Dohrn Maike F, Winter Natalie, Dafotakis Manuel
Neurologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, Aachen, Deutschland.
Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland.
Nervenarzt. 2020 Aug;91(8):714-721. doi: 10.1007/s00115-020-00948-3.
Half of all diabetics are affected by a diabetic neuropathy. Microangiopathy, dysfunctional Schwann cell interactions, accumulation of toxic metabolites, and inflammatory processes all contribute to nerve damage.
Overview and perspectives of the pathophysiology as well as the current and future treatment implications.
Literature search (1990-2020).
Clinically predominant are sensory and autonomic symptoms; however, muscle weakness can occur as well. Complications such as unrecognized myocardial infarctions and the diabetic foot syndrome are potentially life-threatening and can cause major disability. The pathophysiology of neuropathies in type 1 and type 2 diabetes mellitus differs due to additional risk factors of the metabolic syndrome. To reduce the risk of neuropathy, an intensive insulin therapy is superior compared to the conventional insulin therapy. Oral antidiabetic drugs should be chosen based on individual risk profiles. Metformin can cause an iatrogenic vitamin B12 deficiency. In the treatment of neuropathic pain, the calcium channel blocker pregabalin has the highest recommendation level. The tricyclic antidepressant amitriptyline is considered to be equally effective, but it is contraindicated in autonomic dysregulation and cognitive impairment. Alternatively, the serotonin-norepinephrine reuptake inhibitor duloxetine is approved for the symptomatic treatment of diabetic neuropathies. Controversially discussed medications include alpha-lipoic acid, epalrestat, and L‑serine.
The diabetic neuropathy is frequent and causes severe complications. A good understanding of the underlying pathophysiology can contribute to the development of novel treatment strategies in the future.
所有糖尿病患者中有一半受到糖尿病神经病变的影响。微血管病变、施万细胞功能失调、有毒代谢产物的积累以及炎症过程均会导致神经损伤。
概述糖尿病神经病变的病理生理学以及当前和未来的治疗意义。
文献检索（1990 - 2020年）。
临床上主要表现为感觉和自主神经症状；然而，也可能出现肌肉无力。诸如未被识别的心肌梗死和糖尿病足综合征等并发症可能危及生命，并可导致严重残疾。1型和2型糖尿病神经病变的病理生理学因代谢综合征的其他风险因素而有所不同。为降低神经病变风险，强化胰岛素治疗优于传统胰岛素治疗。应根据个体风险状况选择口服降糖药。二甲双胍可导致医源性维生素B12缺乏。在治疗神经性疼痛方面，钙通道阻滞剂普瑞巴林的推荐级别最高。三环类抗抑郁药阿米替林被认为同样有效，但在自主神经调节障碍和认知障碍中禁用。另外，5-羟色胺-去甲肾上腺素再摄取抑制剂度洛西汀已被批准用于糖尿病神经病变的对症治疗。存在争议的药物包括α-硫辛酸、依帕司他和L-丝氨酸。
糖尿病神经病变很常见，并会导致严重并发症。深入了解其潜在病理生理学有助于未来开发新的治疗策略。
