Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity
Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity
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DOI：
10.1002/dmrr.1226
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发表时间：
2011-10-01
影响因子：
8
通讯作者：
Russell, James W.
中科院分区：
文献类型：
--
作者：
Dyck, Peter J.;Albers, James W.;Russell, James W.
在2009年10月13日至18日在加拿大安大略省多伦多举行的Neurodiab协会和糖尿病神经病变国际研讨会联合会议之前，英国谢菲尔德的所罗门·特斯法耶召集了一个神经肌肉专家小组，提供与糖尿病相关的多发性神经病变的最新情况(多伦多DPN共识小组，2009)。在此，我们提供了典型和非典型糖尿病多神经病(DPN)的定义，诊断标准，以及诊断感觉运动性多发性神经病和估计严重程度的方法。糖尿病感觉运动性多发性神经病(DSPN)，或典型的DPN，通常发生在长期的高血糖、随之而来的代谢紊乱和微血管改变。它经常与微血管、视网膜和肾脏疾病有关，但必须排除其他原因。相比之下，非典型DPN是并发的疼痛和自主小纤维多发性神经病。认识到有必要有效和重复性地检测和评估DSPN的严重程度，我们使用神经传导标准来定义亚临床DSPN，并定义了可能的、可能的和确认的DSPN的临床水平。在进行流行病学调查和随机对照试验时，有必要预先明确使用神经传导的哪些属性、诊断标准、参考值、适用变量的校正以及DSPN的具体标准。在此，我们提供了在健康受试者和糖尿病受试者队列中诊断感觉运动性多发性神经病的几个标准的表现特征。本文还概述了评估DSPN严重程度的阶段性和连续性方法。版权所有(C)2011 John Wiley&Sons，Ltd.
Prior to a joint meeting of the Neurodiab Association and International Symposium on Diabetic Neuropathy held in Toronto, Ontario, Canada, 13-18 October 2009, Solomon Tesfaye, Sheffield, UK, convened a panel of neuromuscular experts to provide an update on polyneuropathies associated with diabetes (Toronto Consensus Panels on DPNs, 2009). Herein, we provide definitions of typical and atypical diabetic polyneuropathies (DPNs), diagnostic criteria, and approaches to diagnose sensorimotor polyneuropathy as well as to estimate severity. Diabetic sensorimotor polyneuropathy (DSPN), or typical DPN, usually develops on long-standing hyperglycaemia, consequent metabolic derangements and microvessel alterations. It is frequently associated with microvessel retinal and kidney disease - but other causes must be excluded. By contrast, atypical DPNs are intercurrent painful and autonomic small-fibre polyneuropathies. Recognizing that there is a need to detect and estimate severity of DSPN validly and reproducibly, we define subclinical DSPN using nerve conduction criteria and define possible, probable, and confirmed clinical levels of DSPN. For conduct of epidemiologic surveys and randomized controlled trials, it is necessary to pre-specify which attributes of nerve conduction are to be used, the criterion for diagnosis, reference values, correction for applicable variables, and the specific criterion for DSPN. Herein, we provide the performance characteristics of several criteria for the diagnosis of sensorimotor polyneuropathy in healthy subject-and diabetic subject cohorts. Also outlined here are staged and continuous approaches to estimate severity of DSPN. Copyright (C) 2011 John Wiley & Sons, Ltd.