Distal Symmetric Polyneuropathy: A Review.
Distal Symmetric Polyneuropathy: A Review.
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DOI：
10.1001/jama.2015.13611
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发表时间：
2015-11-24
影响因子：
120.7
通讯作者：
Feldman, Eva L.
中科院分区：
文献类型：
--
作者：
Callaghan, Brian C.;Price, Raymond S.;Feldman, Eva L.
周围神经病变是一种高度流行和病态的疾病，影响2-7%的人口。患者经常遭受疼痛，并有福尔斯、溃疡和截肢的风险。我们的目的是审查最近的诊断和治疗进展，周围神经病的远端对称性多发性神经病，最常见的亚型周围神经病。目前的证据支持对远端对称性多发性神经病患者进行有限的常规实验室检查。不明原因的患者应进行全血细胞计数、综合代谢检查、B12、血清蛋白电泳免疫固定、空腹血糖和葡萄糖耐量试验。存在非典型特征，如不对称、非长度依赖、运动优势、急性或亚急性发作和/或显著的自主神经受累，应立即咨询神经科医生或神经肌肉专家。神经轴的电诊断测试和磁共振成像是诊断评估成本的主要驱动因素，但缺乏支持其使用的证据。强有力的证据支持使用三环类抗抑郁药、5-羟色胺和去甲肾上腺素再摄取抑制剂以及电压门控钙通道配体治疗神经性疼痛。强化血糖控制可显著降低1型糖尿病患者远端对称性多发性神经病变的发生率，但对2型糖尿病患者无此作用。存在改善远端对称性多发性神经病患者指南一致性测试的机会。此外，电诊断测试的作用需要进一步定义，并需要干预措施，以减少磁共振成像在这一人群中的使用。尽管存在用于神经性疼痛治疗的几种有效药物，但疼痛仍然未被充分认识和治疗。需要新的疾病修饰药物来预防和治疗周围神经病变，特别是2型糖尿病。
Peripheral neuropathy is a highly prevalent and morbid condition affecting 2–7% of the population. Patients frequently suffer from pain and are at risk of falls, ulcerations, and amputations. We aimed to review recent diagnostic and therapeutic advances in peripheral neuropathy in distal symmetric polyneuropathy, the most common subtype of peripheral neuropathy. Current evidence supports limited routine laboratory testing in patients with distal symmetric polyneuropathy. Patients without a known cause should have a complete blood count, comprehensive metabolic panel, B12, serum protein electrophoresis with immunofixation, fasting glucose, and a glucose tolerance test. The presence of atypical features such as asymmetry, non-length-dependence, motor predominance, acute or subacute onset, and/or prominent autonomic involvement should prompt a consultation with a neurologist or neuromuscular specialist. Electrodiagnostic tests and magnetic resonance imaging of the neuroaxis are the main drivers of the cost of the diagnostic evaluation, but evidence supporting their use is lacking. Strong evidence supports the use of tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, and voltage-gated calcium channel ligands in the treatment of neuropathic pain. More intensive glucose control substantially reduces the incidence of distal symmetric polyneuropathy in patients with type 1 diabetes, but does not in type 2 diabetes. The opportunity exists to improve guideline concordant testing in distal symmetric polyneuropathy patients. Moreover, the role of electrodiagnostic tests needs to be further defined, and interventions to reduce magnetic resonance imaging use in this population are needed. Even though several efficacious medications exist for neuropathic pain treatment, pain is still under-recognized and undertreated. New disease modifying medications are needed to prevent and treat peripheral neuropathy, particularly in type 2 diabetes.
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影响因子：
120.7
作者：
Berk, John L.;Suhr, Ole B.;Obici, Laura;Sekijima, Yoshiki;Zeldenrust, Steven R.;Yamashita, Taro;Heneghan, Michael A.;Gorevic, Peter D.;Litchy, William J.;Wiesman, Janice F.;Nordh, Erik;Corato, Manuel;Lozza, Alessandro;Cortese, Andrea;Robinson-Papp, Jessica;Colton, Theodore;Rybin, Denis V.;Bisbee, Alice B.;Ando, Yukio;Ikeda, Shu-ichi;Seldin, David C.;Merlini, Giampaolo;Skinner, Martha;Kelly, Jeffery W.;Dyck, Peter J.
通讯作者：
Dyck, Peter J.
影响因子：
5.1
作者：
Attal, N.;Cruccu, G.;Nurmikko, T.
通讯作者：
Nurmikko, T.
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
16.2
作者：
Abbott CA;Malik RA;van Ross ER;Kulkarni J;Boulton AJ
通讯作者：
Boulton AJ
影响因子：
3.4
作者：
Beekman, R;Van Der Plas, JPL;Visser, LH
通讯作者：
Visser, LH