Aston Brain Centre, School of Life &Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK.
Regional Neuromuscular Service, University Hospitals Birmingham, Birmingham B15 2WB, UK.
Nat Rev Neurol. 2017 Oct;13(10):599-611. doi: 10.1038/nrneurol.2017.123. Epub 2017 Sep 15.
Distal symmetric polyneuropathy (DSPN) is the most common neuropathy to occur in diabetes mellitus. However, patients with diabetes can also develop inflammatory neuropathies, the most common and most treatable of which is chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Whether diabetes is a risk factor for CIDP remains under debate. Early studies suggested that patients with diabetes were at increased risk of CIDP, but epidemiological studies failed to confirm the association, and subsequent data have re-opened the debate. Inadequate interpretation of investigations and differentials between CIDP and other neuropathies that can occur in diabetes, such as DSPN, diabetic radiculoplexus neuropathies and vasculitic multiple mononeuropathy, might mean that CIDP is under-recognized. Despite a response rate of >80% to first-line therapies for CIDP in patients with or without diabetes, those with diabetes often present with greater disability owing to late referral and axonal pathology attributed to DSPN. The increasing worldwide prevalence of diabetes creates an urgent need to improve identification of potentially treatable neuropathies, such as CIDP. In this Review, we consider the features of CIDP in patients with diabetes, and discuss how these features can be used to differentiate the condition from other neuropathies. We also review the management options for CIDP and other inflammatory neuropathies in patients with diabetes.
远端对称性多发性神经病（DSPN）是糖尿病中最常见的神经病变。然而，糖尿病患者也可能发生炎性神经病，其中最常见且最具治疗性的是慢性炎性脱髓鞘性多发性神经根神经病（CIDP）。糖尿病是否是 CIDP 的危险因素仍存在争议。早期研究表明，糖尿病患者发生 CIDP 的风险增加，但流行病学研究未能证实这种关联，随后的数据重新引发了争论。对 CIDP 和其他可能发生于糖尿病的神经病（如 DSPN、糖尿病性神经根丛神经病和血管炎性多发性单神经病）之间的检查和鉴别不足，可能意味着 CIDP 被低估了。尽管无论是否合并糖尿病，CIDP 的一线治疗的应答率均＞80%，但由于糖尿病患者常常因就诊延迟以及归因于 DSPN 的轴索性病变而导致残疾程度更高。全球范围内糖尿病的患病率不断增加，迫切需要提高对潜在可治疗性神经病（如 CIDP）的识别。在这篇综述中，我们探讨了糖尿病患者 CIDP 的特征，并讨论了如何使用这些特征将其与其他神经病相鉴别。我们还回顾了糖尿病患者 CIDP 和其他炎性神经病的治疗选择。
