【正文】 eeded 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。,53,Recommendations 建議(ji224。),● Education of patients about selfcare of the feet and referral for special shoes/inserts are vital components of patient management. (B) 自我(z236。,54,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。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(yùn)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。i)的神經(jīng)損傷目前除了良好控制血糖外沒有其他特效療法可以有效治療，對于遠(yuǎn)端對稱性多神經(jīng)病變和自主神經(jīng)病變采用有效的對癥治療是可行的,第五十四頁，共六十三頁。li225。)一項以上的臨床檢查方法診斷遠(yuǎn)端對稱性多神經(jīng)病變的敏感性87%,第五十五頁，共六十三頁。li225。ngzhu224。,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。n jīnɡ)病變,Major clinical manifestations of diabetic autonomic neuropathy include resting tachycardia, exercise intolerance, orthostatic hypotension,constipation, gastroparesis, erectile dysfunction, sudomotor dysfunction, impaired neurovascular function, “brittle diabetes,” and hypoglycemic autonomic failure. 糖尿病自主神經(jīng)病變的常見臨床表現(xiàn)包括：靜息時心動過速、運(yùn)動不耐受、便秘、胃輕癱、勃起機(jī)能障礙、泌汗功能障礙、神經(jīng)血管功能受損，“脆性糖尿病”、低血糖性自主神經(jīng)功能衰竭 Cardiac autonomic neuropathy may be indicated by resting tachycardia (100 bpm), orthostasis (a fall in systolic blood pressure20 mmHg upon standing), or other disturbances in autonomic nervous system function involving the skin, pupils, or gastrointestinal and genitourinary systems. 靜息時心動過速（100bpm）、靜息狀態(tài)（站立時收縮壓下降超過20mmHg以上）、或者(hu242。,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。n jīnɡ)病變,Gastrointestinal disturbances (e.g., esophageal enteropathy, gastroparesis, constipation, diarrhea, fecal incontinence) are common, and any section of the gastrointestinal tract may be affected. Gastroparesis should be suspected in individuals with erratic glucose control. 胃腸道功能紊亂(如：食道性腸病、胃輕癱、便秘、腹瀉、大便失禁)是最常見的，同時胃腸道的任何部位都有受累的可能。ngy224。,59,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。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(jī)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。li225。zh236。 jiǎ)腎上腺素再攝取抑制劑,阿米替林,去甲替林,丙米嗪,加巴噴丁,卡馬西平,普加巴林,辣椒辣素,第六十頁，共六十三頁。li225。上述這些治療方法經(jīng)常被用于改善病人的癥狀 Although they do not change the underlying pathology and natural history of the disease process, their use is recommended due to the impact they may have on the quality of life of the patient. 即使這些治療不能改變潛在的病理變化和疾病的自然進(jìn)程，但由于這些治療能改善病人的生活質(zhì)量，故還是(h225。,62,Summary 總結(jié)(zǒngji233。ngzhǐ)對糖尿病神經(jīng)病變的漏診 治療DPN的第一步也是很重要的一步就是首先要穩(wěn)定而且理想的控制血糖 目前DPN的發(fā)病機(jī)制尚未明確，學(xué)術(shù)界只認(rèn)同是多因素的結(jié)果，所以對因治療是非常困難，故象醛糖還原酶抑制劑、α硫辛酸等病因治療藥物在此版診療標(biāo)準(zhǔn)中未被提及 凡是能改善病人生活質(zhì)量的各種治療方法都是推薦使用的,第六十二頁，共六十三頁。ir243。本資料摘自中華醫(yī)學(xué)雜志2005年7月27日第85卷第28期。 zhǐ)或足截肢，美國報告15%截肢。任何一個異常均需給于病足所需的特殊靴鞋、或者讓預(yù)防專家或足醫(yī)進(jìn)行會診（B