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diabetesneuropathies:updateondefinitions,diagnosticcriteria,estimationofseverity,andtreatments糖尿病神经病变：更新的定义，诊断标准，估计的严重程度，与治疗TesfayeS,BoultonAJ.DyckPJ,etal.内容概要，博尔顿一·戴克磷，等。AbstractPrecedingthejointmeetingofthe19thannualDiabeticNeuropathyStudyGroupoftheEuropeanAssociationfortheStudyofDiabetes(NEURODIAB)andthe8thInternationalSymposiumonDiabeticNeuropathyinToronto,Canada,13–18October2009,expertpanelswereconvenedtoprovideupdatesonclassification,definitions,diagnosticcriteria,andtreatmentsofdiabeticperipheralneuropathies(DPNs),autonomicneuropathy,painfulDPNs,andstructuralalterationsinDPNs.前联席会议第十九年糖尿病神经病变研究组欧洲糖尿病研究协会（neurodiab）和第八届国际糖尿病神经病变在多伦多，加拿大，–13182009年十月，专家小组召开了提供更新的定义，分类，诊断标准，治疗糖尿病周围神经病变（标准草案），自主神经病变，痛苦的标准草案，和结构改变的标准草案。CLASSIFICATIONANDDEFINITIONOFDIABETICNEUROPATHIES定义和分类糖尿病神经病变SolomonTesfaye,MD,FRCP,1AndrewJ.M.Boulton,MD,2PeterJ.Dyck,MD,3RoyFreeman,MD,4MichaelHorowitz,MD,PHD,5PeterKempler,MD,PHD,6GiuseppeLauria,MD,7RayazA.Malik,MD,2VincenzaSpallone,MD,PHD,8AaronVinik,MD,PHD,9LucianoBernardi,MD,10PaulValensi,MD,11andonbehalfoftheTorontoDiabeticNeuropathyExpertGroup*所罗门内容概要，医学博士，联邦民事诉讼规则，1安得烈J.博尔顿，医学博士，2彼得·戴克，医学博士，医学博士，43罗伊，迈克尔霍洛维茨，医学博士，博士，5彼得肯普勒，医学博士，博士，6家7rayaz朱塞佩，医学博士，马利克，医学博士，医学博士，博士2文森泽斯帕龙，，8亚伦vinik，医学博士，博士，9大卢西亚诺，医学博士，10保罗瓦朗西，博士，11代表多伦多糖尿病神经病变专家组CLASSIFICATIONANDDEFINITIONOFDIABETICNEUROPATHIESTheneuropathiesdevelopinginpatientswithdiabetesareknowntobeheterogenousbytheirsymptoms,patternofneurologicinvolvement,course,riskcovariates,pathologicalterations,andunderlyingmechanisms(1,2).Thomas(3)andBoultonetal.(4)separatedtheseintogeneralizedandfocal/multifocalvarieties(e.g.,multiplemononeuropathy,lumbosacral,thoracic,andcervicalradiculoplexusneuropathies)(3,4).Itisknownthatsimilarpatternsofneuropathyoccurinpatientswithoutdiabetes(2).Moreover,diabeticpatientscandevelopchronicinflammatorydemyelinatingpolyradiculopathy.Theevidencethatgeneralizedvarietiescanbefurtherclassifiedintoatleasttwomajorsubgroupsseemscompelling(3,4).ThetypicalDPNisachronic,symmetrical,length-dependentsensorimotorpolyneuropathy(DSPN)andisthoughttobethemostcommonvariety(1).Itdevelopson(orwith)abackgroundoflong-standinghyperglycemia,associatedmetabolicderangements(increasedpolyolflux,accumulationofadvancedglycationendproducts,oxidativestress,andlipidalterationsamongothermetabolicabnormalities)andcardiovascularriskfactors(5–7).Alterationsofmicrovessels,similartothoseobservedindiabeticretinopathyandnephropathy,appeartobeassociatedwiththepathologicalterationsofnerves(8).Totalhyperglycemicexposureisperhapsthemostimportantriskcovariate(5,7).Thisvarietyhasbeenshowntobestabilized,perhapsevenimproved,byrigorousglycemiccontrol.Thispolyneuropathyhasbeenshowntobestatisticallyassociatedwithretinopathyandnephropathy(1,6).Autonomicdysfunctionandneuropathicpainmaydevelopovertime.TheatypicalDPNsaredifferentfromDSPNinseveralimportantfeatures,i.e.,onset,course,manifestations,associations,andperhapsputativemechanisms(3,4,9).Theyappeartobeintercurrentvarieties,developingatanytimeduringthecourseofapatient'sdiabetes(3,9).Onsetofsymptomsmaybeacute,subacute,orchronic,butthecourseisusuallymonophasicorfluctuatingovertime.Painandautonomicsymptomsaretypicalfeatures(3,9)andalteredimmunityhasbeensuggested.Studieshavesuggestedthatimpairedfastingglucoseorimpairedglucosetolerance(IGT)ismorecommoninchronicidiopathicaxonalpolyneuropathy,butotherstudiesdonotsupportthisview(3,10).定义和分类糖尿病神经病变的发展neuropathiesthe糖尿病患者已知是异质性的症状，模式的神经系统的参与，当然，风险变量，病理改变，和基本机制（1,2）。托马斯（3）和博尔顿等。（4）分隔成广义和联络/多品种（例如，多慢性神经痛，腰骶神经根神经病变及颈，胸，）（3,4）。据了解，类似的模式，神经病变发生在糖尿病患者（2）。此外，糖尿病患者可发展为慢性炎症性脱髓鞘性多发性神经病。有证据表明，广义的品种可进一步分为至少2个主要分组似乎令人信服的（3,4）。典型的病变是一种慢性，对称，长度依赖性神经病感觉（dspn）和被认为是最常见的种类（1）。它的发展对（或）在长期的高血糖，代谢紊乱（增加醇通量，积累的先进的糖化终产物，氧化应激，和血脂的变化之间的其他代谢异常）和心血管危险因素（5–7）。改建的微血管，类似的观察，糖尿病视网膜病变和肾病，似乎与病理改变神经（8）。总高血糖曝光，也许是最重要的风险变量（5,7）。该品种已被证明是稳定的，甚至可能提高，严格的血糖控制。这神经病已被证明是统计学与视网膜病变和肾病（1,6）。自主神经功能障碍和神经性疼痛可能随着时间的发展。非典型标准草案是不同的dspn在几个重要的特点，即，发病，当然，表现，协会，和也许假定机制（3,4,9）。他们似乎是并发品种，发展在任何时间的过程中病人的糖尿病（9）。出现症状，可能是急性，亚急性或慢性，但，当然通常是单相或波动随着时间的。疼痛和植物神经症状的典型特征（9）和免疫功能的改变已建议。研究表明，空腹血糖或糖耐量受损（公司）是较常见的慢性特发性轴索神经病，但其它的研究不支持这一观点（3,10）。DiabeticsensorimotorpolyneuropathyCasedefinition.The1988SanAntonioConferenceonDiabeticNeuropathy(11),Boultonetal.(4),andtheAmericanAcademyofNeurology(AAN),AmericanAssociationofElectrodiagnosticMedicine(AAEM),andAmericanAcademyofPhysicalMedicineandRehabilitation(AAPM&R)(12)haveproposedcriteriafordiabeticneuropathies.WeproposeseparatedefinitionsfortypicalDPN(DSPN)andatypicalDPNs.DSPNisasymmetrical,length-dependentsensorimotorpolyneuropathyattributabletometabolicandmicrovesselalterationsasaresultofchronichyperglycemiaexposure(diabetes)andcardiovascularriskcovariates.Anabnormalityofnerveconductiontests,whichisfrequentlysubclinical,appearstobethefirstobjectivequantitativeindicationofthecondition.Theoccurrencesofdiabeticretinopathyandnephropathyinagivenpatientstrengthenthecasethatthepolyneuropathyisattributabletodiabetes.Othercausesofsensorimotorpolyneuropathyneedtobeexcluded.Forepidemiologicsurveysorcontrolledclinicaltria