糖尿病痛性神经病变的发病机制和治疗课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,糖尿病痛性神经病变的,发病机制和治疗,糖尿病痛性神经病变的,1,糖尿病在世界范围的流行趋势,600,366 million people with DM in 2011,2201,200,135,2025,Zimmet P, et aL. Nature 2001: 414: 782-7.,2.idf.org/node/10497unode=3b96844a-c026-2fd3-87e85fdz293f42e9,糖尿病在世界范围的流行趋势,2,2型糖尿病成为年轻人日益增长的威胁,近年来在儿童或青少年中2型糖尿病的流行呈引人注目地增高,2型糖尿病成为年轻人日益增长的威胁,3,糖尿病并发症,增加2-4倍的心血,糖尿病眼底,死亡和中风,病变,适龄成人失明的主要原因,中风,心血管疾病,糖尿病肾病,终末期肾病的主要原因,糖尿病外周,神经病变,非创伤性下肢截肢的主要原因,糖尿病并发症,4,Diabetic Neuropathies: Update on,Definitions, Diagnostic Criteria, Estimation,of Severity, and Treatments,TESFATE, MD FRCP,ATOZ A MALIK, MD,M. BouLTON, MD,has been shawn to be stabilized, per-,gycemIc control. Thts polyneuropathy,PETER KEI,PALL VALE OF THE TORONTO D山mrE,GIUSEPPE LALRLA, MD,NEUROPATHY EXPERT GROUP,ction and neuro-,Diabetes Care 2010: 33: 2285-93,Diabetic Neuropathies: Update,5,Mechanisms and Management,of Diabetic Painful distal Symmetrical,P。 loner。 pathy,DLOMON TESFAYE,indication of the condition. The occurrence,ANTHONY H. DICKENSON. FHDS,of diabetic retinopathy and nephropathy,ch a number of the dabetic neuropathies may result n panful symptomatology this that predisposes to foot ulceration(1)and/,(DSPN).t is est mated that 15-20% of diabetic patients may have paim fal DSPN, baut not all of orneuroparhepain(painful DSPN), which,longitudinal studies and clinical trials, quantitive sensory testing and ce由出 to assess clinical features of painful,the frequency and severity of neuropathic padn. Although the exac pathophysldlogial processes DSPN-The onset of DSPN is usually,har result n dabetic neuropathic pam remain enigmatic, both peripheral and cenral mecha. gradual or insidious and is heralded b,ensor symptoms that start in the to,mumber cf pharma. and then progress proximally to involv,m上htm出已dma,d,orities for painful neuropathy,nr and pathogenic therapy, has evi-,y lower limbs in more severe cases,there is,dence of efficacy but isnot hcensed in the U.S. and several Euopean countries.,i s with upper hmb involvement, with a similar,DSPN are at increased nsk of foot ulceration and require