糖尿病合并慢性炎症性脱髓鞘性多发性神经病-4例临床分析并文献回顾

Diabetic chronic inflammatory demyelinating neuropathy-4 cases of clinical analysis and literature review

目的探讨糖尿病(diabetic mellitus,DM)合并慢性炎性脱髓鞘性多发性神经病(chronic inflammatory demyelinating polyneuropathy,CIDP)的临床、电生理特点,并与糖尿病周围神经病(diabetic peripheral neuropathy,DPN)进行早期鉴别诊断。方法回顾性分析4例DM合并CIDP患者的临床表现、电生理检查及诊疗特征。结果 4例DM合并CIDP患者中,1例仅表现为对称性肢体乏力,其余3例均伴有对称性的麻木或疼痛,仅1例患者伴有颅神经损害;4例患者均存在腱反射均减弱或消失,病程均超过2个月,且均有脑脊液蛋白-细胞分离现象;4例患者肌电图检查均提示脱髓鞘病变为主,使用激素冲击治疗后症状均好转,其中2例复发患者分别采用丙种球蛋白和血浆置换术治疗后症状好转,4例患者目前均恢复良好。结论当糖尿病患者出现周围神经病变时,早期根据其临床特征及辅助检查,诊断其是否合并CIDP,并对DM合并CIDP患者合理使用免疫抑制治疗效果良好。

Objective To investigate the clinical and neurophysiologic features of diabetic chronic inflammatory demyelinating polyneuropathy （CIDP） and provide gist to differentiate CIDP in diabetes from DPN. Methods Four cases of DM-CIDP were retrospectively studied on aspects of clinical and neurophysiologic features and treatment. Results Of the 4 diabetics,3 presented with symmetry numbness or pain in addition to 1 case of symmetry limbs weakness, 1 involved of cranial nerve, tendon reflex were all reduced or disappeared, with a clinical course for more than 2 months, dissociation of protein from cells could be seen on cerebrospinal fluid examination. 4 cases met at least 3 of the 4 electrophysiological criteria of demyelination. An improvement could be seen in 4 patients after glucocortieoid pulse therapy,2 cases of recurrence were administered with gamma globulin and plasma replacement therapy respectively ,4 patients all got well recovered now. Conclusion An early diagnosis can be made based on the relatively typical clinical and neurophysiologic features of CIDP in a diabetic patient when presenting with peripheral neurology, reasonable immunosuppressive therapy have a good effect on DM-CIDP.