应用胰岛素快速控制血糖引发急性痛性神经病变五例报道及文献复习

Five cases of acute painful neuropathy induced by rapid glycaemic control with insulin and literature review

分析2010年至2012年在本院内分泌科应用胰岛素快速控制血糖引起的急性痛性神经病变5例患者的临床资料及感觉定量和电生理研究等相关检查资料。结果显示，5例患者均为男性，年龄31～49岁，体重指数偏低，诊断为成人隐匿性自身免疫性糖尿病（LADA）或2型糖尿病患者。应用胰岛素前血糖控制很差，应用胰岛素后高血糖在短时间内纠正迅速，在胰岛素控制血糖期间常出现低血糖反应。肢体疼痛于应用胰岛素后2～4周内出现，经治疗2~6个月可部分或完全缓解。疼痛表现为刺痛、触痛，难以忍受，夜间明显。注射胰岛素几分钟后疼痛加重。应用弥可保、硫辛酸、前列地尔等药物治疗无明显好转。常伴有严重焦虑症状。神经肌电图检查显示双下肢胫、腓总神经运动传导速度正常或减慢，手足感觉阈值正常。

The characteristics of clinical data and relevant inspection （quantitative sensory and electrophysiological studies ）in 5 patients hospitalized with acute painful neuropathy following rapid glycaemic control with insulin from 2010 to 2012 in our hospital were analyzed. The results showed that 5 patients were all males, aged 31-49 years, with lower body mass index, and diagnosed as latent autoimmune diabetes of adults （LADA） or type 2 diabetes.Glycaemic control was poor before application of insulin. When insulin was used, the hyperglycemia was rapidly corrected in a short time, with recurrent episodes of hypoglycemia during insulin treatment.The painful neuropathic symptoms appeared within 2-4 weeks after application of insulin, and were relieved partially or completely after 2-6 months.Neuropathic symptoms manifested as tingling and tenderness, with worsening during night and after insulin injection. The neuropathic symptoms were not significantly alleviated after application of neurotrophic drugs such as methycobal,protogen, and prostaglandin. These patients often suffered from severe anxiety. Nerve electromyogram examination showed slowed or normal motor conduction velocity of tibial and fibular nerves, and normal feeling threshold.