弥可保对糖尿病周围神经病变治疗作用的实验研究

目的　为探讨弥可保（ 甲钴酰胺） 对糖尿病周围神经病变的治疗作用。方法　对链脲佐菌素（ Ｓ Ｔ Ｚ） 诱导的糖尿病周围神经病变大鼠早期给予弥可保５００μｇ／ｋｇ 肌肉注射，每天１ 次，２ 个月后行摇尾试验，测定坐骨神经运动传导速度和局部血流量，并分离腓肠神经，光镜下行腓肠神经形态学定量分析。结果弥可保治疗后大鼠热痛阈值显著低于糖尿病组（ Ｐ＜ ０ ．０１） ，但坐骨神经运动传导速度和血流量差异不显著（ Ｐ＞ ０ ．０５） 。大鼠腓肠神经有髓鞘神经纤维数量和密度显著高于糖尿病组，神经轴索和髓鞘显著大于糖尿病组（ Ｐ＜ ０ ．０１） 。结论　弥可保对实验性糖尿病鼠周围神经损害有一定的防治作用。     

痛性糖尿病周围神经病变的临床治疗进展

痛性糖尿病周围神经病变(PDPN)是一种常见的较难治疗的糖尿病并发症,疼痛症状常导致患者抑郁和生活质量下降.治疗主要是针对潜在疾病,要控制好血糖,防止神经病变进展.缓解疼痛是治疗糖尿病周围神经病变(DPN)的重点与难点.目前疗法主要包括药物和物理治疗.药物主要有抗氧化剂、神经营养因子、抗抑郁药、抗癫痫药、抗心律失常药、麻醉类镇痛药及中药等.新一代药物不良反应较少,为治疗PDPN提供了新的选择.本文就其治疗的进展及机制作一综述.     

维生素D缺乏与糖尿病周围神经病变的相关性研究

目的 研究2型糖尿病患者维生素D缺乏与糖尿病周围神经病变(DPN)的相关性.方法 选取2型糖尿病患者200例和正常对照者100名,其中2型糖尿病患者分为DPN组(109例)和无糖尿病周围神经病变(NDPN)组(91例).通过ELISA法测定25 (OH) D3水平,常规测定肝、肾功能,HbA1c,血脂,血钙、磷,β2微球蛋白,尿微量白蛋白等指标.25 (OH) D3与各指标之间进行相关性分析.结果 与正常对照组相比,NDPN组和DPN组25 (OH) D3水平降低,DPN组降低更加明显(F=202.265,P＜0.01),且DPN组维生素D缺乏患者比例(76.1％)明显高于NDPN组(47.3％)(x2=17.763,P＜0.01).维生素D水平与DPN、病程、年龄、性别、空腹血糖、HbA1c、总胆固醇、低密度脂蛋白-胆固醇、24 h尿微量白蛋白、β2微球蛋白均呈显著负相关(r=-0.315～-0.144,P均＜0.05),而与血钙呈正相关(r=0.193,P=0.006).二元Logistic回归分析显示,维生素D缺乏是DPN的独立危险因素(OR=3.564,95％ CI:1.950 ～6.511,P＜0.001).结论 维生素D缺乏是DPN的独立危险因子,并可能在2型糖尿病及DPN的发生、发展中发挥作用.     

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.     

Diagnosing peripheral neuropathy in South‐East Asia: A focus on diabetic neuropathy

Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10‐g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South‐East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug‐induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B₁, B₆, B₁₂, D) should be actively excluded.     

