普瑞巴林治疗糖尿病痛性周围神经病变的疗效观察

目的 评价普瑞巴林治疗糖尿病痛性周围神经病变的疗效和安全性. 方法 入选T2DM患者60例,随机分为普瑞巴林组和阿米替林组,每组各30例.共观察4周.治疗开始和4周时测定血生化及周围神经传导速度,每日行疼痛强度数字分级法（NRS）评估,并记录药物不良反应.计算两组治疗4周时疼痛缓解≥50％的发生率. 结果 治疗后两组FPG、LDL-C较治疗前下降（P＜0.05）,但两组间比较差异无统计学意义.治疗前后主要终点指标NRS评分,普瑞巴林组为（5.2±1.4）vs（1.3±1.2）分;阿米替林组为（4.9±0.9）vs（2.2±1.3）分（P均＜0.01）.4周时普瑞巴林组NRS低于阿米替林组（P＜0.05）.普瑞巴林组和阿米替林组疼痛缓解≥50％的发生率为75.9％ vs 50.0％（P＜0.05）.普瑞巴林组头痛1例,心悸1例;阿米替林组头晕1例,嗜睡5例,便秘1例,水肿1例. 结论 普瑞巴林和阿米替林均可缓解糖尿病痛性周围神经病变,且普瑞巴林更有效、起效更快.     

Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus

Aims

To investigate the prevalence and risk factors for diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese.

维生素D缺乏与糖尿病周围神经病变

糖尿病周围神经病变（DPN）患者中普遍存在维生素D缺乏的现象.1,25（OH）2D3作为维生素D的活性形式,通过与细胞内的维生素D受体（VDR）结合发挥生物学作用.已有研究证明DPN与维生素D缺乏之间具有相关性.维生素D缺乏导致DPN的机制尚不完全清楚,但有资料证实维生素D缺乏可导致神经系统发育障碍、神经损伤及神经变性性疾病,减弱抗炎作用,促进动脉粥样硬化发展,损害胰岛β细胞功能及上调基质金属蛋白酶水平,进一步导致DPN的发生和发展.     

葛根素注射液治疗糖尿病周围神经病变的疗效观察

目的 观察葛根素注射液治疗糖尿病周围神经病变（ＤＰＮ）的疗效。方法 采用葛根素注射液治疗ＤＰＮ６６例,同时与甲钴胺治疗的２２例作对照,观察葛根素注射液对ＤＰＮ患者肌电图,空腹血糖,糖化血红蛋白、血液流变学及红细胞山梨醇的影响。结果 治疗组显效率为５１．５１％,对照组为２２．７２％（Ｐ〈０．０１）,治疗组总有效率为８９．３９％,对照组为５８．１０％（Ｐ〈０．０５）,治疗组在治疗后,空腹血糖略有下降（     

2型糖尿病患者周围神经病变危险因素分析

目的 探讨T2DM住院患者糖尿病周围神经病变（DPN）患病率及危险因素. 方法 选取T2DM住院患者205例,以多伦多临床评分系统（TCSS）评分作为DPN诊断标准,分为DPN组和无DPN（NDPN）组,比较两组各项指标. 结果 DPN患病率43.9％.DPN组年龄（57.76±12.50）vs（49.50±13.28）岁]、病程[（8.12±2.50）vs（5.67±1.99）年]、体重[（62.50±10.46） vs （67.03±13.43）kg]、DBP[（82.79±13.69）vs（86.98±12.18） mmHg]、BUN[（10.15±1.52）vs（41.35±5.66）μmol/L]、Scr[（102.79±61.56）vs（74.61±34.26）μmol/L]、UAlb/Cr[（211.66±26.78）vs（44.21±9.77）mg/24 h]和DR患病率[41（45.5％） vs 20（17.4％）]与NDPN组比较差异有统计学意义（P＜0.01）.Logistic多元回归分析显示,年龄、病程、UAlb/Cr、合并DR与DPN发生呈正相关. 结论 年龄、病程、UAlb/Cr、合并DR可能是T2DM住院患者发生DPN的危险因素.     

糖尿病周围神经病变的诊断方法

糖尿病周围神经病变( DPN)难以治愈,不仅影响患者生活质量,还易造成其足部疼痛、溃疡、截肢等不良后果.现有的DPN诊断方法或对早期病变灵敏度低,如临床评分方法、单丝检测;或为侵入性检查,如皮肤活检、神经活检,亟需灵敏、简单、有效且安全的方法.一些新的诊断技术如泌汗功能检测、足底压力测定、角膜共聚焦显微镜等也已在临床上开始应用.     

