Ross M A
Department of Neurology, University of Iowa College of Medicine, Iowa City.
Med Clin North Am. 1993 Jan;77(1):111-24. doi: 10.1016/s0025-7125(16)30275-9.
Diabetic neuropathy is the most frequent complication of diabetes and the leading cause of polyneuropathy in the Western world. A distal symmetric predominantly sensory polyneuropathy is the most common of the diverse neuropathies that occur secondary to diabetes. Pain is often the most bothersome and difficult to treat symptom of diabetic neuropathy. Autonomic neuropathy is a frequent feature of diabetic neuropathy and the source of many significant problems including postural hypotension, gastroparesis, diarrhea, constipation, neurogenic bladder, and male impotence. Physicians need to be familiar with the multiple, less common forms of diabetic neuropathy, as these often mimic other medical or neurologic conditions. The cause of diabetic neuropathy is not determined, but abundant evidence suggests that both metabolic and ischemic nerve injury are likely factors. These should not be considered mutually exclusive causes of diabetic neuropathy as both factors likely operate to different degrees to produce the clinical spectrum of neuropathies that are seen in diabetes. Although no effective treatment exists to cure diabetic neuropathy, improvement is possible with glycemic control and symptomatic therapy.
糖尿病性神经病变是糖尿病最常见的并发症，也是西方世界多发性神经病变的主要病因。远端对称性主要为感觉性的多发性神经病变是继发于糖尿病的各种神经病变中最常见的一种。疼痛常常是糖尿病性神经病变最困扰人且最难治疗的症状。自主神经病变是糖尿病性神经病变的常见特征，也是许多严重问题的根源，包括体位性低血压、胃轻瘫、腹泻、便秘、神经源性膀胱和男性阳痿。医生需要熟悉糖尿病性神经病变的多种较不常见的形式，因为这些形式常常酷似其他内科或神经科疾病。糖尿病性神经病变的病因尚未明确，但大量证据表明代谢性和缺血性神经损伤可能都是致病因素。不应将这些因素视为糖尿病性神经病变相互排斥的病因，因为这两种因素可能都在不同程度上起作用，从而产生糖尿病中所见的各种神经病变的临床谱。虽然不存在治愈糖尿病性神经病变的确切有效疗法，但通过血糖控制和对症治疗有可能实现病情改善。
