糖尿病周围神经病变诊断治疗的误区

糖尿病周围神经病变是糖尿病的常见并发症，也是周围神经病变最重要的病因之一，严重影响患的生活质量，甚至不乏因足部溃疡经久不愈而导致截肢。尽管目前对糖尿病的认识不断提高，但是对糖尿病周围神经病变仍重视不够，在诊断治疗上存在不少误区，对此应充分加以认识。     

赛莱乐治疗糖尿病性周围神经病变的疗效观察

目的 观察赛莱乐治疗糖尿病性周围神经病变的疗效。方法 87例糖尿病性周围神经病变患者随机分为治疗组49例,给予赛莱乐100mg静脉点滴,每日1次,共28天;对照组38例,应用维生素B1 100mg＋维生素B12 500μg肌肉注射,每日1次,共28天。观察其治疗前后的临床症状及神经传导速度变化。结果 治疗组痛觉过敏、痛觉减退治疗后有效率达66．7％和78．9％,明显高于对照组的42．9％和55．2％（均P＜0．05）;运动神经传导速度（MCV）及感觉神经传导速度（SCV）治疗后均有一定提高,与对照组比较有显著性差异（均P＜0．05）。结论 赛莱乐是治疗糖尿病性周围神经病变的一种有效药物。     

糖尿病周围神经病变的临床观察

我们采用神经电生理检查技术进行早期诊断，运用复方地龙胶囊治疗。结果不论是症状还是神经传导速度，微循环的改善，治疗组均优于对照组。     

糖尿病周围神经病变治疗进展

近年来，随着世界各国社会经济发展和生活方式的改变，糖尿病的发病率及患病率正以惊人的速度增长。流行病学调查显示，我国糖尿病的发病率已由15年前的0．67％上升到近年来的3．21％，每年以100万人以上的数字在递增，其中60％～80％并发周围神经病变，给患本人、家庭乃至社会带来极大负担。糖尿病周围神经病变的早期干预也由此得到众多学的重视，现将近期关于糖尿病周围神经病变治疗的进展简要综述。     

糖尿病周围神经病变的临床与电生理学特点

糖尿病周围神经病变是糖尿病最常见的慢性并发症之一，由于诊断标准不同，献报道有50％～90％的糖尿病患可合并周围神经病变。其发病机制迄今尚未完全阐明，代谢障碍及血管损害被认为可能具有重要作用。糖尿病周围神经病变起病隐匿，主要为感觉神经受累，受累方式可分为大纤维型、小纤维型和混合型3种，临床上以小纤维型最为多见，疾病早期一般仅累及无髓和有髓小纤维神经。患主要表现为温度觉的减退或消失，而糖尿病交感神经病变的早期临床症状及体征常不明显，通过临床表现判断有时较为困难。目前，临床上对糖尿病周围神经病变的早期诊断需借助多种神经电生理检查技术，它们可为该病的早期诊断提供一定的客观依据，但各种技术的诊断和监测作用有所不同。     

糖尿病周围神经病变治疗的循证医学证据

糖尿病周围神经病变是糖尿病最常见的慢性并发症之一，发生率达50％～60％。其发生与糖尿病病程有关，并随着年龄增长其发生率将逐年升高。病因主要是长期严重的高血糖及由此而导致的代谢障碍、微循环异常和自身免疫紊乱。糖尿病周围神经病变临床表现多种多样，一般末梢神经首先受累，对称性多发性神经病变及自主神经病变较常见，而且常呈慢性进行性发展。该病早期的常见表现有肢体麻木、对称性下肢疼痛、刺痛甚至剧痛，部分患可出现单肢周围神经或脊神经分布区域剧烈疼痛。糖尿病周围神经病变严重影响患的生活质量，给患带来巨大痛苦，但目前临床上尚缺乏特异性治疗方法。故以控制饮食、严格控制血糖水平作为预防和治疗的根本措施，同时辅以针对病因的治疗。     

