糖尿

发布时间：2018-05-07 07:54

本文选题：糖尿病-慢性炎性脱髓鞘性多发性神经根神经病 + 糖尿病周围神经病　；参考：《第二军医大学》2016年硕士论文

【摘要】：目的糖尿病-慢性炎性脱髓鞘性多发性神经根神经病(diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy,DM-CIDP)、糖尿病周围神经病(diabetic peripheral neuropathy,DPN)及慢性炎性脱髓鞘性多发性神经根神经病(CIDP)三组疾病的临床、电生理及神经病理改变特点研究。资料和方法收集2009年1月-2015年12月期间就诊于海军总医院及北京大学第一医院神经内科的DM-CIDP、DPN和CIDP三组疾病共32例患者的临床资料,其中DM-CIDP组9例、DPN组13例和CIDP组10例;所有32患者均进行了神经电生理和腓肠神经病理检查;对三组患者的临床资料(发病年龄、病程、起病方式、症状和体征、脑脊液检查)、神经电生理检查(运动神经传导、感觉神经传导及F波)、腓肠神经病理结果(洋葱球、薄髓鞘、神经纤维密度、轴索变性、轴索再生簇、血管基底膜增厚、炎细胞浸润)分别进行对比分析,探讨三组患者在临床症候、神经电生理及神经病理的异同点。结果1、临床特点:(1)三组患者在年龄、性别、病程方面差异无统计学意义(P0.05);(2)起病方式:缓解-复发型CIDP组有4例,DPN组和DM-CIDP两组未见此类型。提示CIDP组较DPN组及DM-CIDP组在起病过程中出现更多的缓解-复发型病例,差异有统计学意义(P0.05)。(3)临床症候:下肢受累起病DPN组(9例,69.2%)最多见,其次是DM-CIDP组(6例,55.6%),而CIDP组(4例,40.0%)最少。DM-CIDP组患者肢体感觉障碍7例(77.8%)、肌力减弱8例(88.9%)、肌萎缩6例(66.7%)、腱反射减弱或消失9例(100%);DPN组患者肢体感觉障碍12例(92.3%)、肌力减弱11例(84.6%)、肌肉萎缩1例(7.7%)、腱反射减弱或消失8例(61.5%);CIDP组患者肢体感觉障碍8例(80.0%)、肌力减弱10例(100%)、肌萎缩4例(40.0%)、腱反射减弱或消失8例(80.0%)。(4)脑脊液结果:DM-CIDP组脑脊液检查5例(蛋白-细胞分离3例);DPN组脑脊液检查4例(蛋白轻微升高和正常各2例);CIDP组脑脊液检查6例,均可见蛋白-细胞分离。2、神经电生理特点:(1)DM-CIDP组:运动神经传导速度(motor nerve conduction velocity,MNCV)异常7例(77.8%),感觉神经传导速度(sensory nerve conduction velocity,SNCV)异常9例(100%),F波异常9例(100%)。(2)DPN组:MNCV异常9例(90%),SNCV异常7例(70%),F波异常8例(80%)。(3)CIDP组:MNCV异常9例(100%),SNCV异常8例(88.9%),F波异常9例(100%)。经统计学分析,DM-CIDP、DPN、CIDP组在运动神经传导、感觉神经传导及F波检测的神经电生理数据,差异均未见统计学意义(P0.05)。3、腓肠神经病理特点:DM-CIDP组(9例)、DPN组(13例)和CIDP组(10例)三组患者的神经病理特点分别为髓鞘“洋葱球”样改变(2/9、0/13、4/10)、薄髓鞘(6/9、6/13、10/10)、无髓神经减少(4/9、9/13、4/10)、轴索变性(8/9、5/13、1/10)、有髓神经纤维再生簇(6/9、13/13、7/10)、血管基底膜增厚(7/9、13/13、3/10)、炎细胞(8/9、1/13、8/10)。对比分析DPN、DM-CIDP和CIDP三组神经病理在洋葱球、薄髓鞘、无髓神经减少、轴索变性、有髓神经纤维再生簇、血管基底膜增厚、炎细胞的构成比方面差异有统计学意义(P0.05)。DM-CIDP和其余两组多重比较发现:(1)CIDP组出现薄髓鞘较DM-CIDP组更为常见,差异有统计学意义(P0.05);(2)DM-CIDP组出现轴索变性显著高于DPN组(P0.05)和CIDP组(P0.01),差异有统计学意义;(3)DPN组出现有髓神经纤维再生簇较DM-CIDP组更为常见,差异有统计学意义(P0.05);(4)DM-CIDP组血管基底膜增厚较CIDP组更为常见,差异有统计学意义(P0.05);(5)DM-CIDP组炎性细胞浸润较DPN组多见,差异有统计学意义(P0.01)。结论(1)CIDP组缓解-复发型病例最为多见,DM-CIDP组和CIDP组的脑脊液蛋白分离较DPN组多见;(2)在神经病理方面:(1)CIDP组薄髓鞘神经纤维较DM-CIDP组常见;(2)DM-CIDP组轴索变性较DPN组和CIDP组多见;(3)DPN组有髓神经纤维轴索再生簇较DM-CIDP组多见;(4)DM-CIDP组血管基底膜增厚较CIDP组多见;(5)DM-CIDP炎性细胞浸润较DPN组多见。
[Abstract]:Objective diabetes - chronic inflammatory demyelinating multiple neuropathy (diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy, DM-CIDP), diabetic peripheral neuropathy (diabetic peripheral neuropathy, DPN) and chronic inflammatory demyelinating multiple neuropathy (CIDP), three groups of diseases Study on the characteristics of physiological and neuropathological changes. Data and methods were collected in the clinical data of 32 patients with three groups of diseases, DM-CIDP, DPN and CIDP, which were diagnosed in Navy General Hospital and the neurology department of Navy General Hospital during January 2009 -2015, including 9 cases in group DM-CIDP, 13 cases in group DPN and 10 cases in group CIDP; all 32 patients underwent nerve. Electrophysiological and sural nerve pathological examination; clinical data of three groups (age of onset, course of disease, onset of disease, symptoms and signs, cerebrospinal fluid examination), electrophysiological examination (motor nerve conduction, sensory nerve conduction and F wave), pathological results of the gastrocnemius (onion, thin myelin sheath, nerve fiber density, axonal degeneration, axonal regeneration, regenerative cluster of axons, blood) The basilar membrane thickening and inflammatory cell infiltration were compared and analyzed to investigate the clinical symptoms, neurophysiology and neuropathic differences between the three groups. Results 1, clinical characteristics: (1) there was no significant difference in age, sex, and course of disease (P0.05) in the three groups (2) the onset mode: remission CIDP group, group DPN and DM-CIDP Two groups were not found in the two group, suggesting that more remission cases were found in the CIDP group than in the DPN group and the DM-CIDP group. The difference was statistically significant (P0.05). (3) the clinical symptoms: the