Said Gérard
l'Hôpital de Bicêtre, Université Paris-Sud.
Arq Neuropsiquiatr. 2007 Dec;65(4B):1272-8. doi: 10.1590/s0004-282x2007000700037.
Diabetic neuropathy is the most common neuropathy in industrialized countries, with a remarkable range of clinical manifestations. The vast majority of the patients with clinical diabetic neuropathy have a distal symmetrical form that progress following a fiber-length dependent pattern, with predominant sensory and autonomic manifestations. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients are exposed to trophic changes in the feet, pains and autonomic disturbances. Less often, diabetic patients may develop focal and multifocal neuropathy that includes cranial nerve involvement, limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, mostly in patients with longstanding diabetes mellitus. The LDDP does not show any trend to improvement and either relentlessly progresses or remain relatively stable over 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最常见的神经病变，临床表现范围显著。绝大多数临床糖尿病性神经病变患者具有远端对称性形式，其按照纤维长度依赖性模式进展，主要表现为感觉和自主神经症状。这种神经病变模式与进行性远端轴索性神经病相关。患者足部会出现营养性改变、疼痛和自主神经功能障碍。糖尿病患者较少会发展为局灶性和多灶性神经病变，包括颅神经受累、肢体和躯干神经病变。这种神经病变模式往往发生在50岁以后，多见于长期患有糖尿病的患者。远端对称性糖尿病性神经病变没有任何改善趋势，多年来要么持续进展，要么相对稳定。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相关，呈自限性，有时会有复发过程。