糖尿病周围神经病变患者神经病理及临床研究

目的 探讨糖尿病神经病变患者临床与神经病理变化的相关性。方法 观察非胰岛素依赖型糖尿病神经病变症状、体征,同时进行血糖、果糖胺、红细胞山梨醇及神经传导速度（ＮＣＵ）测定,并做腓肠神经病理检查。结果 １０例患者血糖、果糖胺及红细胞山梨醇明显增高,ＮＣＵ下降,以感觉ＮＣＵ下降明显。神经病理显示不同程度神经纤维减少、轴索变性及血管狭窄。结论 糖尿病病程、代谢紊乱控制程度与ＮＣＵ及神经病理损伤程度有一定相     

弥可保治疗糖尿病性周围神经病变疗效观察

糖尿病性周围神经病变是糖尿病最常见的慢性并发症之一，目前尚无有效治疗方法。此文作者采用弥可保治疗糖尿病性周围神经病变收到较好效果。     

重视糖尿病周围神经病的早期诊断和防治

糖尿病周围神经病(diabetic peripheral neuropathy,DPN)是糖尿病最常见的慢性并发症,其发病率高达60%～90%.DPN主要表现为四肢末端手套袜套样分布区域的麻木、疼痛及感觉异常,严重影响患者的生活质量.     

糖尿病周围神经病的手术治疗

目的探讨Dellon三联周围神经减压术（腓总神经、腓深神经及胫后神经减压术）治疗糖尿病周围神经病（DPN）下肢病变的手术疗效。方法分析2006年7月～2011年11月采用Dellon三联周围神经减压手术治疗的40例（DPN）患者的资料,观察他们的临床特点、手术方法、手术效果和随访结果。结果临床表现以渐进性小腿和足底、足背部麻木起病者35例,以渐进性疼痛起病者5例。术后下肢麻木症状缓解率90％,术后下肢疼痛症状缓解率92％。术后平均随访12个月临床症状缓解的所有患者病情稳定,1例患者术后1个月出现足底部分区域疼痛缓解后再次出现疼痛,其余病人症状无复发或加重。结论Dellon三联周围神经减压术对于（DPN）缓解疼痛、恢复感觉有较好疗效,是一种安全、有效、微创治疗新技术和新方法。     

周围神经显微减压术治疗糖尿病性下肢周围神经病

目的 探讨周围神经显微减压术治疗糖尿病性下肢周围神经病的疗效.方法 应用腓总神经、腓深神经、胫后神经主干及其分支显微减压术治疗42例糖尿病性下肢周围神经病患者(54侧下肢).结果 平均随访40个月.42例糖尿病性下肢周围神经病患者54侧下肢膝下麻木、疼痛症状术后89％ (48/54)缓解,肢体平衡问题术后70％ (21/30)缓解,随访期间54侧下肢无一侧发生顽固性溃疡或截肢.术后拇指两点辨别觉好转40侧(74％,40/54),腓总神经、胫后神经感觉、运动神经传导速度及动作电位波幅改善38侧(70％,38/54).并发症:踝部切口愈合不良3侧(6％,3/54).结论 周围神经显微减压术是治疗糖尿病性下肢周围神经病的有效方法,严格把握手术指征及术中神经彻底减压是保证疗效的关键.     

An aid to the electrophysiological diagnosis of diabetic peripheral neuropathy

The electrophysiological diagnosis of peripheral neuropathy in diabetics becomes increasingly difficult with the increase in number of parameters measured. We have examined 102 subjects: 60 diabetics, 32 control subjects and 10 with impaired glucose tolerance. From the 37 recorded parameters during 8 examinations, a linear discriminant analysis allowed us to separate the 19 diabetics with clinical neuropathy and the control subjects with only 5 parameters, with a good concordance (96%): the motor conduction velocities (MCV) of the peroneal and median nerves, the amplitude of the action potential (AP) of the sural nerve, the Hmax/Mmax ratio and the M latency of the Hoffman reflex. These parameters, weighted with a coefficient, constitute a score of discrimination. This score has been tested by the Jackknife method on the same sample (94% of well-classified patients), then validated on the other patients. Thus we propose a method to aid the diagnosis of diabetic peripheral neuropathy, without the arbitrary character of the classical single parameter method, and allowing easy repetition.     

