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目的比较糖尿病-慢性炎性脱髓鞘性多发性神经根神经病(diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy,DM-CIDP)、糖尿病周围神经病(diabetic peripheral neuropathy,DPN)及慢性炎性脱髓鞘性多发性神经根神经病(CIDP)3组疾病的神经病理改变特点。方法收集2009年1月至2015年12月海军总医院、北京大学第一医院神经内科确诊的DM-CIDP、DPN和CIDP共32例患者的临床资料,对3组患者的腓肠神经病理结果进行对比分析。结果 DM-CIDP、DPN和CIDP3组患者的神经病理改变在洋葱球、薄髓鞘、轴索变性、有髓神经纤维再生簇、血管基底膜增厚、炎细胞浸润出现率的差异有统计学意义(P<0.05)。CIDP组出现薄髓鞘较DM-CIDP组常见,差异有统计学意义(P<0.05);DM-CIDP组出现轴索变性显著高于DPN组(P<0.05)和CIDP组(P<0.001),差异有统计学意义;DPN组出现有髓神经纤维再生簇较DM-CIDP组常见,差异有统计学意义(P<0.05);DM-CIDP组血管基底膜增厚较CIDP组常见,差异有统计学意义(P<0.05);DM-CIDP组炎性细胞浸润较DPN组多见,差异有统计学意义(P<0.001)。结论 DM-CIDP的神经病理改变与DPN及CIDP的病理改变均存在差异。与CIDP相比,DM-CIDP出现薄髓鞘神经纤维较少,而轴索变性及血管基底膜增厚较多;与DPN相比,DM-CIDP出现神经纤维轴索再生簇较少,而轴索变性及炎性细胞浸润多见。
Objective To compare the effects of diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy (DM-CIDP), diabetic peripheral neuropathy (DPN) and chronic inflammatory demyelinating multiple Neuropathic Neuropathy (CIDP) 3 group of diseases of neuropathological changes. Methods The clinical data of 32 patients with DM-CIDP, DPN and CIDP confirmed by Department of Neurology, Navy General Hospital and Peking University First Hospital from January 2009 to December 2015 were collected. The sural neuropathological results of the three groups were collected Comparative analysis. Results The neuropathological changes in DM-CIDP, DPN and CIDP3 groups were statistically significant in onion ball, thin myelin sheath, axonal degeneration, myelinated nerve fiber regeneration tufts, thickening of vascular basement membrane and inflammatory cell infiltration (P <0.05). (P <0.05). Axonal degeneration in DM-CIDP group was significantly higher than that in DPN group (P <0.05) and CIDP group (P <0.001) (P <0.05). The thickening of basilar membrane of DM-CIDP group was more common than that of CIDP group, the difference was statistically significant (P <0.05). There was a significant difference between DPN group and DM-CIDP group Statistical significance (P <0.05). Inflammatory cell infiltration in DM-CIDP group was more common than that in DPN group, the difference was statistically significant (P <0.001). Conclusion The pathological changes of DM-CIDP are different from those of DPN and CIDP. Compared with CIDP, DM-CIDP showed fewer myelinated nerve fibers and axonal degeneration and thickening of vascular basement membrane. Compared with DPN, DM-CIDP showed fewer axonal regeneration clusters, while axis Cable degeneration and inflammatory cell infiltration more common.