Said Gérard
Service de Neurologie, Centre Hospitalier Universitaire de Bicêtre, Université Paris-Sud, 94275 Le Kremlin Bicêtre, France.
Nat Clin Pract Neurol. 2007 Jun;3(6):331-40. doi: 10.1038/ncpneuro0504.
Diabetic neuropathy is the most common neuropathy in industrialized countries, and it is associated with a wide range of clinical manifestations. The vast majority of patients with clinical diabetic neuropathy have a distal symmetrical form of the disorder that progresses following a fiber-length-dependent pattern, with sensory and autonomic manifestations predominating. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients experience pain, trophic changes in the feet, and autonomic disturbances. Occasionally, patients with diabetes can develop focal and multifocal neuropathies that include cranial nerve involvement and limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, and mostly in patients with long-standing diabetes mellitus. Length-dependent diabetic polyneuropathy does not show any trend towards improvement, and either relentlessly progresses or remains relatively stable over a number of years. Conversely, the focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self-limited, sometimes after a relapsing course.
糖尿病性神经病变是工业化国家中最常见的神经病变，且与多种临床表现相关。绝大多数临床糖尿病性神经病变患者患有远端对称性病变形式，该病变遵循纤维长度依赖性模式进展，以感觉和自主神经表现为主。这种神经病变模式与进行性远端轴索性神经病相关。患者会经历疼痛、足部营养性改变以及自主神经功能紊乱。偶尔，糖尿病患者会发展为局灶性和多灶性神经病变，包括颅神经受累以及肢体和躯干神经病变。这种神经病变模式往往在50岁以后出现，且大多见于长期患有糖尿病的患者。长度依赖性糖尿病性多发性神经病变没有任何改善的趋势，要么持续进展，要么在数年中保持相对稳定。相反，局灶性糖尿病性神经病变在神经活检时通常与炎症性血管病变相关，有时经过复发过程后会保持自限性。
