·糖尿病神经病变·

　　方萍 黄佳佳 侯瑞芳 凌丹芸 龚慧 杨洋 张杉杉 汤正义 宁光

　　作者单位：200025上海交通大学医学院附属瑞金医院内分泌代谢病科、上海市内分泌代谢病临床医学中心糖尿病足分中心、上海市内分泌代谢病研究所

　　通讯作者：汤正义，E-mail：tsy2zyp@163.com

　　【摘要】目的对比常规与强化血糖控制对糖尿病周围神经功能的影响。方法筛选临床没有明显神经病变的2型糖尿病患者123例，收集一般临床资料并进行相关生化检查，随机分组后给予强化(HbA1c<7%)治疗(强化组)或常规降糖(HbA1c在8%左右)治疗(对照组)，随访2年，随访中定期检测血糖、随访前后测定神经传导速度(NCV)和定量感觉测定(QST)。 结果无论是强化治疗还是常规治疗，大部分运动神经NCV有所增加，感觉神经的有所减退，两组治疗前后差值比较显示强化组NCV较常规组增加明显，这些差异只有部分神经的NCV有统计学意义(P<0.05)。两组前后的热感觉、冷感觉和振动觉均改善，其差异有统计学意义(P<0.05)，两组治疗前后QST差值比较显示，强化组热感觉及热痛觉较对照组降低明显(P<0.05)。两组数据病变患病率前后均没有显著差异。 结论糖尿病患者降低血糖治疗对神经功能均能带来益处，强化降糖对神经功能的改善获益可能更多。

　　【关键词】 糖尿病，2型;神经传导速度;定量感觉检查;强化降糖治疗

　　doi:10.3969/j.issn.1006-6187.2012.01.011

　　Effect of intensive blood glucose control on the progression of diabetic peripheral neuropathy (DPN)FANG Ping, HUANG Jia-jia, HOU Rui-fang, et al. Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Jiaotong University School of Medicine, Shanghai 200025, China

　　Corresponding author：TANG Zheng-yi, E-mail:tsy2zyp@163.com

　　【Abstract】ObjectiveIntensive blood glucose control was employed to investigate its effects on diabetic peripheral neuropathy (DDN) as compared with conventional therapy in type 2 diabetic patients. Methods After collecting the clinical features, biochemical test results and neurological function parameters, 123 patients with type 2 diabetes were randomly divided into intensive (HbA1c<7%) or conventional (HbA1c around 8%) treatment group and were followed up for 2 years. Nerve conduction velocity(NCV) and quantitative sensory measurement(QST) were examined before and at the end of follow-up. Results Motor NCV was improved but sensitive NCV was getting worse in both groups. The number of NCV improvements was more (P<0.05) in intensive group than in conventional group. Sensitive NCV was decreased (P<0.05) in conventional group, but not in intensive group. Cold sensation and cold pain threshold, warm sensation and hot pain threshold, and vibration threshold were significantly improved (P<0.05) at the end of follow-up in both groups. Warm sensation and heat pain threshold were found with even more amendment in the two groups. The prevalence of neuropathy was not lowered in both groups. Conclusion Nerve functions are improved and the delayed neurological deterioration occurs with reasonable treatment of hyperglycemia. More good points would be acquired under better blood glucose control.

　　【Key words】Diabetes mellitus, type 2; Nerve conduction velocity; Quantitative sensory measurement; Intensive blood glucose control