10g尼龙丝检查在糖尿病周围神经病变中的诊断价值

目的：观察10g 尼龙丝检查在2型糖尿病周围神经病变中的诊断价值。方法对200例2型糖尿病患者分别进行10g尼龙丝检查及神经传导速度（NCV）检查,以NCV结果为金标准,评价10g尼龙丝检查的敏感性、特异性及一致性。结果10g 尼龙丝检查与NCV检查结果一致性为60.0%,特异度为90.2%,敏感度为46.8%,阳性预测值为91.5%,阴性预测值为42.6%。结论10g尼龙丝诊断糖尿病周围神经病变的特异性高,敏感性差,但简易、快速、经济,适于广大基层医院筛查使用。     

糖尿病合并周围神经病变患者的H反射变化

<正>糖尿病并发神经系统病变是最常见的临床并发症之一,其中又以周围神经病变最多见。现将我科30例临床确诊的2型糖尿病患者进行H反射检测,同时作了神经传导速度(NCV)测定,得出H反射异常率,运动神经传导异常率、感觉神经传导异常率,以评价其对糖尿病性神经病变的诊断价值。     

局部应用丝裂霉素C对周围神经痛觉的影响

目的 观察局部应用丝裂霉素C(MMC)对神经痛觉的影响.方法 50只SD大鼠随机均分成五组,暴露大鼠双侧坐骨神经,分别以棉片浸透生理盐水(对照组)或不同浓度MMC(0.1、0.3、0.5、0.7 mg/ml)(MMC组),包绕双侧坐骨神经5min.以热辐射法测定术前、术后1、2、3、5d热缩足潜伏期.结果 与术前及对照组比较,各浓度MMC组在术后1～5 d热缩足潜伏期差异无统计学意义(P＞0.05).结论 局部应用浓度不大于0.7 mg/ml的MMC对大鼠坐骨神经痛觉无明显影响.     

踝肱指数（ABI）对糖尿病下肢动脉病变的筛查及其临床应用

目的：探讨踝肱指数（ABI）对糖尿病下肢动脉病变的筛查的意义及其临床应用。方法：取ABI阳性者68例入院治疗患者,随机分为A、B两组,A组为单纯降糖、降血脂治疗,B组除降糖、降血脂外加用丁咯地尔治疗,治疗3个月后再次复查ABI,观察两组治疗前后ABI、血压、空腹血糖（FPG）、餐后2h血糖（2hPG）、总胆固醇（TC）、甘油三脂（TG）变化。结果：1538例糖尿病患者ABI测定阳性者为394例,阳性率为25.6%,ABI阳性患者经下肢动脉彩超证实符合率达100%,ABI阳性者距诊断糖尿病病史1月至20年,ABI阳性患者病史超过5年者阳性率高达80%。治疗前患者年龄、病程、BMI、SBP、FPG、2hPG、TG、TC、ABI差异均无统计学意义,经治疗后A组患者FPG、TG明显下降（P＜0.05）,SBP、ABI无明显变化。B组患者治疗后较治疗前FPG、TG明显下降（P＜0.05）,SBP无明显变化,ABI明显改善（P＜0.05）。结论：ABI与下肢血管彩超对比相关性好,踝肱指数测量仪既可在诊室中使用,也适用于大规模人群的筛查;应用盐酸丁咯地尔后,临床症状及相关指标均显著优于对照组,ABI明显升高。     

当归四逆汤对糖尿病周围神经病变患者神经传导速度和踝肱指数的影响分析

目的:分析当归四逆汤对糖尿病周围神经病变患者神经传导速度和踝肱指数的影响.方法:采用抽签法将郑州市中医院糖尿病科2014年1月~2015年2月109例糖尿病周围神经病变患者进行分组,对照组54例给予甲钴胺治疗,观察组55例在对照组基础上给予当归四逆汤治疗,观察两组临床疗效、神经传导速度和踝肱指数.结果:观察组治疗后总有效率92.73%高于对照组的77.78%,P<0.05;观察组治疗后神经传导速度及踝肱指数改善幅度优于对照组,P<0.05.结论:在常规西医治疗的基础上,采用当归四逆汤通过控制血糖,温经散寒,养血通脉,改善糖尿病周围神经病变患者神经传导速度和踝肱指数效果确切,值得临床推广.     

