Boulton A J
Department of Medicine, Manchester Royal Infirmary, UK.
Diabet Med. 1991;8 Spec No:S52-7. doi: 10.1111/j.1464-5491.1991.tb02157.x.
A simple classification of the more common neuropathies is presented. The most frequent disorder in diabetes is a symmetrical sensory polyneuropathy in the lower limbs. Acute sensory polyneuropathies frequently follow sudden metabolic disturbance although there may be little evidence of neurological abnormalities on clinical examination. Similar symptoms occur with chronic sensory polyneuropathy but onset is gradual and this condition may persist for years with only minor symptoms. A significant proportion of patients with chronic polyneuropathies have few if any symptoms and are only diagnosed by careful clinical examination. An approach to the diagnosis and management of symptomatic sensory polyneuropathy is suggested. Sensory loss, and the possible complication of vascular dysfunction, greatly increases the risk of insensitive foot lesions in diabetic patients. Some may progress to the insensitive foot without prior evidence of neuropathy. Regular and thorough examination is therefore the only way to identify patients at risk who then require education in preventative foot care. The identification of such patients and the clinical presentation and management of foot ulcers is discussed.
本文介绍了较为常见的神经病变的简单分类。糖尿病中最常见的病症是下肢对称性感觉性多发性神经病变。急性感觉性多发性神经病变常继发于突然的代谢紊乱，尽管临床检查可能几乎没有神经学异常的证据。慢性感觉性多发性神经病变也会出现类似症状，但起病缓慢，这种情况可能会持续数年，症状较轻。相当一部分慢性多发性神经病变患者几乎没有症状，只有通过仔细的临床检查才能确诊。本文提出了一种针对有症状的感觉性多发性神经病变的诊断和管理方法。感觉丧失以及血管功能障碍的可能并发症，大大增加了糖尿病患者发生足部感觉迟钝性病变的风险。有些患者可能在没有先前神经病变证据的情况下发展为足部感觉迟钝。因此，定期和全面的检查是识别有风险患者的唯一方法，这些患者随后需要接受预防性足部护理教育。本文还讨论了此类患者的识别以及足部溃疡的临床表现和管理。