Autonomic denervation may be a prerequisite of diabetic neuropathic foot ulceration

Studies using visceral (cardiovascular) autonomic function testing have left doubt as to the importance of autonomic neuropathy in the development of diabetic neuropathic foot ulceration. A test for peripheral autonomic denervation has been developed (acetylcholine sweatspot test), dependent on intradermal acetylcholine causing secretion by innervated sweat glands, detected by starch/iodine discoloration. The response is photographed and quantified using a grid (normal score = 0 or 1; abnormal = 5 to 60). The sweatspot test was applied to the feet of 19 diabetic patients with a history of foot ulceration, 17 with neuropathic pain, 8 complaining of numbness, and to 15 diabetic control patients. The sweatspot test score of the foot ulcer patients (median 54) was very much greater than that of the other groups (pain group, 4, p less than 0.005; numbness group, 2, p less than 0.01; diabetic control group, 2, p less than 0.0001). All the patients with neuropathic foot ulceration had peripheral autonomic denervation. The results suggest that autonomic denervation in the feet is always present in patients with diabetic neuropathic foot ulceration. Tests of peripheral autonomic denervation such as the acetylcholine sweatspot test may be useful to identify patients at risk of neuropathic foot ulceration.     

牛磺酸对实验性糖尿病神经病变保护作用的机制探讨

目的研究牛磺酸对糖尿病大鼠神经病变的保护作用,并探讨其机制.方法对链脲菌素诱导的糖尿病大鼠模型,予以牛磺酸(0.5%饮水)治疗12周,观察其对血浆6-keto-PGF1.TXB3、坐骨神经糖化终产物、神经传导速度及神经结构的影响.结果牛磺酸可降低血浆TXB3及坐骨神经中糖化终产物,提高血浆6-keto-PGF1α含量,部分改善坐骨神经传导速度,减轻神经的病理改变.结论牛磺酸可通过降低血浆TXB2及坐骨神经糖基化终产物的含量,增加6-ketoPGF1α的生成,对糖尿病神经病变具有防治作用.     

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.     

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.

糖尿病周围神经病变与足型及足底压力的关系

目的分析糖尿病周围神经病变与糖尿病患者足型及静态足底压力的关系。方法2007年8月20日至2008年10月14日从华西医院内分泌科门诊及住院患者中整群抽取540例糖尿病患者（糖尿病组）,其中男227例,女313例,平均年龄（59±12）岁,体质指数（24±4）kg／m^2;另从成都市武侯区纳入年龄、性别、体质指数匹配的健康者231名（健康对照组）,其中男84名,女147名,平均年龄（64±11）岁,体质指数（23±4）kg／m^2。由专人使用密西根神经病变筛查量表（MNSI量表）对糖尿病组患者进行周围神经病变评估。使用足底图像扫描仪及足底压力测量仪测定研究对象足型、足底各部位静态相对压力峰值。采用t检验或卡方检验进行数据统计。结果2组参试者足底静态平均压力峰值（36±21VS36±22,t=-0．544,P=0．587）及足底各部位静态压力峰值无明显差异。糖尿病患者据MNSI评分分成A组（MNSI评分0～4分）、B组（MNSI评分4．5—6．5分）、C组（MNSI评分7分以上）,3组人群体质量及体质指数与健康对照组无差异。3组人群静态足底平均压力峰值与健康对照组比较无明显差异（A组为36±20,B组为35±20,C组为35±20,健康对照组为36±22）。各组足底各部位静态相对压力峰值与健康对照组比较差异亦无统计学意义（均P〉0．05）。糖尿病组锤状趾的发生率明显高于健康对照组[8．7％（47／540）VS4．3％（10／231）,X^2=3．966,P=0．029]。糖尿病组锤状趾和扁平足患者MNSI评分[（6．2±2．0）分VS（5．4±1．2）分,t=2．145,P=0．032;（6．6±2．1）分VS（5．4±1．2）分,t=2．339,P=0．02]高于糖尿病患者。结论MNSI评分不能预测糖尿病患者足底静态压力的变化;糖尿病周围神经病变是足部畸形发生的危险因素;伴足底压力升高或足部畸形的糖尿病周围神经病变患者是糖尿病足的高危人群。     

