Early involvement of the spinal cord in diabetic peripheral neuropathy
Early involvement of the spinal cord in diabetic peripheral neuropathy
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DOI：
10.2337/dc06-0650
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发表时间：
2006-12-01
期刊：
影响因子：
16.2
通讯作者：
Tesfaye, Solomon
中科院分区：
文献类型：
--
作者：
Selvarajah, Dinesh;Wilkinson, Iain D.;Tesfaye, Solomon
目的-糖尿病周围神经病变（DPN）的发病机制知之甚少。我们最近报道了在临床可检测到的DPN阶段，脊髓横截面积显著减少。在这项研究中，我们调查是否脊髓萎缩发生在早期（亚临床）DPN.RESEARCH设计和方法-81男性I型糖尿病患者，24非糖尿病对照组，8例遗传性感觉运动神经病（HSMN）1A型进行了详细的临床和神经生理学评估。糖尿病受试者随后根据神经病变严重程度分为三组（19例无DPN，23例亚临床DPN，39例临床可检测到DPN）。所有受试者均接受颈椎磁共振成像和椎间盘水平C2/C3的脊髓面积测量。结果-无DPN的糖尿病受试者的平均校正脊髓面积指数（SCAI）（校正年龄、身高和体重）为67.5 mm [95%CI 64.1-70.9]。与无DPN的受试者相比，亚临床（62.4 min [59.5-65.3]）和临床可检测DPN（57.2 mm [54.9-59.6]）的受试者的平均SCAI较低（分别为P = 0.03和P < 0.001）。无DPN的糖尿病受试者与非糖尿病对照受试者之间无显著差异（69.2 mm [66.3-72.0]，P = 0.47）。1A型HSMN受试者的平均SCAI（71.07 mm [65.3-76.9]）与非糖尿病对照受试者和无DPN的糖尿病受试者无显著差异。在糖尿病受试者中，SCAI与腓肠神经感觉传导速度和神经病变复合物和症状Scores.Conclusions显著相关-脊髓受累发生在DPN的早期。SCAI的降低与DPN的神经生理学评估之间也存在显著相关性。
OBJECTIVE - The pathogenesis of diabetic peripheral neuropathy (DPN) is poorly understood. We have recently reported a significant reduction in spinal cord cross-sectional area at the stage of clinically detectable DPN. In this study, we investigated whether spinal cord atrophy occurs in early (subclinical) DPN.RESEARCH DESIGN AND METHODS - Eighty-one male type I diabetic subjects, 24 nondiabetic control subjects, and 8 subjects with hereditary sensory motor neuropathy (HSMN) type 1A underwent detailed clinical and neurophysiological assessments. Diabetic subjects were subsequently divided into three groups based on neuropathy severity (19 with no DPN, 23 with subclinical DPN, and 39 with clinically detectable DPN). All subjects under-went magnetic resonance imaging of the cervical spine and cord area measurements at disc level C2/C3.RESULTS - Mean corrected spinal cord area index (SCAI) (corrected for age, height, and weight) was 67.5 mm [95% CI 64.1-70.9] in diabetic subjects without DPN. Those with subclinical (62.4 min [59.5-65.3]) and clinically detectable DPN (57.2 mm [54.9-59.6]) had lower mean SCAIs compared with subjects with no DPN (P = 0.03 and P < 0.001, respectively). No significant difference was found between diabetic subjects without DPN and nondiabetic control subjects (69.2 mm [66.3-72.0], P = 0.47). Mean SCAIs in subjects with HSMN type 1A (71.07 mm [65.3-76.9]) were not significantly different from those for nondiabetic control subjects and diabetic subjects without DPN. Among diabetic subjects, SCAI was significantly related to sural sensory conduction velocities and the Neuropathy Composite and Symptom Scores.CONCLUSIONS - Spinal cord involvement occurs early in DPN. There is also a significant relation between reduction in SCAI and neurophysiological assessments of DPN.