Accelerated atrophy of lower leg and foot muscles-a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI)
Accelerated atrophy of lower leg and foot muscles-a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI)
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DOI：
10.1007/s00125-009-1320-0
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发表时间：
2009-06-01
期刊：
影响因子：
8.2
通讯作者：
Andersen, H.
中科院分区：
文献类型：
--
作者：
Andreassen, C. S.;Jakobsen, J.;Andersen, H.
本研究的目的是确定长期糖尿病患者小腿和足部肌肉体积的损失与神经病变的存在有关，我们重新检查了26例1型糖尿病患者，他们在9至12年前参加了小腿和足部肌肉体积的磁共振成像（MRI）研究。复查包括MRI、等速测力、临床检查、电生理检查和定量感觉检查，踝背屈肌和跖屈肌的肌肉体积每年损失4.5（5.5-3.9）%（中位数[范围]）和5.0神经病患者为（7.0-4.2）%，非神经病患者组分别为（3.2-1.0）%和1.8（2.6-1.3）%，对照组分别为1.7（2.8-0.8）%和1.8（2.4-0.8）%（p < 0.01）。糖尿病患者踝关节背屈肌（r（s）= 0.73，p < 0.01）和踝关节跖屈肌（r（s）= 0.63，p < 0.05）的体积和力量的年变化相关。此外，背屈肌和跖屈肌的肌肉体积的年度变化与所有神经病变测量的综合评分相关（分别为r（s）=-0.68，p < 0.02和r（s）=-0.73，p < 0.01）。神经病患者的足部肌肉体积每年下降3.0（3.4-1.0）%，非神经病患者的足部肌肉体积每年下降1.1（4.0-0.2）%，这两个值与对照组（0.2 [-2.5至2.4]%）显著不同。足部肌肉体积的损失与临床评估的神经病变的严重程度相关（r（s）=-0.6，p < 0.05）。长期糖尿病神经病变的肌肉萎缩发生在足部早期，在小腿稳定进展，与神经病变的严重程度相关，并导致踝关节无力。
The aim of the study was to determine the loss of muscle volume in the lower leg and foot in long-term diabetic patients in relation to the presence of neuropathy.We re-examined 26 type 1 diabetic patients who had participated in magnetic resonance imaging (MRI) studies on muscle volume in the lower leg and foot 9 to 12 years earlier. Re-examination involved MRI, isokinetic dynamometry, clinical examination, electrophysiological studies and quantitative sensory examinations.Annual loss of muscle volume of ankle dorsal and plantar flexors was 4.5 (5.5-3.9)% (median [range]) and 5.0 (7.0-4.2)% in neuropathic patients, 1.9 (3.2-1.0)% and 1.8 (2.6-1.3)% in non-neuropathic patients, and 1.7 (2.8-0.8)% and 1.8 (2.4-0.8)% in controls, respectively (p < 0.01). Annual change of volume and strength correlated for ankle dorsal flexors (r (s) = 0.73, p < 0.01) and for ankle plantar flexors (r (s) = 0.63, p < 0.05) in diabetic patients. In addition, annual change of muscle volume for dorsal and plantar flexors was related to the combined score of all measures of neuropathy (r (s) = -0.68, p < 0.02 and r (s) = -0.73, p < 0.01, respectively). Foot muscle volume declined annually by 3.0 (3.4-1.0)% in neuropathic patients and by 1.1 (4.0-0.2)% in non-neuropathic patients, both values being significantly different from controls (0.2 [-2.5 to 2.4]%). Loss of foot muscle volume was related to severity of neuropathy assessed at clinical evaluation (r (s) = -0.6, p < 0.05).Muscular atrophy in long-term diabetic neuropathy occurs early in the feet, progresses steadily in the lower legs, relates to severity of neuropathy and leads to weakness at the ankle.