糖尿病性心自主神经、末梢神经病变与糖尿病微血管并发症的关系

目的 观察糖尿病性心自主神经病变和末梢神经病变的患病率及其与其他糖尿病慢性并发症的关系。方法 利用心自主神经功能检测系统和神经电生理检测仪测定308例糖尿病患者（平均年龄49岁，平均HbA1c9.8%。平均病程14年）的心自主神经功能和肢体的末梢神经传导速度，皮肤痛温觉，振动觉，同时检测24h尿白蛋白排泄率和眼底视网膜照相。结果 糖尿病患者心自主神经病变患病率为47.1%。末梢神经病变患病率为54.2%,两者呈显著正相关。并与病程和糖尿病控制状况呈显著正相关。并发糖尿病性神经病变患者并发其他糖尿病慢性并发症的机率增高。结论 糖尿病性神经病变患病率较高，并与糖尿病其他慢性并发症密切相关。     

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.     

Autonomic neuropathy and diabetic foot ulceration

Autonomic function was studied in three groups of insulin-dependent diabetic patients. Heart rate changes during deep breathing and on standing were significantly less in 28 patients with a recent history of foot ulceration compared with 40 patients with peripheral neuropathy but without ulceration (p less than 0.001) and 54 patients without neuropathy (p less than 0.001). Sympathetic function was assessed in 36 of these patients from peripheral arterial diastolic flow patterns obtained by Doppler ultrasound measurements and expressed as the pulsatility index (PI). Patients with a history of ulceration (n = 10) showed considerably increased diastolic flow (PI = 4.28 +/- 0.53, mean +/- S.E.M.) compared with 12 neuropathic patients with no history of ulceration (PI = 7.80 +/- 0.68, p less than 0.002) and 14 patients without neuropathy (PI = 9.55 +/- 0.89, p less than 0.002). Severely abnormal autonomic function occurs in association with neuropathic foot ulceration, but patients without ulcers have lesser degrees of autonomic neuropathy, thus a causal relationship has not been established.     

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.     

临床氧化应激指标与糖尿病周围神经病变的相关研究

目的调查2型糖尿病患者的临床氧化应激指标情况,分析其与2型糖尿病患者伴发周围神经病变的相关性。方法收集2016年10月至2017年5月解放军第306医院内分泌科同期住院的212例2型糖尿病患者一般资料及临床资料。根据2型糖尿病患者伴发周围神经病变诊断标准,将入选患者分为伴发周围神经病变(n=97)和未伴发周围神经病变(n=115)2组。应用SPSS 23.0对2组患者的一般情况及临床资料进行比较,采用logistic回归分析2型糖尿病患者伴发周围神经病变的危险因素。探讨2型糖尿病患者伴发周围神经病变的特点及其与临床氧化应激指标的相关性。结果 2型糖尿病患者伴发周围神经病变组患者年龄、病程、糖化血红蛋白、总胆固醇显著高于未伴发周围神经病变组患者,空腹C肽、血红蛋白和总胆红素显著低于2型糖尿病非周围神经病变组患者(P0.05)。单因素logistic回归分析显示年龄、病程、糖化血红蛋白、总胆红素、血红蛋白可能与2型糖尿病患者伴发周围神经病变相关,进一步多因素logistic回归分析显示病程(OR=1.006,95%CI 1.003~1.010)、糖化血红蛋白(OR=1.403,95%CI 1.118~1.657)、血红蛋白(OR=0.976,95%CI0.958~0.994)是2型糖尿病患者伴发周围神经病变的独立危险因素。结论 2型糖尿病患者伴发周围神经病变患者临床氧化应激指标(总胆红素、血红蛋白)低于2型糖尿病非周围神经病变患者,且具有高龄、糖尿病病程长、血糖控制不佳及胰岛功能差的特点。     

神经超声在周围神经疾病中的诊断应用

周围神经病是一种原发于周围神经系统结构或功能损害的疾病,其病因及诊断复杂。近几年神经超声的研究对周围神经病的诊断有一定的辅助价值。本文围绕神经超声在诊断周围神经疾病中的作用综述如下。