indices were also investigated. Electrophysiological alterations were found in 32 (82%) of the DM patients, and more than half of them (62.2%) showed multiple (two to five) abnormal parameters. Because most of the subjects (84.4%) had from two to five nerves involved, these alterations were widespread in the seven nerves evaluated. Forty-two percent of the patients had NCS alterations suggestive of distal median mononeuropathy, implying that metabolic factors in DM make the median nerve more susceptible to focal entrapment. A reduced sensory nerve action potential (SNAP) amplitude was observed in the median nerve in 70% of the patients, in the ulnar in 69% and in the sural nerve only in 22%. In the presence of a decrease in the SNAP amplitude of the ulnar or median nerve, the SNAP amplitude of the sural nerve was normal in 82 or 80% of the subjects, respectively. This finding may be in keeping with a distal involvement of the sensory fibres, as explored by routine median or ulnar NCS. No correlation was found between metabolic indices and NCS parameters. In conclusion, a high percentage of newly diagnosed DM patients show signs of neuropathy, and upper limb nerve sensory NCS seem to be more sensitive in detecting it than lower limb NCS.     

高频超声评价2型糖尿病患者下肢周围神经病变临床观察

目的探讨高频超声用于评价2型糖尿病合并周围神经病变患者下肢股神经和隐神经异常改变的临床价值。方法共81例2型糖尿病患者分为无周围神经病变组(40例)和合并周围神经病变组(41例),通过彩色多普勒超声观察股神经和隐神经内部回声及连续性,测量并比较神经宽径、厚径和横截面积。结果正常对照组受试者股神经和隐神经横切面扫描呈略高回声,内部呈细小筛网格状,纵切面扫描内部呈条状低回声和平行线样排列的条状略高回声;无周围神经病变组患者内部回声略减低,细小筛网格状结构模糊,纵切面条状低回声结构欠清晰;合并周围神经病变组患者内部回声明显减低,细小筛网格状结构显示不清,纵切面条状低回声结构模糊。与正常对照组相比,糖尿病组患者股神经宽径(均P=0.000)、厚径(P=0.023,0.036)和横截面积(均P=0.000)增大;隐神经宽径(P=0.010,0.014)、厚径(均P=0.001)和横截面积(P=0.002,0.004)增大;合并周围神经病变组患者股神经和隐神经厚径(P=0.048,0.012)和横截面积(P=0.031,0.034)较无周围神经病变组增大。结论高频超声可以清晰地显示2型糖尿病合并周围神经病变患者股神经和隐神经主干内部回声及各径线的异常改变,为临床诊断提供客观依据,具有重要临床意义。     

浙江省临海市2型糖尿病患者DPN筛查及相关危险因素分析

目的探讨浙江省临海市2型糖尿病患者糖尿病周围神经病变(DPN)的患病状况及相关危险因素。方法多级分层抽样对临海市2型糖尿病患者进行DPN筛查,有效筛查2609例,男性783例,女性1826例,年龄30~85岁,平均年龄为(64.24±9.93)岁。DPN采用糖尿病周围神经病筛查流程(DPN-SP)进行社区糖尿病患者DPN筛查,根据有无DPN分为DPN组与非DPN组进行分析,并进一步对DPN有关的各危险因素进行二元Logistic多因素回归分析。结果临海市DM人群中DPN患病率为38.67%。两组性别、年龄、糖尿病病程、高血压史、腰围、体质指数(BMI)、SBP、DBP、空腹血糖、肌酐、甘油三脂比较差异有统计学意义(P0.05)。Logistic回归分析显示,DPN患病率与年龄、糖尿病病程、高血压、腰围、体质指数、空腹血糖有关。结论重视对糖尿病患者血糖、血压达标管理,加强体质指数、腰围的干预,对控制和延缓DPN的发生有重要的意义。     

Luminance and chromatic visual evoked potentials in type I and type II diabetes: relationships with peripheral neuropathy

Abstract The objective of the study was to investigate the subclinical visual deficit in type I and II diabetes, and its relationship with peripheral neuropathy. Thirty-two healthy volunteers, 20 patients with type I diabetes and 30 patients with type II diabetes were studied in a clinical neurophysiology setting. Luminance (VEPs) and chromatic visual evoked potentials (CVEPs) were recorded, with white-black, grey-black, red-green and blue-yellow sinusoidal gratings. The peak latencies of the VEP positive wave and CVEP negative wave were recorded. Ten patients with type I and 8 with type II diabetes had peripheral neuropathy. VEPs were slower in patients with type II diabetes and CVEPs were slower in patients with type I and type II diabetes than in controls. Blue-yellow CVEPs were slower in type II than in type I diabetes. VEPs and red-green CVEPs were slower in patients with diabetes with neuropathy than in those without. In conclusion, we found that visual system impairment differs in diabetes with and without peripheral neuropathy.     

Malignant glioma and sensorimotor neuropathy

Summary A case of sensorimotor neuropathy in a male with malignant glioma is reported. The symptoms of peripheral motor and sensory disturbances preceeded those of the intracranial tumor.The history, clinical findings, electrophysiological and histopathological results are presented, as well as immunological data. A possible causal relationship between glioma and peripheral neuropathy is discussed.

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Zusammenfassung Es liegen zahlreiche Veröffentlichungen von peripherer Polyneuropathie bei Patienten mit verschiedenen Malignomen vor. Es wird über einen Fall von sensorimotorischer Polyneuropathie bei einem Mann mit einem malignen Gliom des Gehirnes berichtet. Die Zeichen der peripheren motorischen und sensiblen Störungen manifestierten sich vor denjenigen des intrakraniellen Prozesses.Es wird über Anamnese, klinische Befunde, elektrophysiologische und neuropathologische Untersuchungsergebnisse berichtet sowie über die immunologischen Aspekte. Es wird eine mögliche kausale Beziehung zwischen dem Gliom und der peripheren Polyneuropathie diskutiert.

     

2型糖尿病周围神经病变与C肽水平的相关性研究

目的探讨C肽的生物学活性与2型糖尿病周围神经病变的相关关系,为临床C肽与胰岛素联合应用治疗2型糖尿病并发症提供更多的理论支持。方法回顾性分析98例2型糖尿病患者的神经传导速度与空腹C肽水平的关联性(因不同的神经传导速度不同,特以右侧腓肠神经感觉支为例)。结果相关分析显示:神经传导速度与体重指数,C肽呈正相关,与病程、糖化血红蛋白呈负相关。随着C肽水平的下降,2型糖尿病周围神经病变的分期逐渐加重。结论 C肽对神经具有保护性作用,推测其具有剂量依赖性,外源性C肽应用可能成为2型糖尿病周围神经病变的一种新的治疗手段。