당뇨병성 말초 신경병증의 개괄과 한의학적 연구의 필요성

김진미(Jin-Mi Kim),윤성식(Sung-Sik Youn),안소현(So-Hyun An),최정식(Jeong-Sik Choi),조충식(Chung-Sik Cho),손창규(Chang-Gue Son),김철중(Chul-Jung Kim) 대한한의학회 2009 대한한의학회지 Vol.30 No.5

당뇨병성 미세혈관 합병증 및 신경병증 환자에서 혈청 Lipoprotein ( a ) 의 농도

이경인(Kyoung In Lee),정준훈(Joon Hoon Jeong),최영근(Young Keun Choi),김영민(Young Min Kim),강양호(Yang Ho Kang),손석만(Seok Man Son),김윤성(Yun Seong Kim),김사웅(Sa Woong Kim),유석동(Seok Dong Yoo),김인주(In Joo Kim),김용기(Yong Ki 대한내과학회 1998 대한내과학회지 Vol.54 No.2

Background: Several epidemiological studies have shown that high plasma concentration of lipoprotein(a) [Lp(a)] is associated with an increased risk for atherosclerotic cardiovascular disease and works as an independent risk factor for atherosclerosis. But, the significance of Lp(a) in diabetic microangiopathy & neuropathy is unclear essentially due to a paucity of relevant studies. This study was designed to evaluate whether Lp(a) concentration may be increased in patients with diabetic microangiopathy & neuropathy. Methods : We studied 96 patients who visited the department of internal medicine in Pusan National University Hospital from May 1995 to May 1996. The patients were grouped according to the presence of diabetic complications(microangiopathy and neuropathy, microangiopathy included retinopathy and nephropathy) and therapeutic modalities(diet, insulin, insulin with oral hypoglycemic agent, and oral hypoglycemic agent). Results: 1) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic retinopathy(nonproliferative, 38.6±33.6 mg/dl, proliferative, 39.5±32.1 mg/dl) than that of patients without retinopathy(23.3±25.3 mg/dl). The duration of diabetes was significantly longer(p<0.05) in patients with diabetic retinopathy(nonproliferative, 12.0 years, proliferative, 13.2 years) than that of patients without retinopathy(5.9 years). 2) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic nephropathy(36.5±39.3 mg/dl) than that of patients without nephropathy(23.3±17.8 mg/dl) and the duration of diabetes was also longer in patients with diabetic nephropathy(10.7±7.2 years vs 6.3±5.8 years, p<0.005). 3) Concentration of Lp(a) was significantly higher and the duration of diabetes was longer in patients with diabetic neuropathy than that of patients without neuropathy(35.9±31.7 mg/dl vs 23.2±25.1 mg/dl, p<0.05 and 10.8 years vs 6.2 years, p<0.005). 4) Concentration of Lp(a) was significantly higher in patients with three complications(53.6 mg/dl, p<0.005) and duration of diabetes was significantly longer in patients with two or three complications(11.3 years, 13.6 years, respectively, p<0.0001). than those in patients without complications. 5) When the patients were subgrouped according to the treatment modalities, there were no significant difference in Lp(a) concentration, however the duration of diabetes was longer in patient group treated with combination of insulin and oral hypoglycemics than that of the other groups(p<0.05). 6) In multivariate logistic regression analysis, concentration of Lp(a) ≥ 50 mg/dl was significantly correlated with diabetic retinopathy & nephropathy, but was not significantly correlated with diabetic neuropathy. Duration of diabetes(≥7 years) and total cholesterol(≥20 mg/dl) were signi5cantly correlated with diabetic retinopathy, nephropathy and neuropathy. Conclusions: Lp(a) concentration is increased in patients with diabetic microangiopathy and neuropathy compared with patients without these complications. So, Lp(a) may works as risk factor for diabetic microangiopathy and neuropathy, and further study to evaluate the role of Lp(a) as a risk factor of such complications would be necessary in large number of patients.

Quantification of Nerve Viscosity Using Shear Wave Dispersion Imaging in Diabetic Rats: A Novel Technique for Evaluating Diabetic Neuropathy

Liu Feifei,Li Diancheng,Xin Yuwei,Liu Fang,Li Wenxue,Zhu Jiaan 대한영상의학회 2022 Korean Journal of Radiology Vol.23 No.2

Objective: Viscoelasticity is an essential feature of nerves, although little is known about their viscous properties. The discovery of shear wave dispersion (SWD) imaging has presented a new approach for the non-invasive evaluation of tissue viscosity. The present study investigated the feasibility of using SWD imaging to evaluate diabetic neuropathy using the sciatic nerve in a diabetic rat model. Materials and Methods: This study included 11 diabetic rats in the diabetic group and 12 healthy rats in the control group. Bilateral sciatic nerves were evaluated 3 months after treatment with streptozotocin. We measured the nerve cross-sectional area (CSA), nerve stiffness using shear wave elastography (SWE), and nerve viscosity using SWD imaging. The motor nerve conduction velocity (MNCV) was also measured. These four indicators and the histology of the sciatic nerves were then compared between the two groups. The performance of CSA, SWE, and SWD imaging in distinguishing the two groups was assessed using receiver operating characteristic (ROC) analysis. Results: Nerve CSA, stiffness, and viscosity in the diabetic group was significantly higher than those in the control group (all p < 0.05). The results also revealed a significantly lower MNCV in the diabetic group (p = 0.005). Additionally, the density of myelinated fibers was significantly lower in the diabetic group (p = 0.004). The average thickness of the myelin sheath was also lower in the diabetic group (p = 0.012). The area under the ROC curve for distinguishing the diabetic neuropathy group from the control group was 0.876 for SWD imaging, which was significantly greater than 0.677 for CSA (p = 0.030) and 0.705 for SWE (p = 0.035). Conclusion: Sciatic nerve viscosity measured using SWD imaging was significantly higher in diabetic rats. The viscosity measured using SWD imaging performed well in distinguishing the diabetic neuropathy group from the control group. Therefore, SWD imaging may be a promising method for the evaluation of diabetic neuropathy.

