Sztanek Ferenc, Balogh Bernadett, Molnár Ágnes, Zöld Eszter, Tóth Nóra, Jakab András Áron, Paragh György
Általános Orvostudományi Kar, Anyagcsere Betegségek Nem Önálló Tanszék, Belgyógyászati Intézet,D Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032.
Orv Hetil. 2020 Jul;161(30):1243-1251. doi: 10.1556/650.2020.31799.
The prevalence of diabetes mellitus is significantly increasing worldwide. Distal sensorimotor neuropathy (DSPN) is the most common and the earliest detectable microvascular complication. Due to its diverse clinical appearance and atypical symptoms, DSPN is often recognized in an advanced stage.
In our study, the data of 431 patients who were examined using the Neurometer® between 2011 and 2018 at the Diabetic Neuropathy Center of the University of Debrecen were processed and the correlations between cardiovascular and microvascular complications, laboratory parameters and the severity of DSPN were investigated.
The average age of patients was 63.4 years, 62% of them were women, and 92% had type 2 diabetes mellitus. The average duration of diabetes was 13.7 years. Cardiovascular disease (CVD) was diagnosed in 42% of the patients. The incidence of retinopathy was 12%, persistent microalbuminuria was 16%. Despite DSNP complaints, neuronal damage could not be detected in 19%; in the examined patients 49% had mild, 19% moderate and 13% severe neuropathy. Diabetes-related neurological damage was more serious in the presence of both diabetic retinopathy (p<0.001) and microalbuminuria (p<0.001). The incidence of these microvascular complications and the severity of DSPN showed a significant positive correlation (p<0.001). There was no correlation between the severity of peripheral neuropathy and the development of CVD, and we did not find any correlations between the severity of DSPN and CVD.
Based on our investigation, correlation between the progression of diabetic neuropathy and cardiovascular complications was not found, although the progression of diabetic neuropathy indicated the development of other microvascular diseases. Peripheral neurological examination using the Neurometer® is appropriate for controlling the DSPN status and the establishment of the severity of neuropathy determines the quality of life in diabetic patients. Among these patients, the risk of CVD can be assessed by Ewing's test for autonomic nervous system function. Orv Hetil. 2020; 161(30): 1243-1251.
全球糖尿病患病率显著上升。远端感觉运动性神经病变(DSPN)是最常见且最早可检测到的微血管并发症。由于其临床表现多样且症状不典型,DSPN常于晚期才被发现。
在我们的研究中,对2011年至2018年间在德布勒森大学糖尿病神经病变中心使用Neurometer®进行检查的431例患者的数据进行了处理,并研究了心血管和微血管并发症、实验室参数与DSPN严重程度之间的相关性。
患者的平均年龄为63.4岁,其中62%为女性,92%患有2型糖尿病。糖尿病平均病程为13.7年。42%的患者被诊断患有心血管疾病(CVD)。视网膜病变的发生率为12%,持续性微量白蛋白尿为16%。尽管有DSPN相关主诉,但19%的患者未检测到神经损伤;在接受检查的患者中,49%患有轻度神经病变,19%为中度,13%为重度。在同时存在糖尿病视网膜病变(p<0.001)和微量白蛋白尿(p<0.001)的情况下,糖尿病相关神经损伤更为严重。这些微血管并发症的发生率与DSPN的严重程度呈显著正相关(p<0.001)。周围神经病变的严重程度与CVD的发生之间无相关性,且我们未发现DSPN的严重程度与CVD之间存在任何相关性。
基于我们的调查,未发现糖尿病神经病变进展与心血管并发症之间存在相关性,尽管糖尿病神经病变的进展表明存在其他微血管疾病。使用Neurometer®进行周围神经检查适用于控制DSPN状态,神经病变严重程度的确定决定了糖尿病患者的生活质量。在这些患者中,可通过尤因自主神经系统功能测试评估CVD风险。《匈牙利医学周报》。2020年;161(30):1243 - 1251。