A comparison of electrophysiological tests for the early diagnosis of diabetic neuropathy

Clinical criteria and several electrophysiological parameters for detecting nerve damage were compared in 99 patients with diabetes mellitus type 1 and type 2. Abnormal results were found in sural/radial amplitude ratio (51%), minimal F-wave latency of the tibial nerve (36.4%), sensory conduction velocity of the sural nerve (29.8%), and sural sensory nerve action potential amplitude (29.3%) when pooling data from all patients and comparing them to age- and height-matched normal control subjects. Analysis of all the parameters revealed large differences between the diabetes mellitus type 1 and type 2 groups, suggesting that the type of diabetes must be taken into account when comparing the sensitivity of nerve conduction tests. In diabetes mellitus type 1, the sural/radial ratio had the clearest correlation with course of illness and was the first parameter to show a significant reduction. We conclude that the simple ratio between sural and radial amplitudes is a very sensitive parameter and abnormalities in this ratio provide the means for earliest detection of neuropathy in diabetes mellitus type 1.     

皮肤交感反应在糖尿病周围神经病早期诊断中的价值

目的　探讨皮肤交感反应 (SSR)与糖尿病自主神经系统交感神经病变的关系 ,为糖尿病自主神经系统病变的早期诊断提供客观依据。方法　对 80例糖尿病患者及 30名健康人四肢进行SSR测定 ,对两组SSR各波潜伏期及波幅的均值行t检验。结果　两组SSR的起始潜伏期、N波、P波潜伏期比较差异有显著意义 (P <0 0 0 1) ;N波波幅、P波波幅差异无显著意义 (P >0 0 5 )。健康对照组全部可引出SSR ,而糖尿病组仅 2例患者四肢可正常引出SSR ,78例 (97 5 % )患者至少有一肢SSR潜伏期异常。结论　SSR为糖尿病性自主神经系统交感神经病变的早期诊断提供了新的方法和客观依据 ,可发现糖尿病自主神经系统交感神经纤维的早期病变。     

Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy

OBJECTIVE: The reliability and accuracy of the Michigan neuropathy screening instrument (MNSI) have been discussed recently. As a result of the difficulties of performing and analyzing nerve biopsy as a standard diagnostic test, electromyography and neuronography is used as the best alternative diagnostic procedure. The objective of this study was to determine the diagnostic performance of the test characteristics and cut-off point of MNSI scoring for the diagnosis of diabetic peripheral neuropathy. METHOD: Over a 2-year period, a cross-sectional study was conducted on 176 type 2 diabetic patients. An internist carried out the MNSI and the sum of scores varying from 0 to 1 for each abnormality as revealed in foot appearance, ulceration, ankle reflexes and vibratory perception has been recorded. A neurologist, who was blind to the MNSI scores, performed all neurophysiological studies. The test performance characteristics of the MNSI procedure were measured for different cut-off values. RESULTS: MNSI scores of 1.5, 2.0, 2.5 and 3.0 were assessed as cut-off values. Sensitivities were 79%, 65%, 50% and 35% and specificities were 65%, 83%, 91% and 94%, respectively. Positive predictive values increased and negative predictive values decreased for each score. Accuracies, likelihood ratios and post-test probabilities were measured. CONCLUSION: The accuracy of MNSI scoring makes it a useful screening test for diabetic neuropathy in taking a decision regarding which patients should be referred to a neurologist for electrophysiological studies. High specificity, likelihood ratios over 5 and a moderate to good post-test probability give a high diagnostic impact for MNSI scoring. We suggest a cut-off point of 2 for the MNSI procedure. However, electrophysiological studies should be considered when the patient has signs and symptoms other than those rated by the MNSI, suggesting peripheral nerve involvement, and also because the MNSI is still just a screening test.