Manschot S M, Biessels G J, Rutten G E H M, Kessels R P C, Gispen W H, Kappelle L J
Rudolf Magnus Institute of Neuroscience, Department of Neurology, University Medical Center, Utrecht, The Netherlands.
J Neurol Sci. 2008 Jan 15;264(1-2):157-62. doi: 10.1016/j.jns.2007.08.011. Epub 2007 Sep 12.
Diabetes mellitus is associated with end-organ complications in the peripheral and central nervous system. It is unknown if these complications share a common aetiology, and if they co-occur in the same patient. The aim of the present study was to relate different measures of peripheral neuropathy in patients with type 2 diabetes mellitus (DM2) to cognition and brain MRI. A standardized neurological examination and questionnaire, neuropsychological examination and brain MRI were performed in 122 patients with DM2 and 56 matched controls. Measures of peripheral neuropathy were vibration threshold, a sensory examination sum score and the Toronto Clinical Neuropathy Scoring System. Neuropsychological test scores were expressed in standardized z-values across five predetermined cognitive domains. White matter lesions and cortical and subcortical atrophy were rated on MRI. Overall 38% of the patients with DM2 and 12% of the controls were classified as having any neuropathy (p<0.001). Patients with DM2 had a lower performance on the neuropsychological tests, more white matter lesions (p<0.01) and more atrophy (p<0.01) than controls. Within the DM2 group none of the measures of peripheral neuropathy was related to MRI abnormalities or cognitive dysfunction (linear regression analyses, adjusted for age, education, sex). We conclude that peripheral neuropathy in patients with DM2 is not related to cognitive dysfunction and brain abnormalities. This indicates that central and peripheral neurological complications of DM2 might have different etiologies.
糖尿病与外周和中枢神经系统的终末器官并发症相关。目前尚不清楚这些并发症是否具有共同的病因，以及它们是否会在同一患者中同时出现。本研究的目的是将2型糖尿病（DM2）患者外周神经病变的不同测量指标与认知及脑部磁共振成像（MRI）相关联。对122例DM2患者和56例匹配的对照者进行了标准化的神经学检查及问卷调查、神经心理学检查和脑部MRI检查。外周神经病变的测量指标包括振动觉阈值、感觉检查总分以及多伦多临床神经病变评分系统。神经心理学测试分数以五个预先确定的认知领域的标准化z值表示。通过MRI对白质病变以及皮质和皮质下萎缩进行评分。总体而言，38%的DM2患者和12%的对照者被归类为患有任何神经病变（p<0.001）。与对照者相比，DM2患者在神经心理学测试中的表现较差，白质病变更多（p<0.01），萎缩更严重（p<0.01）。在DM2组中，外周神经病变的各项测量指标均与MRI异常或认知功能障碍无关（线性回归分析，校正年龄、教育程度、性别）。我们得出结论，DM2患者的外周神经病变与认知功能障碍和脑部异常无关。这表明DM2的中枢和外周神经并发症可能具有不同的病因。