DPN group (9 cases, 69.2%) of the lower extremities (9 cases, 69.2%), followed by the DM-CIDP group (6 cases, 55.6%), and the CIDP group (4, 40%) with the least.DM-CIDP patients' limb sensory impairment. In 7 cases (77.8%), muscle strength decreased in 8 cases (88.9%), muscle atrophy was 6 (66.7%), tendon reflex was weakened or disappeared in 9 cases (100%); in group DPN, 12 cases (92.3%), muscle atrophy 11 (84.6%), muscle atrophy 1 (84.6%), tendon reflex weakened or disappeared, and CIDP group, muscle atrophy, muscle atrophy, muscle atrophy, muscle atrophy, muscle atrophy, and muscle atrophy Cases (40%), tendon reflex weakened or disappeared in 8 cases (80%). (4) cerebrospinal fluid results in group DM-CIDP, 5 cases of cerebrospinal fluid examination (3 cases of protein cell separation), 4 cases of cerebrospinal fluid examination in group DPN (mild protein increase and 2 cases of normal); and 6 cases of cerebrospinal fluid examination in group CIDP, all showed protein cell separation.2, neurophysiological characteristics: (1) DM-CIDP group: DM-CIDP group: motor nerve conduction velocity Degree (motor nerve conduction velocity, MNCV) abnormal 7 cases (77.8%), sensory nerve conduction velocity (sensory nerve conduction velocity, SNCV) abnormal 9 cases (100%), F wave abnormality in 9 cases (100%). (2) DPN group: 9 cases (90%), 7 exceptions (80%). (100%). After statistical analysis, DM-CIDP, DPN, and CIDP groups were in the neuroelectrophysiological data of motor nerve conduction, sensory nerve conduction and F wave detection, the difference was not statistically significant (P0.05).3, the pathological characteristics of the gastrocnemius: DM-CIDP group (9 cases), DPN group (13 cases) and CIDP group (10 cases), the neuropathological characteristics were the myelin "onion bulb", respectively. Sample change (2/9,0/13,4/10), Bo Suiqiao (6/9,6/13,10/10), myeloamedullary neuropathy (4/9,9/13,4/10), axonal degeneration (8/9,5/13,1/10), myelinated nerve fiber regeneration cluster (6/9,13/13,7/10), vascular basement membrane thickening (7/9,13/13,3/10), inflammatory cells (8/9,1/13,8/ 10). Comparative analysis of DPN, DM-CIDP and CIDP three in onion bulb, thin myelin sheath, and unmyelinated group Neurodegeneration, axonal degeneration, regenerative clusters of myelinated nerve fibers, thickening of vascular basilar membrane, and significant difference in the composition of the inflammatory cells (P0.05).DM-CIDP and the other two groups of multiple comparisons found: (1) the thin myelin sheath in the CIDP group was more common than the DM-CIDP group (P0.05); (2) there was a significant higher axonal degeneration in the DM-CIDP group. The difference was statistically significant between group DPN (P0.05) and group CIDP (P0.01). (3) there were more common myelinated nerve fibers in DPN group than that in DM-CIDP group (P0.05); (4) the thickening of the basilar membrane in the group DM-CIDP was more common than the CIDP group, and the difference was statistically significant (P0.05); (5) the infiltration of inflammatory cells in DM-CIDP group was more common than the DPN group, and the difference was less than that of the DPN group. There was statistical significance (P0.01). Conclusion (1) the most common remission cases in group CIDP were seen, and the separation of cerebrospinal fluid protein from group DM-CIDP and CIDP was more common than that in group DPN; (2) neuropathic aspects: (1) group CIDP thin myelin nerve fibers were more common than those in the DM-CIDP group; (2) DM-CIDP group was more common than the DPN group and CIDP group; (3) DPN group had the myelinated nerve fiber axis. The regenerated clusters were more common than those in group DM-CIDP; (4) thickening of basement membrane in group DM-CIDP was more common than that in group CIDP; (5) inflammatory cell infiltration in DM-CIDP was more common than that in DPN group.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R744.5;R587.2

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