糖尿病足神經(jīng)病理學(xué)-課件

1、 Pathophysiology of DiabeticNeuropathyZhijie Xi, MDGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Pathophysiology of DiabeticZhDiabetic Peripheral Neuropathy Can Progress Over TimeSymptoms (numbness, prickling, pain)ReflexesPressure Sensation (Monofilament)Vibrat

2、ory SensationNerve Conduction AbnormalitiesSubclinicalClinicalTimeSignsOnset ofClinical DiseasesSymptoms may occur any time and intermittentlyPatients may or may not have symptoms of diabetic peripheral neuropathyPatients frequently do not report symptoms to their physicians until the symptoms are s

3、evereThe majority of signs of diabetic peripheral neuropathy are not evident at the onset of diabetesDiabetic Peripheral NeuropathySymptoms and Signs of Diabetic Peripheral NeuropathySymptomsNumbness or loss of feeling (asleep or “bunched up sock under toes” sensation)Prickling/TinglingAching PainBu

4、rning PainLancinating PainUnusual sensitivity or tenderness when feet are touched (allodynia)SignsDiminished vibratory perceptionDecreased knee and ankle reflexesReduced protective sensation such as pressure, hot and cold, painDiminished ability to sense position of toes and feetSymptoms and signspr

5、ogress from distal to proximal over timeSymptoms and Signs of DiabeticDiabetic Peripheral Neuropathy Severity ScaleRatingDescription0No neuropathy1Subclinical diabetic peripheral neuropathy2aClinical diabetic peripheral neuropathy with symptoms, mild to moderate2bClinical diabetic peripheral neuropa

6、thy insensate foot, loss of feeling/negative symptoms3Disability/late stageDiabetic Peripheral NeuropathyEffects of Diabetic Peripheral NeuropathyEffects of Diabetic PeripheralNeuropathyMotorSensoryAutonomic nociception Proprioception,Unawarenessof foot positionReduced sweatingDry skinFissures andcr

7、acksMuscle wastingFoot weaknessPostural deviationDeformities, stressand shear pressuresTraumaStress on bones & jointsPlantar pressureCallus formationInfectionUlcerNeuropathyMotorSensoryAutonomi糖尿病足神經(jīng)病理學(xué)-課件糖尿病足神經(jīng)病理學(xué)-課件糖尿病足神經(jīng)病理學(xué)-課件糖尿病足神經(jīng)病理學(xué)-課件糖尿病足神經(jīng)病理學(xué)-課件糖尿病足神經(jīng)病理學(xué)-課件Simple Tests of Large-Fiber Function Simple Tests of Large-Fiber FuThe PNS is comprised of both neurons and SCs The PNS is comprised of both nPathways Implicated in Diabetic Neuropathy PathogenesisPathways Implicated in DiabetiBioenergetic Mechanisms of Nerve Injury in Diabetes Bioenergetic M