Diabetic neuropathy: An intensive review
Diabetic neuropathy: An intensive review
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DOI：
10.1093/ajhp/61.2.160
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发表时间：
2004-01-15
影响因子：
2.7
通讯作者：
Rasmussen, KA
中科院分区：
文献类型：
--
作者：
Duby, JJ;Campbell, RK;Rasmussen, KA
目的.本文就糖尿病神经病变的流行病学、分类、病理及治疗进行综述。糖尿病周围神经病变是糖尿病的常见并发症，可导致显著的发病率和死亡率。大约30%的住院糖尿病患者和20%的社区糖尿病患者患有周围神经病变;年发病率约为2%。主要危险因素是高血糖。感觉运动神经病以疼痛、感觉异常和感觉丧失为特征。心脏自主神经病变（CAN）可导致心肌梗死、恶性心律失常和猝死。胃轻瘫是胃肠道自主神经病变的最衰弱的并发症。生殖泌尿自主神经病变可引起性功能障碍和神经源性膀胱。糖尿病神经病变的病理学涉及氧化应激、晚期糖基化终产物、多元醇途径通量和蛋白激酶C活化;所有这些都有助于微血管疾病和神经功能障碍。对于症状管理，来自临床试验的当前证据支持使用地昔帕明、阿米替林、辣椒素、曲马多、加巴喷丁、安非他酮和文拉法辛作为首选药物。西酞普兰、非甾体类镇痛药和阿片类镇痛药可用作辅助药物。拉莫三嗪、奥卡西平、帕罗西汀、左旋多巴和α-硫辛酸是可考虑的替代品。认为支持使用唑尼沙胺、氟西汀、美西律、美沙芬和苯妥英的证据不明确。补充疗法也显示出疗效。CAN的症状可以用氟氢可的松、可乐定、米多君、二氢麦角胺或咖啡因、奥曲肽和β受体阻滞剂来改善。胃轻瘫可用胃复安或红霉素治疗。最有前途的疾病改善疗法是ruboxietin，这是在III期试验。血糖控制仍然是预防的基础和适当治疗的前提。糖尿病神经病变是糖尿病的多方面并发症，可以用一系列药物进行治疗。
Purpose. The epidemiology, classification, pathology, and treatment of diabetic neuropathy are reviewed.Summary. Diabetic peripheral neuropathy is a common complication of diabetes that can cause significant morbidity and mortality. Some 30% of hospitalized and 20% of community-dwelling diabetes patients have peripheral neuropathy; the annual incidence rate is approximately 2%. The primary risk factor is hyperglycemia. Sensorimotor neuropathy is marked by pain, paresthesia, and sensory loss. Cardiac autonomic neuropathy (CAN) may contribute to myocardial-infarction, malignant arrhythmia, and-sudden death. Gastroparesis is the most debilitating complication of gastrointestinal autonomic neuropathy. Genitourinary autonomic neuropathy can cause sexual dysfunction and neurogenic bladder. The pathology of diabetic neuropathy involves oxidative stress, advanced glycation end products; polyol pathway flux, and protein kinase C activation; all contribute to microvascular disease and nerve dysfunction. For symptom management current evidence from clinical trials supports the use of desipramine, amitriptyline, capsaicin, tramadol, gabapentin, bupropion, and venlafaxine as preferred medications. Citalopram, nonsteroidal antiinflammatory drugs, and opioid analgesics may be used as adjuvant agents. Lamotrigine, oxcarbazepine, paroxetine, levodopa, and alpha-lipoic acid are alternatives considerations. Evidence supporting the use of zonisamide, fluoxetine, mexiletine, dextromethorphan, and phenytoin is considered equivocal. Complementary therapies have also shown efficacy. The symptoms of CAN may be ameliorated with fludrocortisone, clonidine, midodrine, dihydroergotamine or caffeine, octreotide, and beta-blockers. Gastroparesis may be treated with metoclopramide or erythromycin. The most promising disease-modifying therapy is ruboxistaurin, which is in Phase III trials. Glycemic control remains the foundation of prevention and the prerequisite of adequate treatment.Conclusion. Diabetic neuropathy is a many-faceted complication of diabetes that can be managed symptomatically with an array of drugs.