糖尿病性多发性神经病.ppt

糖尿病性多发性神经病（DiabeticPolyneuropathy，DP）一、绪论（Introduction)MarchaldeCalvi1864年首先提出糖尿病是引起多发性神经病的原因之一。01DP是糖尿病最常见的表现之一。02二、流行病学（Epidemiology）DP的总的发病率30%左右，与年龄、病程、血糖水平、糖尿病类型、身高、舒张压及血脂有关。5%新诊断的DMDP发病率病程50%25Years弥散型远端对称性感觉运动多发性神经病自主神经病心血管型胃肠型泌尿生殖型异常出汗型对称性下肢近端运动神经病（amyotrophy）颅神经型（Cranialneuropathy）1神经根/神经丛型（Radiculopathy/plexopathy）2嵌压性神经病（Entrapmentneuropathy）3局限型FiberTypeSizeModalityA-alpha(I)13-20micrometersLimbproprioceptionmyelinatedA-beta(II)6-12micrometersLimbproprioceptionmyelinatedA-delta(III)1-5micrometersVibrationmyelinatedPressureC(IV)0.2-1.5micrometersMechanicalsharppainUnmyelinatedThermalpainMechanicalburningpainSmall-FiberSensoryLarge-FiberSensoryAutonomicBurningpainLossofvibrationsensationHeartrateabnormalCutaneoushyperesthesiaLossofproprioceptionPosturalhypotensionParesthesiasLossofreflexesAbnormalsweatingLancinatingpainLossofpainSlowednerveandtemperatureconductionvelocitiesGastroparesissensationNeuropathicdiarrheaLossofvisceralpainFootulceration