目的：糖尿病周围神经病变是糖尿病最常见的并发症，我们对治疗2型糖尿病周围神经病变的有效方法进行了偿试。方法:将66例2型糖尿病周围神经病变患者随机分为两组。在常规应用口服降糖药或胰岛素治疗的基础上，治疗组加用弥可保500 μg肌注每周3次，前列腺素E1100 μg加入生理盐水250 mL中静脉滴注，每日1次；对照组加用维生素B12500 μg肌注每周3次，复方丹参注射液20 mL加入生理盐水250 mL中静脉滴注，每日1次，疗程均为4周。结果:治疗组总有效率82.3%，与对照组比较差异有显著性（Plt;0.05）。临床症状改善方面，治疗组肢体麻木、肢体疼痛改善率分别达72%和75%，明显高于对照组的37%和44%，感觉减退、多汗、口干、腹泻、便秘、排尿障碍改善也优于对照组（分别为53%比26%、51%比16%、53%比19%、57%比26%、51%比28%、61%比26%）。结论:弥可保与前列腺素E1合用治疗糖尿病周围神经病变是一种有效的方法。
Objective To observe the corneal nerve fibres damage in different stage of diabetic retinopathy (DR) with type 2 diabetes. Methods A cross-sectional study. One hundred and twenty eyes of 120 patients with type 2 diabetes served as diabetes group. According to International Clinical Diabetic Retinopathy Disease Severity Scales (2002), diabetes patients were classified into 4 subgroups: patients without diabetic retinopathy (NDR), patients with mild or moderate non-proliferative diabetic retinopathy (mNPDR), patients with severe non-proliferative diabetic retinopathy (sNPDR) and patients with proliferative diabetic retinopathy (PDR), each subgroup has 30 eyes of 30 patients. Another 30 eyes of 30 healthy participants served as control group. All eyes were scanned with HRT3 in vivo corneal confocal microscopy. Images of sub-basal nerve plexus were quantified including nerve fiber length (NFL), nerve fiber density (NFD), nerve fiber branch density (NFB), and nerve tortuosity (NT). The correlations of corneal nerve fiber with age, duration of diabetes and glycated hemoglobin (HbA1c) were analyzed using Spearman correlation analysis. Results NFL, NFD and NFB were found to be significantly lower in diabetic patients (F=147.315, 142.586, 65.898;P=0.000, 0.000, 0.000), NT was significantly greater in diabetic patients (F=39.431,P=0.000), when compared to control group. In diabetic patients, NFL, NFD and NFB were gradually reduced with DR severity, NT was gradually increased with DR severity. While the difference of NFL, NFD, NFB, NT was not statistically significant between sNPDR and PDR subgroups (P＞0.05), but was statistically significant between other subgroups (P＜0.05). Spearman correlation analysis results showed that age (r=－0.071, －0.080, 0.001, 0.100;P=0.391, 0.328, 0.991, 0.224) and HbA1c (r=－0.109, －0.115, －0.126, 0.025;P=0.238, 0.211, 0.169, 0.781) had no correlation with NFL, NFD, NFB, NT. Duration of diabetes was negatively correlated with the NFL, NFD (r=－0.212, －0.264;P= 0.020, 0.004), positive correlated with NT (r=0.261,P=0.004), and had no correlation with NFB (r=－0.119,P=0.194). Conclusions Corneal nerve fiber loss and nerve tortuosity increased were found in patients with type 2 diabetes, and even without diabetic retinopathy. The progress of corneal neuropathy was correlated with the severity of DR, but it was not change significantly between sNPDR and PDR.
ObjectiveTo construct a prediction model of diabetics distal symmetric polyneuropathy (DSPN) based on neural network algorithm and the characteristic data of traditional Chinese medicine and Western medicine. MethodsFrom the inpatients with diabetes in the First Affiliated Hospital of Anhui University of Chinese Medicine from 2017 to 2022, 4 071 cases with complete data were selected. The early warning model of DSPN was established by using neural network, and 49 indicators including general epidemiological data, laboratory examination, signs and symptoms of traditional Chinese medicine were included to analyze the potential risk factors of DSPN, and the weight values of variable features were sorted. Validation was performed using ten-fold crossover, and the model was measured by accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and AUC value. ResultsThe mean duration of diabetes in the DSPN group was about 4 years longer than that in the non-DSPN group (P<0.001). Compared with non-DSPN patients, DSPN patients had a significantly higher proportion of Chinese medicine symptoms and signs such as numbness of limb, limb pain, dizziness and palpitations, fatigue, thirst with desire to drink, dry mouth and throat, blurred vision, frequent urination, slow reaction, dull complexion, purple tongue, thready pulse and hesitant pulse (P<0.001). In this study, the DSPN neural network prediction model was established by integrating traditional Chinese and Western medicine feature data. The AUC of the model was 0.945 3, the accuracy was 87.68%, the sensitivity was 73.9%, the specificity was 92.7%, the positive predictive value was 78.7%, and the negative predictive value was 90.72%. ConclusionThe fusion of Chinese and Western medicine characteristic data has great clinical value for early diagnosis, and the established model has high accuracy and diagnostic efficacy, which can provide practical tools for DSPN screening and diagnosis in diabetic population.