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糖尿病运动神经病变的诊断及治疗
糖尿病性周围神经病变是糖尿病三大并发症之一,是一组以感觉和自主神经症状为主要临床表现的周围神经病.糖尿病运动神经病变是慢性的糖尿病周围神经病变的表现之一,其进展大多隐匿、缓慢,往往容易被病人忽视而延误诊治,酿成严重后果.病因糖尿病性周围神经病的基本病因是糖尿病未得到有效控制,导致周围神经病变.这是糖尿病常见的慢性并发症之一,临床表现多种多样,很难用单一的机制来解释如此多样的神经病变.多元病理机制的共同作用可能终导致复杂多变的临床表现.其中,运动神经病变以一侧下肢近端严重疼痛多见,可与双侧远端运动神经同时受累,伴迅速进展的肌无力和肌萎缩,是肌肉常受到累及的类型.
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Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Afifl-iated Hospital of Kunming Medical University in China from June 2008 to September 2013: 221 cases showed symptoms of peripheral neuropathy (symptomatic group) and 279 cases had no symptoms of peripheral impairment (asymptomatic group). One hundred healthy control sub-jects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were signiifcantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. More-over, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases (71.6%), among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The ampli-tude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, as-ymptomatic stage of diabetic peripheral neuropathy.
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多灶性运动神经病的临床表现和诊断
1985~1986年,多位学者分别报道了远端受累重于近端的进展性纯运动神经病,其肢体无力多不对称,从上肢开始,伴有典型的电生理特点,为运动神经的多灶性持续性传导阻滞(conduction block),而感觉神经未见受累.