糖尿病患者的多發性神經病變

Diabetic Polyneuropathy

糖尿病的神經病變可能是糖尿病最常見的併發症，嚴格說來，或許比糖尿病的視網膜病變、腎病變及血管病變都來得多。一般來說，糖尿病的神經病變可分為二大類，一是廣泛性的神經病變(diffuse neuropathy)，這包括了多發性神經病變(polyneuropathy)及自主神經病變(autonomic neuropathy)。

There are many forms of diabetic neuropathy including symmetric polyneuropathy, autonomic neuropathy, radiculopathies, mononeuropathies, and mononeuropathy multiplex. This article will review the clinical manifestations and diagnosis of diabetic polyneuropathy. The incidence of diabetic polyneuropathy increases in patients over time. A study from Finland revealed that the prevalence of diabetic polyneuropathy progressively increased from 8.3% at baseline to 41.9% 10 years post diagnosis. Diabetic polyneuropathy is primarily a symmetrical sensory neuropathy, initially affecting the distal lower extremities. With disease progression, sensory loss ascends and, when reaching approximately mid-calf, appears in the hands. This gradual evolution causes the typical ”stocking-glove” sensory loss. Motor involvement with frank weakness occurs in the same pattern, but only later and in more severe cases. Historically, the diagnosis of diabetic polyneuropathy was based on subjective interpretation of a constellation of symptoms and signs such as loss of vibratory or light touch sensation and reduced or absent ankle reflexes. However, accurate assessment of symptoms in diabetic neuropathy is known to be difficult. In the Rochester diabetic neuropathy study, assessment of symptoms by either the neuropathy symptom score or the neuropathy symptom profile was poorly reproducible and significant differences in judging symptom severity occurred even among highly trained neurologists. Therefore, some screening and diagnostic tests using score system have been developed. These include the United Kingdom screening test, the Michigan Neuropathy Screening Score, and the Michigan Diabetic Neuropathy Score. The prevention and treatment of diabetic polyneuropathy include good blood glucose control, foot care, and symptomatic therapy. The preliminary reports of aldose reductase inhibitors and angiotensin-converting enzyme inhibitors seemed to be beneficial to diabetic neuropathy; however, further larger studies are needed to confirm their effect.