糖尿病周围神经病变患者催汗与伤害感受器轴突反射的差异损伤

• 作 者: Berghoff M. Kilo S. Hilz M.J. Freeman R. 李青波
• 机 构: Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School 1 Deaconess Roa
• 出 处: 世界核心医学期刊文摘(神经病学分册)
• 发表日期: 2006年08期
• 关键词: 伤害感受器 轴突反射 周围神经病变 糖尿病 神经纤维 伤害性感受器 传出神经 硅橡胶 交感神经 激光多普勒

It is not known whether C- fiber functional subclasses are differentially affected by diabetes mellitus or whether the patterns of C- fiber dysfunction are different between type 1 and type 2 diabetes. We therefore examined efferent sympathetic sudomotor and primary afferent nociceptor C- fiber function in diabetic patients. Acetylcholine (10% ) was used to evoke C- fiber (axon- reflex)mediated responses. The nociceptor (flare) response was measured using a laser Doppler device. The sudomotor response was quantified with silastic imprints. The nociceptor C- fiber- mediated flare response was reduced in type 2 diabetic patients (P < 0.008) but was similar to controls in type 1 diabetic patients. The sympathetic C- fiber- mediated responses, including sweat volume (P < 0.05) and the number of activated sweat glands (P = 0.003), were increased in patients with type 1 diabetes. There also was a trend toward a larger axon- reflex sweat area in patients with type 1 diabetes (P = 0.09). No differences in these sweat responses were found in patients with type 2 diabetes compared to controls. These findings suggest that the functional abnormalities in diabetic peripheral neuropathy are not homogeneous and that C- fiber subclasses are differentially affected in type 1 and 2 diabetes mellitus.

It is not known whether C-fiber functional subclasses are differentially affected by diabetes mellitus or whether the patterns of C-fiber dysfunction are different between type 1 and type 2 diabetes. We thereby examined the effects of sympathetic sudomotor and primary afferent nociceptor C-fiber function in The nociceptor (flare) response was measured using a laser Doppler device. The nociceptor response was quantified with silastic imprints. The nociceptor C-fiber (axon- reflex) mediated responses. fiber-mediated flare response was reduced in type 2 diabetic patients (P <0.008) but was similar to controls in type 1 diabetic patients. The sympathetic C-fiber-mediated responses, including sweat volume There was was in patients with type 1 diabetes. There were was a trend toward a larger axon-reflex sweat area in patients with type 1 diabetes (P = 0.09). No di fferences in these sweat responses were found in patients with type 2 diabetes compared to controls. These findings suggest that the functional abnormalities in diabetic peripheral neuropathy are not homogeneous and that C-fiber subclasses are differentially affected in type 1 and 2 diabetes mellitus.