糖尿病的周围神经病变:研究与治疗  

Diabetic peripheral neuropathy:research and therapy

作　　者：宋荷花 魏在荣 Song Hehua;Wei Zairong(Department of Burn and Plastic Surgery,The Affiliated Hospital of Zunyi Medical University,Zunyi 563003,Guizhou Province,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州省遵义市563003

出　　处：《中国组织工程研究》2023年第8期1278-1285,共8页Chinese Journal of Tissue Engineering Research

基　　金：省部共建协同创新中心项目(教科技厅函[2020]39号),项目负责人:魏在荣;贵州省科技计划项目(黔科合平台人才[2020]5012),项目负责人:魏在荣。

摘　　要：背景:糖尿病周围神经病变致残率高,是最常见的糖尿病慢性并发症之一,其发病机制复杂多样,目前尚无公认的治疗方式。临床上治疗和管理这种慢性疾病仍是一种挑战,但该方面的综述较少。目的:探讨糖尿病周围神经病变的相关发病机制,并就不同治疗方式对糖尿病周围神经病变的应用效果展开综述。方法:由第一作者检索中国知网、万方数据库及PubMed数据库中收录的相关文献,中文检索词为“糖尿病周围神经病变,糖尿病并发症,发病机制,诊断,治疗,中医,外科治疗,手术,电刺激,神经松解术,神经减压术”,英文检索词为“DPN,diabetic peripheral neuropathy,pathogenesis,diagnosis,therapy,treatment,drug,surgery,nervedecompression,nerveelectricalstimulation,gene,exosome”。文献检索时间限定在2000年1月至2022年1月,通过阅读文章摘要对文献进行初步筛选,排除与文章主题不相关的文献,纳入的文献数为88篇。结果与结论:①高血糖是糖尿病周围神经病变的根本病因,加强控制血糖是治疗糖尿病周围神经病变的最基础也是最重要的一步;②镇痛药物可显著减轻糖尿病周围神经病变患者的疼痛症状,α-硫辛酸、依帕司他通过抗氧化应激发挥作用,甲钴胺、神经生长因子可促进神经功能恢复;③根据糖尿病周围神经病变的“双重挤压”的致病机制,神经松解术和神经转移术可改善糖尿病周围神经病变患者神经病变程度、减轻疼痛、提高神经传导速度;④基因及干细胞等疗法是具有前景的新疗法,它们具有靶向性,但目前缺乏临床研究,且存在伦理及安全性问题。BACKGROUND:Diabetic peripheral neuropathy has a high disability rate and is one of the most common chronic complications of diabetes.Because its pathogenesis is complex and diverse,there is no recognized treatment method currently.It is a challenge to treat and manage this chronic disease.However,there are few reviews in this area.OBJECTIVE:To explore the related pathogenesis of diabetic peripheral neuropathy and to review the application effect of different treatment methods in diabetic peripheral neuropathy.METHODS:The first author searched the relevant literature in CNKI,WanFang and PubMed databases.The Chinese search terms were“diabetic peripheral neuropathy,diabetic complications,pathogenesis,diagnosis,treatment,Chinese medicine,surgical treatment,surgery,electrical stimulation,nerve release,nerve decompression”and the English search terms were“DPN,diabetic peripheral neuropathy,pathogenesis,diagnosis,therapy,treatment,drug,surgery,nerve decompression,nerve electrical stimulation,gene,exosome.”The literature search time was limited from January 2000 to January 2022.The literature was initially screened by reading the abstracts of the articles and those unrelated to the theme of the article were excluded.Finally 88 articles were included for review.RESULTS AND CONCLUSION:Hyperglycemia is the root cause of diabetic peripheral neuropathy.Strengthening blood sugar control is the most basic and important step in the treatment of diabetic peripheral neuropathy.Analgesic drugs can significantly reduce pain symptoms of patients with diabetic peripheral neuropathy.α-Lipoic acid and epalrestat play an anti-oxidative stress role;mecobalamin and nerve growth factor can promote the recovery of nerve function.According to the pathogenesis of“double extrusion”of diabetic peripheral neuropathy,nerve decompression and nerve transferring can reduce the degree of neuropathy,relieve pain and increase nerve conduction velocity in patients with diabetic peripheral neuropathy.Gene and stem cell therapies are promising

关 键 词：糖尿病周围神病变 发病机制 诊断 治疗 神经松解术 神经减压术 

分 类 号：R453[医药卫生—治疗学] R318[医药卫生—临床医学] R616.2