Prevalence and risk factors for diabetic peripheral neuropathy,neuropathic pain and foot ulceration in the Arabian Gulf region

Aims/IntroductionThis study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN), painful DPN and diabetic foot ulceration (DFU) in patients with type 2 diabetes in secondary healthcare in Qatar, Kuwait and the Kingdom of Saudi Arabia.Materials and MethodsAdults aged 18–85 years with type 2 diabetes were randomly enrolled from secondary healthcare, and underwent clinical and metabolic assessment. DPN was evaluated using vibration perception threshold and neuropathic symptoms and painful Diabetic Peripheral Neuropathy was evaluated using the Douleur Neuropathique 4 questionnaire.ResultsA total of 3,021 individuals were recruited between June 2017 and May 2019. The prevalence of DPN was 33.3%, of whom 52.2% were at risk of DFU and 53.6% were undiagnosed. The prevalence of painful DPN was 43.3%, of whom 54.3% were undiagnosed. DFU was present in 2.9%. The adjusted odds ratios for DPN and painful DPN were higher with increasing diabetes duration, obesity, poor glycemic control and hyperlipidemia, and lower with greater physical activity. The adjusted odds ratio for DFU was higher with the presence of DPN, severe loss of vibration perception, hypertension and vitamin D deficiency.ConclusionsThis is the largest study to date from the Middle East showing a high prevalence of undiagnosed DPN, painful DPN and those at risk of DFU in patients with type 2 diabetes, and identifies their respective risk factors.     

糖尿病周围神经病变和血管病变对糖尿病足溃疡的相互作用及相关性探讨

目的 探讨糖尿病足溃疡（DFU）发生的危险因素,分析糖尿病周围神经病变（DPN）和糖尿病血管病变（PAD）与DFU的相互作用.方法 选取T2DM患者278例,按其是否合并DFU分成糖尿病足溃疡组（DFU,102例）和糖尿病非足溃疡组（NDFU,176例）,回顾性分析两组生化特征和并发症情况.采用Logistic回归分析DFU发生的危险因素,并通过相对超额危险度比（RERI）,归因比（AP）和相互作用指数（S）评价DPN与PAD的相加相互作用.结果 与NDFU组比较,DFU组HbA1c和纤维蛋白原（FIB）水平,DR、DPN和PAD发生率均升高,血红蛋白（Hb）、血白蛋白（Alb）、TC和LDL-C降低（P＜0.05）.Logistic回归分析显示,DFU相关影响因素有：HbA1 c、DPN、PAD、Hb、Alb和FIB（OR分别为1.41、3.66、3.00、0.98、0.79和2.51）.DPN和PAD对DFU的相加相互作用指标RERI、AP和S分别为3.45（95％CI：1.22～8.56）、0.29（95％CI：0.02～0.58）和1.45（95％CI：1.03～4.96）.结论 血糖控制欠佳、合并DPN和PAD、营养不良及FIB代谢失衡是DFU发生的主要危险因素.DPN和PAD对DFU存在相加相互作用,同时患有DPN和PAD可增加DFU的患病风险.     

糖尿病周围神经病变的神经传导检查特点

目的 分析神经传导检查在糖尿病周围神经病变（DPN）中的特点,提高此方法诊断DPN的敏感性. 方法 对符合标准的213例患者的2283条神经行传统的神经传导、F波、H反射检查,并分析各条神经总的神经电生理检查情况. 结果 2283条神经进行常规神经传导检查结果显示,感觉神经传导速度（SCV）中,正中神经的异常率最高;运动神经传导速度（MCV）中,胫神经、正中神经异常率高;最长的胫神经运动神经神经传导异常率为47.45％,容易合并卡压的正中神经感觉神经传导异常率为46.83％,而腓肠神经感觉神经传导异常率最低（22.60％）.对有临床明确症状的21条神经进行神经传导检查,异常率可达76.19％.对感觉神经传导异常的尺神经进行运动神经传导检查,尺神经异常率为57.14％.常规神经传导检查,正中神经感觉神经传导异常率（46.83％）高于正中神经运动神经传导异常率（41.13％）.正中神经感觉神经传导异常者运动神经传导异常率为76.56％,正中神经运动神经传导异常者感觉神经传导异常率为89.63％.尺神经F波、胫神经H反射的异常率分别为25.83％、52.24％.结论 DPN具有长度依赖性、与临床表现一致、感觉重于运动、全长弥漫受累等特点,根据这些特点选择神经进行神经传导检查,可提高神经传导检查诊断DPN的敏感性.     

