452例2型糖尿病合并神经病变的临床特点

目的 总结2型糖尿病合并神经病变的临床特点，探讨糖尿病性神经病变发病的危险因素。方法 回顾性分析452例糖尿病性神经病变患者的临床表现特点，对相关因素作统计学分析。结果 周围神经病变临床表现较自主神经病变常见；脂代谢紊乱、病程和餐后高血糖与糖尿病性神经病变的发病呈正相关。结论 糖尿病性神经病变最常表现为周围神经病变；糖尿病性神经病变患病的危险因素为脂代谢紊乱、病程和女性性别。     

中国Leber遗传性视神经病变14484位点突变的家系分析

目的:了解我国Leber遗传性视神经病变(Leber’shereditaryopticneuropathy,LHON)线粒体DNA(mtDNA)14484位点突变患者的发病率和临床特征。方法:对来自117个家系的119例临床确诊或疑诊LHON的患者进行mtDNA检测。对3例证实为14484位点突变的家系做深入调查并收集相关病史及临床资料,抽取15例家属的血样进行mtDNA检测。结果:存在线粒体DNA突变的62例(62/119,52.1%)中,14484位点突变仅3例(4.8%)。该3例3个家系56例中,28例有眼部症状,外显率50%。发病经过和临床表现类似11778位点突变的LHON,但其中视力恢复者17例(60.7%)。15例家属的血样检测再次证实为14484位点突变。结论:我国LHON患者中14484位点突变者少见,其临床表现与11778位点突变者相似,惟视力恢复率高。     

针刺对糖尿病周围神经病变治疗作用的实验研究

目的探讨针刺对糖尿病大鼠周围神经病变的机理.方法用链脲佐菌素造模.设立正常对照组、糖尿病模型组、降糖治疗组、针刺治疗组、药物治疗组.针刺治疗组取脾俞、肾俞、三阴交、足三里穴,隔日针刺1次.各组均于治疗4、8周测定大鼠热痛阈值、坐骨神经感觉神经传导速度(SNCV)、坐骨神经血流量并进行对照观察.结果治疗4周,与降糖治疗组比较,针刺治疗组热痛阈值降低,坐骨神经SNCV增加,坐骨神经血流量增加(P＜0.05).治疗8周,针刺治疗组和药物治疗组热痛阈值、坐骨神经SNCV与降糖治疗组差异显著(P＜0.05或P＜0.01),与正常对照组比较,差异无显著性.针刺治疗组坐骨神经血流量与降糖治疗组比较,差异显著(P＜0.05).结论益气养阴活血针刺治疗改善糖尿病大鼠坐骨神经功能的作用与弥可保相似,但针刺治疗起效迅速,而且能明显增加坐骨神经组织血流量.     

Hypertrophic perineurial dysplasia in multifocal and generalized peripheral neuropathies

Two cases are described, one with a multifocal cranial and limb neuropathy of adult onset associated with optic neuropathy, and the other with a diffuse demyelinating neuropathy characterized by congenital cataract, mental retardation and progressive lower limb paresis with an onset in childhood. Extensive investigation in both failed to establish the causation. No family history of similar disorder was obtained in either case. Nerve biopsy in both showed similar perineurial abnormalities, the endoneurium being compartmentalized by hypertrophic perineurial cells that exhibited dysplastic features. The appearances resemble those described in a previously reported case of multifocal neuropathy and probably represent an unusual but non-specific response to a peripheral neuropathy.     

前列地尔治疗糖尿病周围神经病变42例疗效观察

目的探讨前列地尔治疗2型糖尿病合并周围神经病变的疗效和安全性。方法将84例2型糖尿病合并周围神经病变患者,随机分为治疗组和对照组。两组均给予维生素B1、维生素B6和甲钴胺治疗,治疗组同时加用前列地尔。观察两组治疗前后症状改善及神经传导速度情况。结果治疗组临床症状、运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)较对照组均有明显好转(P<0.01)。治疗组仅2例患者出现轻微不良反应。结论前列地尔是治疗糖尿病周围神经病变安全、有效的药物。     

针刺益气养阴活血法治疗糖尿病周围神经病变机制的实验研究

目的:探讨针刺对糖尿病大鼠周围神经病变的治疗作用和机制。方法:对链脲佐菌素(STZ)诱导的糖尿病大鼠取穴脾俞、肾俞、三阴交、足三里,隔日针刺1次,每次30 min,针刺治疗8周后测定大鼠感觉神经传导速度(SNCV)、热痛域,坐骨神经能够内山梨醇、一氧化氮(NO)和Na -K -ATPase活性。结果:糖尿病大鼠SNCV明显减慢,热痛域值明显升高;坐骨神经内山梨醇升高、NO降低,Na -K -ATPase活性降低,与正常组比较差异显著(P<0.05或0.01)。针刺治疗可使上述改变减轻,与糖尿病模型组比较差异显著(P<0.05或0.01)。结论:针刺治疗通过降低实验性糖尿病大鼠坐骨神经内山梨醇含量,防止NO降低和Na -K -ATPase活性下降,可有效恢复其神经传导速度、热痛域等神经障碍,为治疗DPN的有效方法。     

