Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy.
Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy.
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DOI：
10.1002/ana.21952
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发表时间：
2010-04
影响因子：
11.2
通讯作者：
Freeman, Roy
中科院分区：
文献类型：
--
作者：
Gibbons, Christopher H.;Freeman, Roy
描述出现与血糖控制相关的急性疼痛性神经病变（也称为“胰岛素神经炎”）的糖尿病患者的自然病史、临床、神经生理学和组织学特征及结局。16名患有急性疼痛性神经病变的受试者在18个月内进行了神经系统和视网膜检查、实验室研究、自主神经测试和疼痛评估。8名受试者进行皮肤活检，以评价表皮内神经纤维密度。所有受试者在强化血糖控制的8周内均出现严重疼痛。在所有受试者中，自主性心血管、胃肠道、泌尿生殖系统和催汗症状的患病率较高。69%的受试者出现直立性低血压和副交感神经功能障碍。所有受试者的视网膜病变均恶化。在所有受试者中均观察到表皮内神经纤维密度（IENFD）降低。血糖控制18个月后，疼痛、自主神经症状、自主神经测试结果和IENFD均有实质性改善。与2型糖尿病受试者相比，1型糖尿病受试者在18个月后的自主神经症状（心血管p<0.01;胃肠道p<0.01;泌尿生殖系统p<0.01）和自主神经功能测试（交感神经和副交感神经功能测试p<0.01）方面有更大的改善。治疗诱导的神经病变的特征在于强化血糖控制后的急性、剧烈疼痛、周围神经变性和自主神经功能障碍。神经病变与糖尿病视网膜病变恶化同时发生，表明存在共同的潜在病理生理机制。尽管长期血糖控制不良，但这些糖尿病患者的临床特征和小的有髓和无髓神经纤维的客观测量可以改善，1型糖尿病患者的改善更大。
To describe the natural history, clinical, neurophysiological and histological features and outcomes of diabetic patients presenting with acute painful neuropathy associated with glycemic control, also referred to as ‘insulin neuritis’. Sixteen subjects, presenting with acute painful neuropathy had neurological and retinal examinations, laboratory studies, autonomic testing and pain assessments over 18 months. Eight subjects had skin biopsies for evaluation of intra-epidermal nerve fiber density. All subjects developed severe pain within 8 weeks of intensive glucose control. There was a high prevalence of autonomic cardiovascular, gastrointestinal, genitourinary, and sudomotor symptoms in all subjects. Orthostatic hypotension and parasympathetic dysfunction were seen in 69% of subjects. Retinopathy worsened in all subjects. Reduced intra-epidermal nerve fiber density (IENFD) was seen in all tested subjects. After 18 months of glycemic control, there were substantial improvements in pain, autonomic symptoms, autonomic test results and IENFD. Greater improvements were seen after 18 months in type 1 vs. type 2 diabetic subjects in autonomic symptoms (cardiovascular p<0.01; gastrointestinal p<0.01; genitourinary p<0.01) and autonomic function tests (p<0.01, sympathetic and parasympathetic function tests). Treatment induced neuropathy is characterized by acute, severe pain, peripheral nerve degeneration and autonomic dysfunction after intensive glycemic control. The neuropathy occurred in parallel with worsening diabetic retinopathy suggesting a common underlying pathophysiological mechanism. Clinical features and objective measures of small myelinated and unmyelinated nerve fibers can improve in these diabetic patients despite a prolonged history of poor glucose control, with greater improvement seen in patients with type 1 diabetes.
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影响因子：
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