阿魏酸钠治疗糖尿病周围神经病变的作用机制

目的　观察阿魏酸钠治疗 2型糖尿病周围神经病变的临床疗效 ,探讨其作用机制。方法　将 32例 2型糖尿病并发周围神经病变患者随机分成治疗组 2 0例、对照组 12例 ,在常规治疗基础上 ,观察组加用阿魏酸钠30 0 mg/ d,对照组予以丹参注射液 2 0 ml/ d,总疗程均为 4周。治疗前后测定运动神经传导速度 (MNCV)、感觉神经传导速度 (SNCV)、血浆内皮素 - 1(ET- 1)、血清一氧化氮 (NO)水平及红细胞山梨醇含量。结果　治疗组神经传导速度明显改善 (P<0 .0 5 ) ,血浆 ET- 1及红细胞山梨醇含量明显下降 (P<0 .0 1) ,血清 NO明显升高 (P<0 .0 1) ;对照组则无明显变化。结论　阿魏酸钠治疗糖尿病性周围神经病变的作用与其拮抗 ET- 1、升高 NO和降低神经组织山梨醇水平有关。     

Heart rate‐corrected QT interval: A novel diagnostic biomarker for diabetic peripheral neuropathy

Aims/IntroductionTo explore the relationship between heart rate‐corrected QT (QTc) interval and diabetic peripheral neuropathy (DPN), and whether QTc interval has diagnostic utility for DPN beyond nerve conduction velocity.Materials and MethodsA total of 965 patients with diabetes, including 473 patients with DPN and 492 patients without DPN, underwent standard 12‐lead electrocardiography and detailed assessments of peripheral neuropathy.ResultsPatients with DPN had longer QTc intervals than those without. Among participants, from the first to fourth quartile of QTc interval, the proportion of patients with DPN appreciably increased and the nerve conduction velocity obviously decreased (P for trend <0.001). The univariate and multivariate analyses showed that prolonged QTc interval was closely associated with increased risk of DPN (univariable odds ratio 1.112, 95% confidence interval 1.097–1.127, P < 0.001; multivariable odds ratio 1.118, 95% confidence interval 1.099–1.137, P < 0.001). Receiver operating characteristic analysis for the diagnosis of DPN showed a greater area under the curve for QTc interval of 0.894 than the median nerve motor conduction velocity of 0.691, median nerve sensory conduction velocity of 0.664 and peroneal nerve motor conduction velocity of 0.692. The optimal cut‐off point of QTc interval for DPN was 428.5 ms with sensitivity of 0.715 and specificity of 0.920 (P < 0.001). The combination of QTc interval and nerve conduction testing increased the area under the curve for the diagnosis of DPN (from 0.736 to 0.916; P < 0.001).ConclusionsQTc interval with 428.5 ms has more reliable diagnostic utility for DPN than nerve conduction velocity, and prolonged QTc interval is closely associated with an increased risk of DPN.     

糖尿病周围神经病变临床诊断方法的价值评估

目的 探讨神经症状/神经缺陷评分（NSS/NDS）、密歇根神经病变筛选法（MNSI）、多伦多临床评分系统（TCSS）在糖尿病周围神经病变（DPN）中的临床诊断价值. 方法 188例T2DM患者行神经肌电图、NSS/NDS、MNSI、TCSS检查,以神经传导速度（NCV）作为“金标准”,分析3种检查方法的特异性、敏感性、受试者工作特征（ROC）曲线下面积（Az）等,比较不同检查方法诊断DPN的准确性和诊断价值. 结果 MNSI≥2.5分及TCSS≥5分时与NCV相关性好（P＜0.01）.MNSI、TCSS与NCV一致性高于NSS/NDS （Kappa值分别为0.524、0.547、0.534）.MNSI≥2.5分分别与TCSS≥5分和TCSS≥6分的诊断结果进行比较差异无统计学意义.NSS/NDS、MNSI、TCSS的Az分别为（0.579±0.027）、（0.794±0.034）、（0.814±0.032）,MNSI、TCSS的诊断准确性中等,NSS/NDS的诊断准确性较低. 结论 MNSI、TCSS与NCV有较高的一致性,诊断准确性均高于NSS/NDS.MNSI≥2.5分及TCSS≥5分时,诊断DPN价值较好,且诊断价值相当,MNSI操作相对简单、耗时短.     

