Уважаемая Галина Афанасьевна, в литературе встречаются сведения о возможности развития хронической воспалительной демиелинизирующей полинейропатии у пациентов с СД 1 и 2 типов. Можно ли рассматривать эту версию?
Arch Neurol. 2002 May;59(5):758-65.
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Demyelinating neuropathy in diabetes mellitus.
Sharma KR, Cross J, Farronay O, Ayyar DR, Shebert RT, Bradley WG.
Department of Neurology, University of Miami School of Medicine (M740), 1150 NW 14th St, Room 603, Miami, FL 33136, USA. [Ссылки доступны только зарегистрированным пользователям ]
BACKGROUND: Recent studies have reported that patients with diabetes mellitus (DM) have a predisposition to develop chronic inflammatory demyelinating polyneuropathy (CIDP). OBJECTIVES: To determine whether patients with DM have a polyneuropathy fulfilling electrophysiologic criteria for CIDP, and whether CIDP is more frequent in patients with type 1 than in patients with type 2 DM. METHODS: We prospectively studied the frequency of electrophysiologic changes meeting the criteria for CIDP in patients with DM seen in our electrophysiology laboratory during a 51-month period (period 1). To evaluate the relationship between DM and CIDP, we prospectively determined during a 14-month period (period 2) the frequency of DM in patients seen in our electrophysiology laboratory with other neuromuscular diseases, and the frequency of idiopathic CIDP. RESULTS: During period 1, 120 patients with DM met the electrophysiologic criteria for CIDP (DM-CIDP). The most frequent clinical features of DM-CIDP were those of a predominantly large-fiber sensorimotor neuropathy, with recent motor deterioration and a moderately increased cerebrospinal fluid protein concentration. Twenty-six of the 120 patients were given intravenous immunoglobulin (400 mg/kg per day for 5 days), and 21 patients (80.8%) had significant improvement in the neurologic deficit at the end of 4 weeks of therapy. The DM-CIDP occurred equally in type 1 and type 2 DM. During period 2, 1127 patients were seen. Of these, 189 (16.8%) had DM with various neurologic disorders, including 32 patients (16.9%) with DM-CIDP. Among the remaining 938 patients without DM, 17 (1.8%) had idiopathic CIDP. The odds of occurrence of DM-CIDP was 11 times higher among diabetic than nondiabetic patients (P<.001). CONCLUSIONS: Demyelinating neuropathy meeting the electrophysiologic criteria for CIDP occurred in both types of DM, and its occurrence was significantly higher in diabetic than in nondiabetic patients.
PMID: 12020257 [PubMed - indexed for MEDLINE]
J Peripher Nerv Syst. 2003 Mar;8(1):23-8.
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Severe chronic sensory-motor polyneuropathy: coexistence of 3 unrelated etiologies in a type 1 diabetic patient. A case report and review of the literature.
Micco A, Nobile-Orazio E, Baron P, Conti G, Napoli L, Serafini M, Scarlato G, Scarpini E.
Department of Neurological Sciences, University of Milan, IRCCS Ospedale Maggiore Policlinico, Milan, Italy. [Ссылки доступны только зарегистрированным пользователям ]
We present the case of a 58-year-old man, who has suffered from type 1 diabetes mellitus since he was young. He had monoclonal IgM kappa gammopathy of undetermined significance and high anti-MAG antibody titer. He developed a polyneuropathic picture with the clinical and laboratory features of chronic inflammatory demyelinating polyneuropathy within the span of approximately 2 years. He benefited from IV administration of high doses of immunoglobulins. Investigation of all parameters, but particularly of the clinical phenotype, can lead to a better definition of the polyneuropathic picture, especially for therapeutic and prognostic purposes.
PMID: 12678551 [PubMed - indexed for MEDLINE]
Diabetes Metab. 2001 Apr;27(2 Pt 1):155-8.
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An unusual neuropathy in a diabetic patient: evidence for intravenous immunoglobin-induced effective therapy.
Romedenne P, Mukendi R, Stasse P, Indekeu P, Buysschaert M, Colin IM.
Department of Internal Medicine, CHR-St Joseph Medical Center, Mons, Belgium.
We report the case of a 68-year old type-2 diabetic male patient who was admitted to hospital for progressive weakness in the right lower limb. Although his metabolic control was good, he lost more than 20 kg of weight. Despite intensive physio- and vitaminotherapy, his neurological condition kept on degrading with a severe amyotrophy and pain of the right thigh. He was unable to walk and to stand alone. Besides a yet known sensitive polyneuropathy, the electrophysiological study revealed an obvious motor involvement with signs of demyelination and axonal degeneration. Combined with the albuminocytologic dissociation observed in the cerebrospinal fluid, these specific clinical and electrophysiological features led us to postulate a diagnosis of inflammatory neuropathy. The patient underwent a treatment by methylprednisolone and immunoglobins that rapidly induced a striking improvement of his neurological condition. This case report illustrates that rare forms of neuropathy such as inflammatory neuropathies close to chronic inflammatory demyelinating polyneuropathy (CIDP) can occur in diabetic patients and superimpose on the more commonly described forms of neuropathies. It recalls the importance of recognizing CIDP-like neuropathies because unlike other forms of neuropathy, inflammatory neuropathies are perfectly curable.
PMID: 11353882 [PubMed - indexed for MEDLINE]