Gene expression of antioxidant enzymes in experimental diabetic neuropathy

Chronic hyperglycemia results in a large deficit in nerve blood flow. Both autoxidative- and ischemia-induced lipid peroxidation occurs, with resultant peripheral sensory neuropathy in streptozotocin-induced diabetes in the rat. Free radical defenses, especially involving antioxidant enzymes, have been suggested to be reduced, but scant information is available on chronic hyperglycemia. We evaluated the gene expression of glutathione peroxidase, catalase, and superoxide dismutase (cuprozinc and manganese separately) in L4,5 dorsal root ganglion (DRG) and superior cervical ganglion, as well as enzyme activity of glutathione peroxidase in DRG and sciatic nerve in experimental diabetic neuropathy of 3 months and 12 months durations. We also evaluated nerve electrophysiology of caudal, sciatic-tibial, and digital nerves. A nerve conduction deficit was seen in all nerves in experimental diabetic neuropathy at both 3 and 12 months. Gene expression of glutathione peroxidase, catalase, cuprozinc superoxide dismutase, and manganese superoxide dismutase were not reduced in experimental diabetic neuropathy at either 3 or 12 months. Catalase mRNA was significantly increased in experimental diabetic neuropathy at 12 months. Glutathione peroxidase enzyme activity was normal in sciatic nerve. We conclude that gene expression is not reduced in peripheral nerve tissues in very chronic experimental diabetic neuropathy. Changes in enzyme activity may be related to duration of diabetes or due to post-translational modifications.     

Autonomic neuropathy in patients with HIV: Course, impact of disease stage, and medication

The purpose of this article is to examine the prevalence, degree, and natural course of pupillary neuropathy (PANP), cardiovascular autonomic neuropathy (CANP), and sensorimotor neuropathy (SNP) and to study the impact of disease stage and medication on neuropathy in 61 consecutive patients with HIV. PANP, CANP, and SNP were assessed by standardized test procedures. Overall prevalence of PANP, CANP, and SNP were 66%, 15%, and 15%, respectively. The maximal pupillary area (pupillary measure, p<0.0001) and the lying-to-standing ratio (cardiovascular measure, p<0.0001) were abnormal as compared with control subjects. The changes in CD4+ T-lymphocytes and respiratory sinus arrhythmia percentile during 2 years of follow-up correlated significantly (r=0.758, p=0.007). Patients with CANP were more often in an advanced disease stage than patients without CANP (p=0.004). SNP, but not PANP or CANP, was associated with the intake of the neuropathogenic drugs dideoxycytidine, dideoxyinosine, and 2,3 didehydro-2,3 dideoxythymidine (p<0.05). Autonomic and sensorimotor neuropathy are frequent in patients with HIV, and progression of CANP may put patients at risk for unexpected cardiorespiratory arrest.     

银杏达莫注射液治疗老年糖尿病周围神经病变疗效观察

目的:观察银杏达莫注射液治疗老年糖尿病周围神经病变的疗效。方法:对86例糖尿病周围神经病变患者进行随机对照临床观察,治疗组在常规治疗基础上予以银杏达莫注射液25ml加生理盐水250ml静脉滴注,日1次;对照组在常规治疗基础上予以脉络宁注射液30ml加生理盐水250ml静脉滴注,日1次。结果:治疗组显效19例,有效17例,无效6例,总有效率85.71%,明显高于对照组40.9%。经x2检验P<0.01,且未见明显不良反应。结论:银杏达莫注射液是治疗老年糖尿病周围神经病变较理想的药物。     

周络通对糖尿病周围神经病变大鼠坐骨神经功能影响

目的:研究周络通(黄芪,桂枝,当归,生地,细辛等)对链脲佐菌素(STZ)糖尿病大鼠坐骨神经功能和多元醇代谢通路的影响.方法:动物ig给药,连续8周,观察药物对链脲佐菌素糖尿病大鼠坐骨神经形态学改变、神经传导速度、坐骨神经Na ,K -ATP酶和醛糖还原酶活性及山梨醇、肌醇、果糖、葡萄糖、甘露糖等多元醇含量的影响.结果:周络通对链脲佐菌素糖尿病大鼠坐骨神经形态学改变有明显保护作用,坐骨神经传导速度明显性提高,Na ,N -ATP酶活性增强、醛糖还原酶活性降低,山梨醇、葡萄糖含量降低.结论:周络通可改善糖尿病大鼠周围神经组织的代谢,改善神经组织功能,对STZ糖尿病大鼠周围神经病变具有防治作用.