Non-invasive and quantitative assessment of sudomotor function for peripheral diabetic neuropathy evaluation

Aims

Perturbation of pain sensation is considered one of the major initiating risk factors for diabetic foot ulcer. Sweat dysfunction leading to abnormal skin conditions, including dryness and fissures, can increase foot ulcer risk. The aim of this study was to evaluate Sudoscan™, a new, quick, non-invasive and quantitative method of measuring sudomotor dysfunction as a co-indicator of the severity of diabetic polyneuropathy (DPN).

Methods

A total of 142 diabetic patients (age 62 ± 18 years, diabetes duration 13 ± 14 years, HbA_1c 8.9 ± 2.5%) were measured for vibration perception threshold (VPT), using a biothesiometer, and for sudomotor dysfunction, using electrochemical sweat conductance (ESC) based on the electrochemical reaction between sweat chloride and electrodes in contact with the hands and feet. Retinopathy status was also assessed, as well as reproducibility between two ESC measurements and the effect of glycaemia levels.

Results

ESC measurements in the feet of patients showed a descending trend from 66 ± 17 μS to 43 ± 39 μS, corresponding to an ascending trend in VPT threshold from < 15 V to > 25 V (P = 0.001). Correlation between VPT and ESC was −0.45 (P < 0.0001). Foot ESC was lower in patients with fissures, while VPT was comparable. Both VPT and foot ESC correlated with retinopathy status. Bland–Altman plots indicated good reproducibility between two measurements, and between low and high glycaemia levels.

Conclusion

Sudoscan™ is a reproducible technique with results that are not influenced by blood glucose levels. Sweating status may be a quantitative indicator of the severity of polyneuropathy that may be useful for the early prevention of foot skin lesions.     

血浆同型半胱氨酸和胱抑素C与糖尿病周围神经病变的相关性研究

目的 探讨同型半胱氨酸（Hcy）和胱抑素C（Cys-C）与糖尿病周围神经病变（DPN）的相关性. 方法 选取2009年1月至2013年10月于我院就诊的T2DM患者248例,根据2010年版《中国2型糖尿病防治指南》诊断标准将对象分为亚临床糖尿病神经病变组（SDPN组）80例、糖尿病神经病变组（DPN组）52例和单纯T2DM组（T2DM组）116例.检测各组Hcy、Cys-C、FPG、HbA1 c、TG及TC等水平. 结果 3组年龄、性别比、BMI、FPG、TG、TC、HDL-C和LDL-C、SBP、DBP及血清肌酐（Scr）比较差异无统计学意义（P＞0.05）.与T2DM组比较,SDPN组和DPN组病程、Hcy和Cys-C升高（P＜0.05或P＜0.01）,且DPN组Hcy高于SDPN组（P＜0.05）.SDPN组和DPN组正中神经运动神经传导速度（MCV）和感觉神经传导速度（SCV）、腓总神经MCV和SCV较T2DM组降低（P＜0.05或P＜0.01）;DPN组正中神经MCV和SCV、腓总神经MCV和SCV较SDPN组低（P＜0.05或P＜0.01）.SDPN组和DPN组正中神经F波潜伏期和腓总神经H反射潜伏期较T2DM组升高（P＜0.05或P＜0.01）;DPN组正中神经F波潜伏期,腓总神经H反射潜伏期较SDPN组高（P＜0.05或P＜0.01）.Logistic回归分析显示,Hcy、Cys-C、病程、SBP和HbA1c是DPN的独立影响因素. 结论 SDPN和DPN患者神经反射潜伏期延长,MCV和SCV减慢,且血浆Hcy与肌电图各参数相关,提示血浆Hcy与神经传导异常相关,说明血浆Hey可作为DPN的预测因子与危险因素.这两类患者Cys-C浓度升高,且与Hcy水平相关,提示Cys-C可能与Hcy共同作用,加重DPN.     

