Kästenbauer Thomas, Irsigler Paul, Sauseng Susanna, Grimm Angelika, Prager Rudolf
L Boltzman Institute of Metabolic Diseases and Nutrition, Hospital Lainz, Wolkersbergenstrasse 1, 1130 Vienna, Austria.
J Diabetes Complications. 2004 Jan-Feb;18(1):27-31. doi: 10.1016/S1056-8727(03)00071-0.
The aim of this study was to analyze the prevalence and severity of sensorimotor and autonomic neuropathic symptoms within an outpatients diabetic population. A total of 350 consecutive Type 1 (26.9%) and Type 2 diabetic subjects were investigated using the Michigan Neuropathy Screening Instrument (MNSI). The original questionnaire was extended with questions on autonomic neuropathy and to include a six-point scale to rate the severity of symptoms, which were recorded accurately in order to avoid overrating. More than one half of Type 2 and nearly a third of Type 1 diabetic subjects suffer from at least one neuropathic symptom; the former suffered significantly more often from paresthesia (P<.05) and burning pain (P=.05). Less than 10% of the study population had autonomic symptoms. The prevalence of symptomatic polyneuropathy (PNP), diagnosed by an abnormal MNSI together with the presence of any symptom, was 16.0% in Type 1 and 37.5% (P<.001) in Type 2 diabetic subjects. Subjects with an abnormal ankle reflex (54.6%) had in 48.2% any sensorimotor, in 35.1% any autonomic, and in 25.7% any sensorimotor plus autonomic symptoms. The corresponding percentages for subjects with an abnormal vibration perception threshold (VPT; 28.9%) were 59.4%, 46.5%, and 34.7%, respectively. An abnormal ankle reflex was significantly correlated to numbness, and to the the sum of sensorimotor and autonomic symptoms. An abnormal vibration perception was significantly correlated to numbness, to paresthesia pain, and to the sum of sensorimotor and autonomic symptoms. A higher percentage of Type 2 diabetic subjects had symptoms of neuropathy and the most frequent symptoms were numbness, muscle cramps and postural hypotension.
本研究旨在分析门诊糖尿病患者中感觉运动和自主神经病变症状的患病率及严重程度。使用密歇根神经病变筛查工具（MNSI）对总共350例连续的1型（26.9%）和2型糖尿病患者进行了调查。原始问卷扩展了有关自主神经病变的问题，并纳入了一个六点量表来评估症状的严重程度，症状被准确记录以避免高估。超过一半的2型糖尿病患者和近三分之一的1型糖尿病患者至少患有一种神经病变症状；前者患感觉异常（P<0.05）和灼痛（P=0.05）的频率明显更高。不到10%的研究人群有自主神经症状。经异常MNSI诊断且伴有任何症状的症状性多发性神经病变（PNP）患病率在1型糖尿病患者中为16.0%，在2型糖尿病患者中为37.5%（P<0.001）。踝反射异常的患者中有48.2%有任何感觉运动症状，35.1%有任何自主神经症状，25.7%有任何感觉运动加自主神经症状。振动觉阈值（VPT）异常的患者（28.9%）相应的百分比分别为59.4%、46.5%和34.7%。踝反射异常与麻木以及感觉运动和自主神经症状的总和显著相关。振动觉异常与麻木、感觉异常性疼痛以及感觉运动和自主神经症状的总和显著相关。2型糖尿病患者中神经病变症状的比例更高，最常见的症状是麻木、肌肉痉挛和体位性低血压。