10g单尼龙丝及振动阈值的检查与神经传导速度检查在糖尿病神经病变中的应用价值

目的分析10g单尼龙丝（10gSWME）及振动阈值的检查（VPT）及神经传导速度（NCV）检查在诊断糖尿病周围神经病变（DPN）中的相关性及差异,探讨临床应用价值。方法对108名2型糖尿病（T2dM）患者进行双侧正中、尺、胫、腓总神经运动支和感觉支的NCV、振幅、潜伏期及10g单尼龙丝及振动阈值检查,分析比较10g单尼龙丝及振动阈值检查与NCV检查的相关性及临床应用价值。结果 10g单尼龙丝及振动阈值与NCV检查结果有显著相关性（P均〈0.001）;振动阈值检查的异常率均显著大于NCV及10g单尼龙丝（P均〈0.05）;在NCV检查正常的患者中,10g单尼龙丝检查的异常率、振动阈值检查的异常率分别为13.8%和48.3%,在振动阈值检查正常的患者中,正中、尺、胫神经运动支及正中、腓总神经感觉支的NCV的异常率分别为22.1%、20.2%、28.7%、23.5%和31.9%。结论在DPN诊断中,10g单尼龙丝及振动阈值检查与NCV检查在临床中各有其应用价值,不能完全相互替代,全面了解DPN病情还需要结合临床。     

糖尿病周围神经病变筛查与诊断进展

糖尿病周围神经病变(DPN)是糖尿病慢性并发症之一,可导致糖尿病足、溃疡、感染和截肢的发生.研究显示,30％～ 50％的糖尿病患者合并有DPN[1].随着对DPN的日趋重视,一些新的诊断技术也不断涌现,本研究主要就DPN的筛查与诊断进展及治疗作一综述. 1 DPN的筛查及诊断 1.1 DPN的临床评分系统 1.1.1神经缺陷评分(NDS)系统 NDS系统用来评估神经病变的体征,是为一般神经病变设计,并非专门用于DPN.该方法主要根据双侧踝反射、大拇趾振动觉、温度觉、针刺觉评分,最高分为10分,能较好地预测糖尿病患者足溃疡及周围神经病变终点事件的发生情况.研究表明,评分≥6分者无症状足溃疡的发生风险增加[2],该评分可用于预测糖尿病患者足溃疡及周围神经病变终点事件的发生情况.     

不同检查方法在糖尿病周围神经病变筛查中的应用

目的评价两种不同的方法在糖尿病周围神经病变（diabetic peripheral neuropathy,DPN）诊断中的临床价值。方法以神经电生理检查作为金标准,分别对706例于2009年12月—2012年12月在河南省人民医院内分泌科住院的2型糖尿病（type 2 diabetes mellitus,T2DM）患者进行多伦多临床评分系统（Toronto Clinical Scoring System,TCSS）评分和糖尿病周围神经病变筛查流程（diabetic peripheral neuropathy screening process, DPN - SP）。评价二者筛查DPN敏感性与特异性的异同。结果706例患者中,神经电生理检查阳性者384例（54．39％）,阴性者322例（45．61％）;TCSS评分〉5分者377例,TCSS评分≤5分者329例,该检查方法灵敏度、特异度、阳性预测值、阴性预测值分别为：78．57％、77．82％、82．38％、81．42％,约登指数为0．56。DPN—SP阳性者418例,阴性者288例,该检查方法灵敏度、特异度、阳性预测值、阴性预测值分别为：85．49％、66．92％、78．93％、76．52％,约登指数为0．52。两种筛查方法无统计学差异（P〉0．05）。结论DPN—SP与TCSS在诊断DPN时均具有较高的灵敏度与特异度,可作为DPN筛查的有效的方法。     

2型糖尿病下肢血管病变踝肱指数检测的临床意义

目的：研究踝肱指数（ ABI）在诊断2型糖尿病患者下肢动脉病变（ PAD）中临床意义与影响因素。方法采用多普勒血流探测仪检测2型糖尿病患者足背动脉、胫后动脉与肱动脉血压的比值,以ABI〈0.9为切割点分成PAD组和非PAD组,比较两组患者的临床资料并分析其危险因素。结果检出糖尿病下肢血管病变21例（19.8%）,其中无临床症状者10例。和非PAD组比较,PAD组患者年龄大,病程长,餐后2 h血糖（2 hPBG）、甘油三酯（TG）、低密度脂蛋白（LDL-C）、糖化血红蛋白（HbA1C）均明显升高,有显著性差异（P〈0.05）。结论踝肱指数可用于早期诊断糖尿病下肢血管病变,且无创、价廉、简单,患者易接受。高龄、病程长、高血糖、高TG、LDL-C是引起下肢血管病变的危险因素。     