黄芩甙治疗糖尿病周围神经病变的初步观察

目的观察黄芩甙对醛糖还原酶（AR）活性的抑制作用及其对糖尿病神经病变的疗效。方法74例糖尿病患者随机分为黄芩甙治疗组和对照组,治疗组每天服黄芩甙3g。结果黄芩甙治疗后患者红细胞AR活性显著降低（1．29±0．64U／gHbvs2．42±0．85U／gHb,P＜0．01）;黄芩甙缓解神经病变症状总有效率为583％,明显高于对照组（3．3％,P＜0．01）;治疗后黄芩甙组神经传导速度趋于稳定,部分项目略有改善,而对照组则呈进行性恶化趋势,两组腓总神经、胫神经传导速度有显著性差异,分别为31．4±6．1m／svs269±5．3m／s（P＜0．05）和31．8±5．2m／svs26．5±4．8m／s（P＜0．05）,黄芩甙组的腓总神经、医神经末端潜伏期明显绍短,分别为5．00±0．64m／svs5．60±0．56m／s（P＜0．05）和5．10±0．58m／svs5．60±0．57m／s（P＜0．05）,正中神经和尺神经的感觉神经动作电位波幅也显著提高（P＜0．05）。未见明显不良反应及肝肾毒性。结论黄芩甙在体内具有明显的AR活性抑制作用,可有效的缓解糖尿病周围神经病变的临床症状,改善其神经传导速度,从而有助于防止糖尿病神经病变的发生与发展。     

Efficacy and safety evaluation of pregabalin treatment over 52 weeks in patients with diabetic neuropathic pain extended after a double‐blind placebo‐controlled trial

Aims/Introduction:  Diabetic peripheral neuropathy (DPN) is often associated with pain, and thus a new treatment option is anticipated. We recently showed the efficacy of pregabalin in a randomized, double‐blind, placebo‐controlled, 14‐week trial in Japanese patients with painful DPN. In the present study, we evaluated the long‐term efficacy and safety of pregabalin for the relief of painful DPN.Materials and Methods:  A total of 123 patients were enrolled in a 52‐week open‐label study, from among those who participated in the preceding double‐blind trial. The subjects received pregabalin 150–600 mg/day. Pain intensity was measured using the short‐form McGill pain questionnaire (SF‐MPQ: total score, visual analog scale and present pain intensity).Results:  The efficacy parameter SF‐MPQ showed a decrease over the treatment period. The changes in visual analog scale and present pain intensity at the final evaluation were −25.4 mm and −0.7, respectively, suggesting an analgesic effect of pregabalin. Commonly reported adverse events were somnolence, weight gain, dizziness and peripheral edema, but most of them were mild to moderate in intensity. No new concerns about safety as a result of long‐term administration of pregabalin were identified.Conclusions:  The findings from this trial suggest that long‐term treatment with pregabalin is beneficial for pain relief in patients with DPN. This trial was registered with ClinicalTrials.gov (no. {"type":"clinical-trial","attrs":{"text":"NCT00553280","term_id":"NCT00553280"}}NCT00553280). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00122.x, 2011)     

Electrophysiological measurements of diabetic peripheral neuropathy: A systematic review

Introduction

Peripheral neuropathy is one of the main complications of diabetes mellitus. One of the features of diabetic nerve damage is abnormality of sensory and motor nerve conduction study. An electrophysiological examination can be reproduced and is also a non-invasive approach in the assessment of peripheral nerve function. Population-based and clinical studies have been conducted to validate the sensitivity of these methods. When the diagnosis was based on clinical electrophysiological examination, abnormalities were observed in all patients.

加巴喷丁治疗糖尿病性神经痛的研究进展

糖尿病性神经痛是神经病理性疼痛的一个主要类型,患病人数多,治疗困难.加巴喷丁是一种新型的抗癫痫药物,目前被广泛应用十治疗糖尿病性神经痛,其镇痛机制尚未完全明确,对电压门控钙通道α2δ-1亚单位的调节作用可能是其主要作用机制.加巴喷丁治疗糖尿病神经性疼痛效果明确,不良反应轻微,是治疗糖尿病性神经痛较为理想的药物.     

α-硫辛酸治疗糖尿病周围神经病变疗效观察

目的观察α-硫辛酸对2型糖尿病（T2DM）患者周围神经病变的疗效。方法T2DM患者50例随机分为：治疗组26例,对照组24例。治疗组给予α-硫辛酸注射液24ml静滴,对照组给予葛根素0．4g静滴,疗程3周。结果治疗组临床疗效、神经传导速度改善明显优于对照组,差异有统计学意义（P〈0．05）。结论抗氧化剂α-硫辛酸能明显改善T2DM患者周围神经病变。