葛根素联用甲钴胺治疗糖尿病周围神经病变32例

目的 观察葛根素联用甲钴胺治疗糖尿病周围神经病变(DPN)的疗效。方法 将诊断明确的64例DPN患者随机分为治疗组和对照组各32例,两组均给予糖尿病饮食和降糖治疗,治疗组给予葛根素联用甲钴胺治疗,对照组单给予葛根素治疗。10天为一疗程,共治疗两疗程,对两组疗效进行比较。结果 治疗组总有效率和神经传导速度改善均好于对照组(P<0.01),且无明显副作用。结论 葛根素联用甲钴铵治疗DPN比单用葛根素疗效好,值得临床推广应用。     

Activity and distribution of phosphoinositidase C in rat sciatic nerve.

The hydrolysis of phosphatidylinositol-4,5-bisphosphate (PIP2) by rat sciatic nerve cytosolic phosphoinositidase C [phosphoinositide-specific phospholipase C (PIC)] was studied at neutral pH and at ionic concentrations that approximate intracellular conditions. The principal water-soluble product formed was shown to be inositol trisphosphate by anion exchange chromatography. The maximum hydrolysis rate (2.5 nmol/min/mg protein) was achieved at less than 100 nM Ca2+. Hydrolysis was markedly increased to 15 nmol/min/mg protein by inclusion of K+ in the reaction mixture. In the presence of 200 mM K+, the optimum Ca2+ was increased to approximately 600 nM. Higher Ca2+ concentrations progressively inhibited PIP2 hydrolysis. Mg2+ also inhibited the reaction, but the presence of equimolar amounts of ATP and Mg2+ had no effect. Appreciable degradation of phosphatidylinositol-4-phosphate (PIP) also occurred in the nanomolar Ca2+ range, whereas breakdown of phosphatidylinositol (PI) required millimolar Ca2+. The presence of PIP but not PI inhibited PIP2 hydrolysis. Upon subcellular fractionation of nerve, more than 50% of recovered PIC activity was in the cytosol and about 20% was located in a myelin-enriched fraction. Using PIP2 as substrate, PIC activities in nerves from normal and streptozotocin-induced diabetic animals were not different. However, the myelin-associated enzyme from diabetic animals was more labile to freezing and thawing.     

Amiodarone-induced experimental acute neuropathy in rats.

Amiodarone was injected endoneurially at increasing doses into the exposed tibial nerve of rats to study its electrophysiologic and pathologic effects on peripheral nerve fibers. Forty-five male Wistar rats were used, and each of the following concentrations was injected into 15 nerves: 25 micrograms/mL, 50 micrograms/mL, and 100 micrograms/mL. Microinjection of a 25 micrograms/mL concentration of amiodarone resulted in a subacute, incomplete conduction block evident at day 3 postinjection. This conduction block remained stable until day 10 and recovery was complete at day 35. Microinjection of a 50 micrograms/mL concentration of amiodarone produced a faster evolving conduction block, and significant axon degeneration (approximately 40% of fibers). Injection of a 100 micrograms/mL concentration resulted in severe acute motor axon degeneration followed by complete but delayed regeneration. Results of morphological studies closely correlated with electrophysiological findings. Amiodarone thus seems to have a direct toxic effect on axons at high concentrations in the peripheral nerve, and we suggest that different pathological changes described in human amiodarone neuropathy could be related to different concentrations of the drug in the nerve, perhaps due to variability of blood-nerve barrier efficacy.     

Neuropathy in children and adolescents with diabetes mellitus

Nerve conduction velocities were studied in the median, posterior tibial, radial and sural nerves of 50 juvenile diabetics, average age 13 +/- 1.3 years and mean duration of diabetes 2.3 +/- 1.4 years. Motor conduction velocity (MCV) in the median nerve was reduced in 10% of the subjects, and in the posterior tibial in 32%. Sensory conduction velocity (SCV) in the radial nerve was reduced in 30% of the subjects, and in the sural in 44%. No relationship was found between the reduction in conduction velocity and the duration of diabetes; nevertheless, a correlation was observed between this reduction and the degree of glycaemic control represented by the glycosylated haemoglobin concentration. The authors emphasize the importance of good glycaemic control for the prevention of diabetic neuropathy.     

Simultaneous noninvasive evaluation of gastric emptying and orocaecal transit times

Summary The aim of the study was to use a novel combination of two methods for the simultaneous evaluation of two effects of oral cisapride in 10 diabetic patients with autonomic neuropathy; gastric emptying time was measured by following radio-opaque markers and orocaecal transit time by the sulphasalazine-sulphapridine method. The study was of double-blind, randomized, placebo-controlled, cross-over design.It was possible to evaluate the effect of a prokinetic drug on gastric emptying and orocaecal transit times using these two noninvasive techniques at the same time. Cisapride significantly reduced both the gastric emptying (1.2 h versus 2.1 h) and orocaecal tansit (5.9 h versus 7.7 h) times.     

听神经病的纯音听阈检查结果分析

目的 探讨听神经病纯音听阈(PTT)检查的特征。方法 对48例听神经病患者的PTT检查结果进行分析，并与耳蜗性聋进行对照比较。结果 听神经病的PTT图有上升型、峰型、匙型、W型、倒S型、水平型和缓降型。双耳对称的PTT图有38例，不对称的有10例。听神经病的听阈升高程度呈轻、中度。左右耳听阈升高程度基本一致。低频听阈升高或以低频听阈升高为主的PTT图型占93．75％(90／96耳)。结论 双耳对称或基本对称的低频听阈升高或以低频听阈升高为主是听神经病的重要特征。     

糖尿病周围神经病97例临床特征与神经电生理分析

目的:探讨糖尿病周围神经病(DPN)患者的临床特征与神经电生理变化。方法:分析97例DPN患者的临床特征,比较DPN组和对照组的神经传导速度(NCV)、远端潜伏期、远端波幅3个参数。结果:①临床特征以肢体麻木(59%)最多见、其次为疼痛(42%)。②患者组NCV、远端波幅值低于对照组,远端潜伏期比对照组延长;两组3个参数比较,除腓总神经远端波幅、尺神经感觉传导速度和正中、尺、腓肠神经远端潜伏期外,差异均有统计学意义(P<0.05)。结论:①DPN患者临床特征以肢体麻木和疼痛最多见;②检测NCV、远端潜伏期、远端波幅,能较早发现临床患者。     

Influence of impaired T- and B-cell compartments on efficacy of IVIg in dysimmune neuropathies

Autoimmune mechanisms are postulated to play a role in the development and progression of dysimmune neuropathies (DN). We investigated the relation between lymphocyte number and marker expression, and disease activity in 20 patients with DN under intravenous immunoglobulins (IVIg) treatment. B- and T-lymphocyte markers were studied by flow cytometry of the expression of CD5, CD25, CD23 and CD38 markers on B cells and of CD3, CD4 and CD8 markers, respectively. These parameters were compared with those obtained from matched healthy volunteers. The proportions of CD38+ B cells were higher in patients compared with those of controls. Proportions of activated CD4+ and CD8+ T cells were comparable in peripheral blood mononuclear cells of patients and controls, but a significant reduction of the absolute numbers of CD3+, CD4+ and CD8+ cells were observed in DN patients. The percentages of CD25+ memory T cells were instead significantly increased in DN patients. Lastly, T-cell reduction and the CD19/CD38 ratio over total B (CD19+) cells directly correlated with a poor response to IVIg therapy. In DN, whereas T-cell number is reduced, activated T and B cells are increased, thus suggesting an intrinsic defect of the immune response.