疼痛管理配合放松训练在踝关节骨折患者术后康复中的应用效果分析

目的 探讨疼痛管理配合放松训练在踝关节骨折患者术后康复中的应用效果.方法 选取2014年2月至2016年2月本院收治的踝关节骨折患者80例,按数字随机表分为两组,各40例.对照组行常规护理,观察组行疼痛管理配合放松训练,对比两组疼痛程度、踝关节功能、护理满意度.结果 观察组手术当天、术后第1d、术后第2d的NRS评分均低于对照组,差异有统计学意义(P＜0.05).观察组护理后踝关节功能评分高于对照组,差异有统计学意义(P＜0.05).观察组护理满意率高于对照组(95.00％ vs.77.50％),差异有统计学意义(P＜0.05).结论 疼痛管理配合放松训练应用于踝关节骨折患者效果显著,可有效缓解患者疼痛,促进踝关节功能恢复,提高满意率,值得推广.     

The efficacy of pregabalin in patients with moderate and severe pain due to diabetic peripheral neuropathy

Objective To compare the therapeutic response to pregabalin in patients with moderate or severe painful diabetic peripheral neuropathy (pDPN).

Research design and methods Data were pooled from 11 placebo-controlled trials to evaluate the efficacy of pregabalin flexible or fixed dose (150, 300 or 600?mg/day) in pDPN patients with mean baseline pain scores of ≥4 to <7 (moderate) or ≥7 to ≤10 (severe). Last observation carried forward imputation was used.

Study number/ClinicalTrials.gov identifier 1008-014/-, 1008-029/-, 1008-040/-, 1008-131/-, 1008-149/-, 1008-000-155/-, A0081030/NCT00156078, A0081060/NCT00159679, A0081071/NCT00143156, A0081081/NCT00301223, A0081163/NCT00553475.

Main outcome measures Pregabalin-mediated change in pain, pain-related sleep interference (PRSI) and patient global impression of change (PGIC) were compared versus placebo and between moderate and severe pain cohorts. Adverse events (AEs) were reported.

Results At baseline, 1816 patients had moderate pain (pregabalin, n?=?1189) and 1119 patients had severe pain (pregabalin, n?=?720). Pregabalin significantly reduced pain scores at endpoint compared with placebo when patients of all pain levels were combined (all doses; p?<?0.05). In the moderate and severe pain cohorts, pregabalin treatment (300, 600?mg/day or flexible) significantly reduced mean pain scores at endpoint compared with placebo (p?<?0.01). Pain reduction was greatest in patients with severe baseline pain compared with moderate baseline pain (pregabalin 300, 600?mg/day or flexible; p?<?0.0001). Pregabalin improved PRSI and PGIC in the moderate and severe cohorts compared with placebo. The greatest improvement in PRSI also occurred in the severe cohort. Treatment-emergent AEs, most commonly dizziness, somnolence and peripheral edema, occurred more frequently in patients treated with pregabalin compared with placebo.

Conclusions Pregabalin was effective in pDPN patients with both moderate and severe baseline pain. Patients with severe pain exhibited greater improvements in pain and PRSI than patients with moderate pain. Pain severity may, in part, predict therapeutic response to pregabalin.     

Estimated prevalence of peripheral neuropathy and associated pain in adults with diabetes in France

ABSTRACT

Objective: To estimate the point prevalence of diabetic peripheral neuropathy (DPN) and pain associated with DPN (pDPN) in French adults with diabetes and compare severity of symptoms across demographic subpopulations.

Design: The participant-administered portion of the Michigan Neuropathy Screening Instrument (MNSI) and selected items of the Brief Pain Inventory (BPI) formed part of a computer-aided telephone survey posed to a representative, random sample of French households from March 1, 2005 to April 30, 2005. Questions from the MNSI and the BPI were used to assess the point prevalence of DPN and pDPN in French adults with self-reported diabetes.

