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糖尿病神经病变

最后审阅: 4 Sep 2023
最后更新: 10 May 2023

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 无症状
  • 疼痛(周围神经)
  • 感知缺失(周围神经)
  • 感觉迟钝(周围神经)
  • 踝反射减弱或消失(周围神经)
  • 无痛损伤(周围神经)
  • 静息心动过速(自主神经)
  • 心率变异性受损(自主神经)
  • 尿频、尿急、夜尿、尿失禁、排尿不畅、尿细流或尿潴留(自主神经)
  • 勃起功能障碍(自主神经)
  • 性欲减退,性交时疼痛增加(自主神经)
  • 直立性低血压(自主神经)
更多 关键诊断因素

其他诊断因素

  • 便秘(自主神经)
  • 大便失禁(自主神经)
  • 无汗症、畏热、皮肤干燥或多汗症(自主神经)
  • 无症状性低血糖(自主神经)
  • 无力(周围神经)
  • 近期跌倒史(周围神经)
  • 共济失调步态(周围神经)
  • 恶心、餐后呕吐、腹胀、食欲丧失、早饱(自主神经)
  • 烧心症状和固体食物吞咽困难(自主神经)
  • 大量水样腹泻(自主神经)
  • 特异性单神经病(周围神经)
  • 颅神经病变(周围神经)
  • 下胸或腹壁疼痛(周围神经)
  • 大腿肌萎缩、疼痛和无力(周围神经)
其他诊断因素

危险因素

  • 高血糖控制不佳
  • 较长的糖尿病病程
  • 高龄(70 岁以上)
  • 身材高大
  • 高血压
  • 甘油三酯水平升高
  • 并存多种心血管疾病 (cardiovascular disease, CVD) 危险因素(2 型糖尿病)
  • 肥胖
  • 免疫失调
  • 吸烟
  • 遗传学
更多 危险因素

诊断性检查

首要检查

  • 临床诊断
  • 空腹血糖
  • HbA1c
  • 血清促甲状腺激素
  • 血清维生素 B12
  • 电解质、尿素、肌酐
  • 血清血脂谱
  • 肝功能检查 (LFT)
  • FBC 和红细胞沉降率
  • 血清/尿液免疫电泳
  • 角膜共聚焦显微镜
更多 首要检查

需考虑的检查

  • 餐后2小时血糖
  • 神经传导检查(神经传导速度 [NCV])
  • 肌电图(EMG)
  • 定量感觉测定(QST)
  • 皮肤活检
  • 心血管反射检查
  • 心率变异性(HRV)
  • 胃排空研究
  • 胃十二指肠镜检查
  • 钡餐
  • 胃肠测压
  • 氢呼吸试验
  • 胃超声检查
  • 胃核磁共振成像
  • 肛门直肠测压
  • 粪便脂肪
  • 右旋木糖吸收试验
  • 尿液培养
  • 膀胱测压,排尿期膀胱内压描记
  • 排尿后尿路超声
  • 影像尿动力学检查
  • 夜间阴茎肿胀的检测以及阴茎、肱动脉血压的测量
  • 血清促黄体激素、睾酮、游离睾酮、催乳素检测(晨起检测,上午 8:00-9:00)
更多 需考虑的检查

治疗流程

持续性治疗

糖尿病周围神经病变

颅神经病变

肢体或躯干单神经病

糖尿病性肌萎缩

糖尿病自主神经病变

撰稿人

作者

Rayaz A. Malik, BSc (Hons), MSc, MBChB, FRCP, PhD

Professor of Medicine

Organizational Official for the Human Research Protection Program

Weill Cornell Medicine - Qatar

Doha

Qatar

利益声明

RAM has been reimbursed for being on the advisory board for an epidemiological study on cardiovascular disease in type 2 diabetes and to give educational lectures on treatment of diabetes undertaken by Novo Nordisk. RAM has been reimbursed for educational lectures on diabetes treatment for Sanofi Aventis, Lilly, and Proctor and Gamble (P&G). RAM has reviewed an investigator-initiated grant to study long COVID from P&G. RAM is an author of a number of references cited in this topic.

Uazman Alam, BSc, MBChB, MPHe, PhD

Senior Lecturer and Consultant Physician

University of Liverpool

Liverpool

UK

利益声明

UA serves on advisory boards for Eli Lilly.

Shazli Azmi, MBchB, MRCP

Consultant Physician

Diabetes and Endocrinology

Central Manchester Foundation Trust

University of Manchester Manchester

UK

利益声明

SA declares that she has no competing interests.

鸣谢

Dr Rayaz Malik, Dr Uazman Alam, and Dr Shazli Azmi would like to gratefully acknowledge Dr Rodica Pop-Busui and Dr Eva Feldman, the previous contributors to this topic.

利益声明

RPB declares that she has received speaking honoraria from Pfizer and research support from Amylin Pharmaceuticals; National Institutes of Health/National Heart, Lung, and Blood Institute; National Institute of Health/National Institute of Diabetes and Digestive and Kidney Diseases; American Diabetes Association; and Juvenile Diabetes Research Foundation. RPB and EF are authors of references cited in this topic.

同行评议者

Zachary T. Bloomgarden, MD

Clinical Professor

Department of Medicine

Mount Sinai School of Medicine

New York

NY

利益声明

ZTB declares that he has no competing interests.

Rajesh K. Garg, MD

Assistant Professor of Medicine

Harvard Medical School

Division of Endocrinology

Diabetes and Hypertension

Brigham and Women's Hospital

Boston

MA

利益声明

RKG has received consultant fees from Aventis and Novartis, and speaker fees from Novartis.

Edward Jude, MBBS, MD, MRCP, DNB

Consultant and Honorary Senior Lecturer

Tameside General Hospital

Diabetes Centre

Ashton Under Lyne

Lancashire

UK

利益声明

EJ has received funding for conferences and lectures from Pfizer and Boehringer Ingelheim.

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