Motor dysfunction in diabetes
Motor dysfunction in diabetes
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DOI：
10.1002/dmrr.2257
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发表时间：
2012-02-01
影响因子：
8
通讯作者：
Andersen, Henning
中科院分区：
文献类型：
--
作者：
Andersen, Henning
神经病变是糖尿病常见的并发症，最常见的是远端对称性感觉运动性多发性神经病（PN）。在临床检查中很少见到运动系统受累。然而，随着定量技术的应用，即等速测力法，已经检测到1型和2型糖尿病患者在踝关节和膝关节处具有无力。肌无力仅见于糖尿病PN患者，而非神经病患者即使长期患有糖尿病也有正常的力量。该弱点与PN的体征和严重程度密切相关。随着磁共振成像的使用，发现肌肉无力被肌肉萎缩所掩盖，这在足部和小腿处观察到。对糖尿病患者随访810年，我们观察到症状性PN患者的肌肉力量加速丧失;同样，在足部和小腿观察到肌肉质量加速丧失。在糖尿病和非糖尿病受试者的大规模研究中，也发现糖尿病患者的肌肉质量较低。因此，除了PN，糖尿病本身导致每单位横纹肌的强度较低。肌肉无力与动作缓慢、步态不稳和更频繁的福尔斯有关。此外，由于肌肉萎缩引起的足部生物力学改变，运动功能障碍导致发生足部溃疡的风险增加。这可能导致皮肤压力增加，从而导致足部溃疡并最终截肢。肌肉和平衡训练可以提高力量，姿势稳定性和步行能力;然而，这需要更详细的研究。版权所有（C）2012约翰威利父子有限公司
Neuropathy is a frequent complication in diabetes and most commonly seen as distal symmetrical sensorimotor polyneuropathy (PN). Involvement of the motor system is infrequently seen at the clinical examination. However, with the application of quantitative techniques, that is, isokinetic dynamometry, type 1 and type 2 diabetic patients have been detected to have weakness at the ankle and the knee. Muscle weakness is found only in diabetic patients with PN, while non-neuropathic patients even with long-term diabetes have normal strength. The weakness is closely related to signs and severity of PN. With the use of magnetic resonance imaging, muscle weakness is found to be paralleled by muscular atrophy, which is observed in the feet and at the lower leg. Following diabetic patients for 810 years, we have observed accelerated loss of muscle strength in patients with symptomatic PN; similarly, accelerated loss of muscle mass is observed in the feet and lower legs. In large-scale studies of diabetic and non-diabetic subjects, lower muscle quality in diabetic patients is also found. Thus, in addition to PN, diabetes per se leads to lower strength per unit striated muscle. Muscle weakness is related to the slowing of movements, unstable gait, and more frequent falls. Furthermore, motor dysfunction leads to an increased risk of developing a foot ulcer due to due to alterations of the biomechanics of the feet caused by muscle atrophy. This may lead to an increased skin pressure that may lead to foot ulceration and ultimately amputation. Muscle and balance training may improve strength, postural stability, and walking performance; however, this needs to be studied in more detail. Copyright (C) 2012 John Wiley & Sons, Ltd.