Results: The mean age of the study sample was 68 years (SD = 15), the mean duration of diabetes was 15 years (SD = 12) and 56% of participants were female. The prevalence rates of DPN and pDPN in French adults with diabetes were 11 and 8%, respectively. The average age and diabetes duration of participants with DPN and pDPN were not different from participants in the total sample. Among those participants with pDPN, 35% classified their pain as severe, 49% as moderate, and 17% as mild. The prevalence of DPN was higher in participants with type 1 diabetes (14%) than those with type 2 (9%). Among participants with DPN, 88% with severe pain received pain treatment compared to 71% with moderate pain and 58% with mild pain. The most significant limitation of this study is the lack of validation for administering only a portion of the MNSI, but other limitations include the imprecision associated with self-reported questionnaires, a survey sample that does not include participants with undiagnosed diabetes, and a bias toward elderly participants.

Conclusion: This study concluded that 8% of participants with diabetes in France had pDPN.     

Randomized study of tramadol/acetaminophen versus placebo in painful diabetic peripheral neuropathy

ABSTRACT

Objective: To examine the efficacy and safety of tramadol/acetaminophen (APAP) for the management of painful diabetic peripheral neuropathy (DPN).

Methods: Adults with painful DPN involving the lower extremities received 37.5?mg tramadol/325?mg APAP or placebo, up to 1–2 tablets four times daily, for 66 days. Subjects rated average daily pain and sleep interference from 0 (‘none’) to 10 (‘pain as bad as you can imagine’ or ‘complete interference’) every night. Baseline values were recorded for 7 days before starting study medication. The primary endpoint was change in mean of average daily pain scores from baseline to final week. Secondary efficacy outcomes included pain intensity, sleep interference, quality of life, mood, and global impression of change. Potential study limitations included permission to use serotonin reuptake inhibitors concomitantly (except venlafaxine or duloxetine) and the lack of a tramadol-alone or APAP-alone control group.

Results: A total of 160 subjects received tramadol/APAP and 153 received placebo. Tramadol/APAP reduced average daily pain significantly compared to placebo from baseline to the final week (–2.71 vs. –1.83, p = 0.001). Tramadol/APAP was associated with significantly greater improvement than placebo (?p ≤ 0.05) for all measures of pain intensity, sleep interference, and global impression, as well as several measures of quality of life and mood. The only adverse event reported by > 10% of subjects in either the tramadol/APAP or placebo group was nausea (11.9% and 3.3%, respectively). Adverse events resulted in early study discontinuation for 8.1% and 6.5% of subjects in the tramadol/APAP and placebo groups, respectively.

Conclusion: Tramadol/APAP was more effective than placebo and was well tolerated in the management of painful DPN.     

前列地尔和甲钴铵治疗糖尿病周围神经病变疗效观察

目的观察前列地尔和甲钴铵治疗糖尿病周围神经病变（DPN）疗效及成本比较。方法将120例2型糖尿病周围神经病变患者,在常规治疗的基础上,采用前列地尔注射液和甲钴铵注射液。观察两种药物治疗糖尿病周围神经病变的疗效及费用。结果两种药物均可改善血液循环,改善缺血、缺氧,促进神经细胞功能恢复,治疗糖尿病周围神经病变（DPN）疗效比较差异无统计学意义。结论前列地尔和甲钴铵治疗糖尿病周围神经病变效果明显,而甲钴铵比前列地尔更经济。     

2型糖尿病足高危患者的踝肱指数与糖尿病足的关系

目的：对2型糖尿病足高危患者的踝肱指数和糖尿病足的发生率关系进行分析,同时对相关的危险因素进行探讨,以期对糖尿病足的发生早期采取有效的措施。方法对我院收治的已经确诊的438例2型糖尿病患者进行研究,其中391例为非糖尿病足组,47例为糖尿病足组,所有的患者都要进行糖化血红蛋白、总胆固醇、甘油三酯等生化资料、踝肱指数的检查,对两组的临床检查资料和不同踝肱指数组的糖尿病患者数的差异进行比较。结果两组患者踝肱指数与患者病程、收缩压、糖尿病肾病发生率、视网膜病变发生率呈负相关（P均＜0.01）;不同的踝肱指数和糖尿病足组的患病率比较,踝肱指数和糖尿病足组的患病率类似“U”型分布,踝肱指数＞1.31组中糖尿病足组的患者发病率为18.1%;0.9＜踝肱指数≤1.3组的发病率为26.0%;0.7＜踝肱指数≤0.9组的发病率为32.5%;0.5＜踝肱指数≤0.7组的发病率为47.6%;而踝肱指数≤0.5组中的糖尿病足患者发病率达到64.29%,各组患病率进行比较有明显的差异。结论踝肱指数和糖尿病足呈负相关,踝肱指数减低或是出现异常的升高能对早期糖尿病足的发生进行预测,对踝肱指数异常的糖尿病足高危患者要采用积极有效的干预措施。     