fooc care, education, and f possible, progression proximally starting in,fingers, As the disease advances further,tor manifestations, such as wasting of,Diabetes Care 36.1-10, 20 13 the small museles of the hands and liml,Mechanisms and Management,6,末梢、对称性、多神经病变,(DSPN)-50% of DM,足溃疡和截肢,最强的危险因索,与视网膜病变和肾脏病变相关,慢性高糖的暴露是脑血管病变,的危险因素,严格血糖控制可以预防微血,管并发症,对称性、长度依赖性、感觉运动性神,经病变,末梢、对称性、多神经病变,7,神经病变,痛自主神经变感觉迟钝,烧灼感,体位性低血压,足溃疡,电击/针刺痛,心脏自主神经病变,感染,胃轻瘫,深部痛,腹泻,截肢,感觉迟钝,便秘,跌倒,麻木,尿失禁,上肢症状,末梢、对称性,性功能障碍,夜间加重,出汗,运动症状,糖尿病伴发疾病(HD,cVD,PVD, obesity,Nephropathy,DR,BP,LDL,A1c,神经病变,8,英国糖尿病学会推荐每年进行足部检查,足部检査应脱鞋和袜子,检查足部畸形的部位,检查出现胼胝的部位,寻找溃疡的征象,询问以往是否有溃疡,检查足背动脉波动,外周神经的检查,(10g单丝或振动觉),检查鞋袜,询问是否出现神经痛,Diabetes UK Putting feet fir,diabetes.org.uk/documeNts/professionals/education%20and%20skills/footcare-pathway.0212.pdf,英国糖尿病学会推荐每年进行足部检查,9,DPN的诊断:病史,“阳性”症状,持续性烧灼样痛或钝痛,阵发性电击样刺痛,感觉异常(痛性感觉异常,诱发痛(痛觉过敏,痛觉超敏),“阴性”症状(感觉或痛觉缺失),麻木,痛觉减退,痛觉丧失,感觉迟钝,感觉缺失,DPN的诊断:病史,10,糖尿病痛性神经病变的发病机制和治疗课件,11,糖尿病痛性神经病变的发病机制和治疗课件,12,糖尿病痛性神经病变的发病机制和治疗课件,13,糖尿病痛性神经病变的发病机制和治疗课件,14,糖尿病痛性神经病变的发病机制和治疗课件,15,糖尿病痛性神经病变的发病机制和治疗课件,16,糖尿病痛性神经病变的发病机制和治疗课件,17,糖尿病痛性神经病变的发病机制和治疗课件,18,糖尿病痛性神经病变的发病机制和治疗课件,19,糖尿病痛性神经病变的发病机制和治疗课件,20,糖尿病痛性神经病变的发病机制和治疗课件,21,糖尿病痛性神经病变的发病机制和治疗课件,22,糖尿病痛性神经病变的发病机制和治疗课件,23,糖尿病痛性神经病变的发病机制和治疗课件,24,糖尿病痛性神经病变的发病机制和治疗课件,25,糖尿病痛性神经病变的发病机制和治疗课件,26,糖尿病痛性神经病变的发病机制和治疗课件,27,糖尿病痛性神经病变的发病机制和治疗课件,28,糖尿病痛性神经病变的发病机制和治疗课件,29,糖尿病痛性神经病变的发病机制和治疗课件,30,糖尿病痛性神经病变的发病机制和治疗课件,31,糖尿病痛性神经病变的发病机制和治疗课件,32,糖尿病痛性神经病变的发病机制和治疗课件,33,糖尿病痛性神经病变的发病机制和治疗课件,34,糖尿病痛性神经病变的发病机制和治疗课件,35,糖尿病痛性神经病变的发病机制和治疗课件,36,糖尿病痛性神经病变的发病机制和治疗课件,37,糖尿病痛性神经病变的发病机制和治疗课件,38,糖尿病痛性神经病变的发病机制和治疗课件,39,糖尿病痛性神经病变的发病机制和治疗课件,40,糖尿病痛性神经病变的发病机制和治疗课件,41,糖尿病痛性神经病变的发病机制和治疗课件,42,糖尿病痛性神经病变的发病机制和治疗课件,43,糖尿病痛性神经病变的发病机制和治疗课件,44,糖尿病痛性神经病变的发病机制和治疗课件,45,糖尿病痛性神经病变的发病机制和治疗课件,46,糖尿病痛性神经病变的发病机制和治疗课件,47,糖尿病痛性神经病变的发病机制和治疗课件,48,糖尿病痛性神经病变的发病机制和治疗课件,49,糖尿病痛性神经病变的发病机制和治疗课件,50,糖尿病痛性神经病变的发病机制和治疗课件,51,糖尿病痛性神经病变的发病机制和治疗课件,52,糖尿病痛性神经病变的发病机制和治疗课件,53,糖尿病痛性神经病变的发病机制和治疗课件,54,糖尿病痛性神经病变的发病机制和治疗课件,55,糖尿病痛性神经病变的发病机制和治疗课件,56,糖尿病痛性神经病变的发病机制和治疗课件,57,糖尿病痛性神经病变的发病机制和治疗课件,58,糖尿病痛性神经病变的发病机制和治疗课件,59,糖尿病痛性神经病变的发病机制和治疗课件,60,糖尿病痛性神经病变的发病机制和治疗课件,61,