Department of Neurology, University Hospital, University Hospital, Masaryk University Brno, Czech Republic.
J Peripher Nerv Syst. 2012 Sep;17(3):341-50. doi: 10.1111/j.1529-8027.2012.00420.x.
The aim of this study was to investigate the characteristics of prediabetes (preDM) and early (<3 years) diabetes mellitus type 2 (eDM2)-associated neuropathy and the value of recently proposed diagnostic criteria for diabetic sensorimotor polyneuropathy (DSPN). A prospective case-control study in a group of 48 consecutive patients with eDM2, 16 preDM patients and 40 age- and sex-matched normoglycaemic controls was performed. Clinical and laboratory diagnostic tests were used to detect neuropathic abnormalities; these were further classified in terms of recent diagnostic criteria. Criteria for confirmed DSPN based on abnormal nerve conduction (NC) studies were met in 7 (14.6%) eDM2 patients compared to no control (p < 0.05), and the proportion significantly increased to 37.5% compared to 2.5% controls (p < 0.001), if intraepidermal nerve fibre density (IENFD) was used as an alternative criterion in addition to NC. The subclinical DSPN criteria based on NC abnormalities were met in 4.2% eDM2 patients, while the proportion of preDM and eDM2 cases with subclinical sensory small-fibre involvement documented by IENFD reached 12.5% and 22.9% compared with 2.5% controls (p = 0.005 for eDM2). The absolute IENFD values from distal leg were significantly lower in both eDM2 (p < 0.0001) and preDM patients (p = 0.005) compared to controls. Neuropathy associated with preDM/eDM2 predominantly involves sensory small fibres.
本研究旨在探讨糖尿病前期（preDM）和早期（<3 年）2 型糖尿病（eDM2）相关神经病变的特征，以及最近提出的糖尿病感觉运动多发性神经病（DSPN）诊断标准的价值。对一组 48 例连续的 eDM2 患者、16 例 preDM 患者和 40 名年龄和性别匹配的正常血糖对照者进行了前瞻性病例对照研究。采用临床和实验室诊断试验来检测神经病变异常；并根据最近的诊断标准对这些异常进行分类。在 7 例（14.6%）eDM2 患者中，根据异常神经传导（NC）研究符合确诊 DSPN 的标准，而对照组无一例符合（p<0.05），如果将表皮内神经纤维密度（IENFD）作为 NC 以外的替代标准，这一比例显著增加至 37.5%，而对照组仅为 2.5%（p<0.001）。基于 NC 异常的亚临床 DSPN 标准在 4.2%的 eDM2 患者中得到满足，而在 IENFD 记录的亚临床感觉小纤维受累的 preDM 和 eDM2 病例中，这一比例分别达到 12.5%和 22.9%，而对照组仅为 2.5%（p=0.005，eDM2）。与对照组相比，eDM2（p<0.0001）和 preDM 患者（p=0.005）的远端腿部 IENFD 绝对值明显更低。preDM/eDM2 相关神经病变主要累及感觉小纤维。