Pharmacokinetic-pharmacodynamic modeling of the effects of clonidine on pain threshold,blood pressure,and salivary flow

Summary Although clonidine analgesia appears to be mediated by the same central ₂-adrenoceptors that mediate its hypotensive effect, it is short-lasting when compared to the fall in blood pressure. This has been investigated by combined pharmacokinetic-pharmacodynamic analysis in 10 healthy volunteers who received (double-blind and crossover) clonidine 200 g orally + placebo i.v. and clonidine orally + naloxone i.v. (2.8 mg/5 h). Analgesia was assessed by measuring the subjective (VAS) and objective (R_III) pain thresholds after transcutaneous electrical stimulations of the sural nerve; the mean arterial blood pressure (MAP), salivary flow (SF), and plasma clonidine concentrations were also monitored. A combined pharmacokinetic (first order absorption — 1 compartment) — pharmacodynamic (linear) model, including a hypothetical effect compartment with and without tolerance, were fitted to the data.Clonidine and clonidine + naloxone increased subjective and objective pain thresholds for 4 h. The concentration-effect plot for MAP showed distinct hysteresis. The t_1/2s for effect compartment equilibration were 29 and 42 min for clonidine + naloxone and clonidine. The concentration-effect curves for R_III had the same shape as MAP but the starting hysteresis suddenly collapsed, suggesting acute tolerance. The best fit was obtained with a model where the linear relationship between concentration in the effect compartment and analgesia changed acutely after the third hour.The short-lived analgesia was probably related to an acute change in pain sensitivity induced by food, suggesting that it is not mediated solely by the ₂-adrenoceptors responsible for hypotension.Presented in part at the XIth International Congress of Pharmacology, Amsterdam, July 1990     

依达拉奉联合依帕司他治疗糖尿病周围神经病变的疗效观察

目的:探讨依达拉奉联合依帕司他治疗糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的临床疗效.方法:将87例糖尿病周围神经病变患者随机分为两组,治疗组采用依达拉奉联合依帕司他治疗,对照组采用甲钴胺治疗.观察临床疗效及肌电图变化.结果:治疗组总有效率明显高于对照组(P＜0.05),治疗组感觉神经传导速度及运动神经传导速度均明显高于对照组(P＜0.05).结论:依达拉奉联合依帕司他治疗糖尿病周围神经病变效果优于甲钴胺.     

奥沙利铂治疗大鼠坐骨神经线粒体呼吸功能及抗氧化酶活性改变的研究

目的:观察奥沙利铂治疗大鼠坐骨神经线粒体呼吸功能的改变及抗氧化酶活性的变化。方法:选取SD雄性大鼠36只,用5%葡萄糖将奥沙利铂溶液稀释到2mg/mL,连续5d(d 0～d 4)腹腔注射2mg/kg;对照组大鼠接受对照液5%葡萄糖注射。并于d 0、d 8、d 15、d 22、d 29、d 35及d 41测定机械异常痛敏(4g VFH)和机械痛敏(15g VFH)。取d 27～d 35并确认存在异常痛敏和机械痛敏的大鼠及对照组大鼠各9只,处死大鼠并取坐骨神经,将神经制作成切碎的纤维细丝(M&T)标本,将标本放入呼吸测定仪里,分别加入底物并测定呼吸比率变化;再取模型和对照组大鼠各9只,取坐骨神经并提取线粒体,分别测定抗氧化酶硫氧还原蛋白还原酶(TrR)和谷胱甘肽过氧化物酶(GPx)的活性。结果:与对照组大鼠比较,注射奥沙利铂大鼠在疼痛高峰期(d 27～d 35)呼吸比率明显下降(下降16%),奥沙利铂治疗大鼠线粒体加入细胞色素C后呼吸明显增加;而且TrR(下降23%)和GPx(下降15.4%)的活性明显下降。结论:奥沙利铂治疗大鼠坐骨神经线粒体功能受损,引起线粒体呼吸功能失调,预示损伤存在于复合物I或复合物II;抗氧化酶活性下降可能是线粒体呼吸功能降低的另一个原因。