Assessing decreased sensation and increased sensory phenomena in diabetic polyneuropathies.
Assessing decreased sensation and increased sensory phenomena in diabetic polyneuropathies.
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作者：
Dyck PJ;Herrmann DN;Staff NP;Dyck PJ
感觉丧失和感觉现象增加是各种糖尿病多发性神经病的主要表现，需要改进临床和研究目的的评估。我们为感觉减弱和感觉现象增加之间的明显悖论提供了神经生物学解释。强烈支持使用 10 克单丝进行足部筛查以检测感觉丧失，目的是改善糖尿病管理并预防足部溃疡和神经源性关节病。我们描述了评估大纤维和小纤维感觉丧失的种类、严重程度和分布的改进方法，以及哪些方法和技术可能有助于进行治疗试验。神经传导属性的异常可以用来验证大感觉纤维的功能障碍。表皮神经纤维/1毫米的异常可用作小纤维感觉丧失的替代测量，但似乎与疼痛的严重程度没有密切相关。增加的感觉现象可以通过患者用来描述它们的特征词以及这些症状的严重性和持续性来识别。触觉和热痛觉过敏测试是神经过度活跃的额外标志，可用于诊断和疾病管理。
Loss of sensation and increased sensory phenomena are major expressions of varieties of diabetic polyneuropathies needing improved assessments for clinical and research purposes. We provide a neurobiological explanation for the apparent paradox between decreased sensation and increased sensory phenomena. Strongly endorsed is the use of the 10-g monofilaments for screening of feet to detect sensation loss, with the goal of improving diabetic management and prevention of foot ulcers and neurogenic arthropathy. We describe improved methods to assess for the kind, severity, and distribution of both large- and small-fiber sensory loss and which approaches and techniques may be useful for conducting therapeutic trials. The abnormality of attributes of nerve conduction may be used to validate the dysfunction of large sensory fibers. The abnormality of epidermal nerve fibers/1 mm may be used as a surrogate measure of small-fiber sensory loss but appear not to correlate closely with severity of pain. Increased sensory phenomena are recognized by the characteristic words patients use to describe them and by the severity and persistence of these symptoms. Tests of tactile and thermal hyperalgesia are additional markers of neural hyperactivity that are useful for diagnosis and disease management.
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