[CDS2010]糖尿病周围神经病变的一些问题--Dan Ziegler教授访谈
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专家访谈 神经病变 作者:DanZiegler 来源:国际糖尿病 2010/11/22 11:29:00    加入收藏

内容概要:目前尚没有关于此种联合治疗的数据资料。只有关于联合应用止痛药的报道,止痛药可以发挥治疗的最佳效果,这种联合显示出其有效性。

  <International Diabetes>:I am here today with Professor Dan Ziegler at the CDS (Chinese Diabetic Society) meeting in Suzhou, China. Dr. Zegler, I would like to thank you for joining us today and as a recognized expert in DPN, we have a lot of questions for you today. ?In your lecture, you introduced a series of methods for the early detection of neuropathy, such as detection of incipient nerve dysfunction including assessing sensory nerve conduction velocity, thermal perception thresholds, vibration perception threshold, NeuroQuick threshold, and skin biopsy, etcetera. So these are all helpful or maybe helpful if they are for early prevention of DPN, do you think these assessment modalities should be performed routinely in patients with diabetes or pre-diabetes in clinical practice? And also it is difficult for a clinic to use all of these particular measurements, which do you think is the most valuable or the most essential of those methods among those for a clinic in particular?

      《国际糖尿病》:我现在和Dan Ziegler教授在中国苏州举行的CDS(中国糖尿病协会)年会现场,非常感谢您作为糖尿病周围神经病变方面的知名专家参加今天的采访,我们今天为您准备了很多的问题。在您的演讲中您提到了一系列早期发现神经病变的方法,如诊断早期神经功能不全的方法,包括评估感觉神经传导速率、温度阈测定、振动觉阈测定和皮肤活检等等。这些检查在早期预防糖尿病周围神经病变中有用或可能有用,您是否认为在临床实践中,对糖尿病或糖尿病前期患者应该常规应用这些评估模型对患者进行评估?在同一家医疗机构同时拥有上述所有的设备是很困难的,您认为哪些是其中最有价值的或最重要的方法?

  Prof.Ziegler: Yes, I agree with what you are saying. ?This is an area of measures which we used over the years in order to show for the time when the neuropathy develops first and obviously if you used all theses qualitative techniques, you can detect the neuropathy at a very early stage which can’t be detected when using the clinical team methods that is the clinical examination.?Of course, these are all quite sophisticated and complicated methods in part so that they can’t be routinely recommended to the routine clinics, because simply there is no time really for screening and also the costs will be very high to screen all these patients.So the assessment of the patient with suspected diabetic neuropathy or the diabetic patients anyway should focus on the yearly assessment using clinical neurological examination and there you would assess the reflexes, especially the ankle reflexes, the pinprick examination and sensation, the monofilament assessment will be important, and also you would assess the thermal threshold using a semi quantitative device and the vibration perception threshold using the tuning fork. Now when you do all these tests and this usually don’t take you longer than 5 to 10 minutes, you will be able to appropriately diagnose the neuropathy on clinical grounds and you should then use validated scores in order to give a number and then clearly say this patient has or has not neuropathy. This is very important because we need some standardization, otherwise, people would come and say neuropathies if the vibration is increased and the other person would say neuropathies when the reflex is not evocable, so we clearly need to go for standardization. And the other tests will remain reserved for the patients whose neuropathy are not possible on clinical grounds for many reasons, for example, there might be a small fiber neuropathy which only involves the small fibers which can’t be detected by clinical examination and usually also can’t be detected by doing nerve conduction studies, so for these patients, the studies like QST--Quantitative Sensory Testing, looking at the warm and cold thresholds should be done and also if required even a skin biopsy, counting the number of the epidermal nerve fibers. So in specific settings, we need a specific set of these measures.

        Ziegler教授:是的,我同意你的观点。这些是我们在过去数年中所采用的用于确定早期神经病变的方法,很显然,如果你采用所有这些定量测定的技术进行评估,就可以在目前临床检查方法尚不能确定的早期阶段发现神经病变。当然,这些评估方法非常复杂和高级,因此不适合推荐作为临床诊所常规检查,很简单,因为没有时间做如此全面的筛查,对所有的患者进行筛查的花费也是很高的。因此应该强调采用临床神经病学检查方法对那些怀疑糖尿病神经病变或糖尿病患者进行评估,这个过程中需要评估的内容包括:反射(特别是踝反射),音叉振动学检查及感觉单尼龙丝检查,此外还需要通过半定量设备评估患者的温度觉阈,用音叉评估患者的振动觉阈。这样你仅仅花了5-10分钟实践就完成所有这些检查,这个时候你就可以对周围神经病变做出合理的临床诊断,此时你需要进行确定的积分评定,得到一个确切的分数,从而明确地诊断患者是否存在神经病变。这个过程很重要,我们在临床实践中需要一些标准,如果没有标准,一些人会把振动觉增强说成神经病变,而另一些人会把反射不能被引出说成神经病变,因此我们必须要有标准。对一些由于种种原因不可能通过临床方法确诊神经病变的患者,我们仍然需要采用其他的测试方法,例如,小神经纤维病变,这种患者只有小神经纤维受累,临床检查不能发现,通常神经传导检查也不能探及,这样的患者需要进行如QST-定量感觉检查确定热觉阈和冷觉阈,必要时还可以考虑通过皮肤活检对表皮神经纤维进行计数。因此,须根据不同情况来选择不同的测量方法组合。
 



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 延伸阅读
网站用户: 王文生 时间:2011/2/4 23:47:04
在临床中发现或病人感到神经病变综合症就症状就损害明显了,不过治疗是一样的过程,如果有早期检测仪器或标准对比,治疗前后的检测更好。

网站用户: 靳素梅 时间:2010/11/25 14:59:00
如果可以用单尼龙丝,振动觉,痛觉同时做检查的话,不管哪一方面有异常都能判断为神经病变吗?

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