【正文】 表現(xiàn) Clinical manifestations,代謝紊亂癥候群 “三多一少”：多飲、多食、多尿、體重減少 并發(fā)癥和(或)伴發(fā)病 各種急慢性并發(fā)癥，有的以肢端麻木等周圍神經(jīng)(zhōuw233。n)標(biāo)準(zhǔn) Criteria for the diagnosis of diabetes 1999年WHO診斷標(biāo)準(zhǔn),1999年WHO診斷標(biāo)準(zhǔn) 1.有糖尿病癥狀(zh232。 糖尿病癥狀包括多尿、多飲和不可解釋的體重減輕。n)標(biāo)準(zhǔn) Criteria for the diagnosis of diabetes 1999年WHO診斷標(biāo)準(zhǔn),糖尿病前期(PreDiabetes) 空腹(kōngf249。,12,IFG診斷(zhěndu224。xi224。,14,高血糖中間狀態(tài)和糖尿病 Intermediate Hyperglycemia amp。,15,輔助(fǔzh249。o) Medical Care in Diabetes,IGT的干預(yù)可以降低糖尿病和微血管病變的發(fā)生率 飲食和運動治療應(yīng)該引起重視 保護(hù)(bǎoh249。)糖尿病前瞻性研究 DCCT Diabetes Control and Complications Trial 美國糖尿病控制與并發(fā)癥試驗,第十七頁，共六十三頁。nɡ)判斷，糖尿病性多發(fā)性神經(jīng)病損害幾乎可占糖尿病患者的47%~91%,第十八頁，共六十三頁。,20,病因及發(fā)病機制目前尚未完全明了 目前認(rèn)為主要是以下因素共同(g242。ji224。nx236。,23,糖尿病周圍神經(jīng)(zhōuw233。n jīnɡ)病變,*此分類摘自2005版中國糖尿病防治(f225。ngyǎnsh233。ngyǎnsh233。),第二十六頁，共六十三頁。)糖尿病防治指南,第二十七頁，共六十三頁。 tǒnɡ)自主神經(jīng)病變 汗腺與周圍血管 瞳孔 對代謝的影響,臨床表現(xiàn) Clinical manifestations of DPN,*此分類摘自2005版中國(zhōnɡ ɡu243。shu236。ngbi224。nɡ) 便秘：大腸的動力降低引起 便秘與腹瀉交替出現(xiàn),第三十四頁，共六十三頁。,37,糖尿病周圍(zhōuw233。i)神經(jīng)病的診斷 Diagnosis of Diabetic Neuropathy,針刺痛覺 溫度覺 音叉振動覺（使用128Hz音叉） 10g單絲壓力覺 踝反射 QST（感覺定量檢查） 肌電圖 神經(jīng)電生理(shēnglǐ)檢查 B超測膀胱殘余尿量,第三十八頁，共六十三頁。li225。,41,糖尿病神經(jīng)病的治療(zh236。o)DPN的關(guān)鍵 UKPDS amp。o) Treatment of Diabetic Neuropathy,修復(fù)(xiūf249。o) Treatment of Diabetic Neuropathy,擴張血管改善微循環(huán) 己酮可可堿 前列地爾 擴張血管、降低血黏度(ni225。li225。n chu225。o) Treatment of Diabetic Neuropathy,抗氧化劑 α硫辛酸(ALA) 清除體內(nèi)多種自由基。 鰲合鐵、銅等金屬離子,降低自由基的產(chǎn)生,摘自《臨床薈萃(hu236。li225。,47,糖尿病神經(jīng)病的治療(zh236。)與止痛劑等 苯妥因及卡馬西平通過阻斷鈉離子通道而穩(wěn)定神經(jīng)細(xì)胞膜,緩解疼痛,但療效欠佳,摘自《臨床(l237。o)標(biāo)準(zhǔn),VI. Prevention and Managerment of Diabetes Complications vi.預(yù)防與處理(chǔlǐ)糖尿病并發(fā)癥 D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療,2007 American Diabetes Association 2007 美國(měi ɡu243。,51,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。,52,Recommendations 建議(ji224。 zhěn)（B） ● Screening for autonomic neuropathy should be instituted at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes. Special electrophysiological testing for autonomic neuropathy is rarely needed and may not affect management and outcomes.(E) 對于自主神經(jīng)病變的篩查應(yīng)開始于診斷2型糖尿病的同時和診斷1型糖尿病的5年之后。),● Education of patients about selfcare of the feet and referral for special shoes/inserts are vital components of patient management. (B) 自我(z236。o),The diabetic neuropathies are heterogeneous with diverse clinical manifestations.They may be focal or diffuse. Most common among the neuropathies are chronic sensorimotor DPN and autonomicneuropathy. 糖尿病神經(jīng)病變的臨床表現(xiàn)多種多樣，它們可能是局灶的也可能是彌漫的，最常見的糖尿病神經(jīng)病變是慢性遠(yuǎn)端對稱性感覺運動性多神經(jīng)病變和自主神經(jīng)病變 Specific treatment for the underlying nerve damage is currently not available,other than improved glycemic control. Effective symptomatic treatments are available for the manifestations of DPN and autonomic neuropathy. 對于潛在(qi225。li225。li225。,57,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療 Diabetic autonomic neuropathy 糖尿病性自主神經(jīng)(z236。,58,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療 Diabetic autonomic neuropathy 糖尿病性自主神經(jīng)(z236。ngy224。o) Symptomatic treatments 對癥治療,The first step in management of patients with DPN should be to aim for stable and optimal glycemic control. 治療糖尿病患者遠(yuǎn)端對稱性多神經(jīng)病變的第一步是穩(wěn)定和理想的血糖控制 Most patients will require pharmacological treatment for painful symptoms: many agents have efficacy confirmed in published randomized controlled trials, though none are specifically licensed for the management of painfulDPN. See Table 10 對于疼痛的癥狀絕大多數(shù)患者都需要藥物治療，發(fā)表的隨機控制試驗證實許多治療方法都是有效的，但是還沒有一種被特別批準(zhǔn)(pī zhǔn)專門用于治療DPN疼痛癥狀的藥物（見表10）,第五十九頁，共六十三頁。zh236。li225。,62,Summary 總結(jié)(zǒngji233。ir243。 zhǐ)或足截肢，美國報告15%截