Clinical Significance of the Presence of Autonomic and Vestibular Dysfunction in Diabetic Patients with Peripheral Neuropathy

김수경,이경주,함종렬,이상민,정태식,정정화,김성수,김덕룡,안성기,최원희,정순일 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.1

Background: We investigated the prevalence of diabetic autonomic neuropathy (DAN) and vestibular dysfunction (VD) in diabetic patients with peripheral neuropathy. Methods: Thirty-five diabetic patients with peripheral neuropathy were enrolled from August 2008 to July 2009. All subjects underwent autonomic function tests. Nineteen of the patients (54.3%) underwent videonystagmography. Results: Diabetic autonomic neuropathy was observed in 28 patients (80%). A mild degree of autonomic failure was observed in 18 patients (64.3%), and a moderate degree of autonomic failure was observed in ten patients (35.7%). Factors related to DAN included diabetic nephropathy (P=0.032), degree of chronic kidney disease (P=0.003), and duration of diabetes (P=0.044). Vestibular dysfunction was observed in 11 of 19 patients (57.9%). There was no significant association between DAN and VD. Conclusion: Diabetic autonomic neuropathy was observed in 28 diabetic patients (80%) with peripheral neuropathy. Vestibular dysfunction was observed in nearly 60% of diabetic patients with peripheral neuropathy who complained of dizziness but showed no significant association with DAN. Diabetic patients who complained of dizziness need to examine both autonomic function and vestibular function.

당뇨병성 신경병증 심도에 따른 체성감각 유발전위 검사 소견

하강욱,권희규,이상헌,김리나,박윤근 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.1

Objective: To investigate the clinical applicability of the somatosensory evoked potentials (SEPs) study in early detection of diabetic neuropathy, and compare the results in different degrees of the disease. Method: The study was performed retrospectively with prospective data collection. The Toronto clinical scoring system was taken as well as nerve conduction study, needle electromyography, and SEPs study with median and posterior tibial nerve stimulations in thirty-eight diabetic patients and twenty non-diabetic adults. The subjects were divided into the non-neuropathy group and the neuropathy group, and the latter was divided into three subgroups (suspected, probable, and definite) according to the degree of neuropathy. Statistical analysis was performed with height and age-related correction of reference values of the latency of SEPs with posterior tibial nerve stimulation. Results: The Toronto clinical scoring system showed concordance with the degree of the diabetic neuropathy (p<0.05, correlation coefficient=0.827). SEPs study with posterior tibial nerve stimulations showed statistically significant latency delay, not only in the neuropathy group, but also in the non-neuropathy group, compared with the non-diabetic group (p<0.05). Moreover, the latency delay was noted in proportion to the degree of the diabetic neuropathy within the neuropathy group. Interpretation of the data with height and age-corrected reference values of latency of posterior tibial SEPs had stronger correlation. Conclusion: The SEPs study is useful in the early diagnosis of diabetic neuropathy. However, application of the SEPs to clinical use needs to go through height and age correction.

Bone Marrow-Derived Mesenchymal Stem Cells Improve the Functioning of Neurotrophic Factors in a Mouse Model of Diabetic Neuropathy

Bae Jin Kim,Hee Kyung Jin,Jae-Sung Bae 한국실험동물학회 2011 Laboratory Animal Research Vol.27 No.2

Diabetic neuropathy is one of the most frequent and troublesome complications of diabetes. Although there has been a continuous increase in the incidence of diabetic neuropathy, treatments have yet to be found that effectively treat diabetic neuropathy. Neurotrophic factors are proteins that promote the survival of specific neuronal populations. They also play key roles in the regeneration of peripheral nervous system. Recent evidence from diabetic animal models and human diabetic subjects suggest that reduced availability of neurotrophic factors may contribute to the pathogenesis of diabetic neuropathy. One way to reverse this effect is to take advantage of the finding that bone marrow derived mesenchymal stem cells (BM-MSCs) promote peripheral nerve repair and the functioning of neurotrophic factors. Therefore, we speculated that treatment with BM-MSCs could be a viable therapeutic strategy for diabetic neuropathy. The present study was designed to examine the possible beneficial effect of BM-MSCs on functions of neurotrophic factors in diabetic neuropathy. To assess this possibility, we used an in vivo streptozotocin-induced diabetic neuropathy mouse model. Quantitative real-time polymerase-chain reacion showed that BM-MSCs significantly increase expression levels of neurotrophic factors. Also, BMMSCs ameliorated nerve conduction velocity in streptozotocin-treated mice. These results may help to elucidate the mechanism by which BM-MSCs function as a cell therapy agent in diabetic neuropathy.

신경합병증을 의심하는 당뇨병 환자에 대한 콤퓨터 적외선 체열촬영의 의의 ( The Study with D . I . T . I .

박성민(Sung Min Park),권중혁(Joong Hyuck Kwon),전윤창(Yun Chan Jun),임병훈(Byung Hoon Lim),강진호(Jin Ho Kang),김병익(Byung Ik Kim),이만호(Man Ho Lee),이상종(Sang Jong Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.5

Objectives: Thermography have been used to demonstrate the regional skin temperature. Computerized thermography is capable of measuring a infrared emission from the skin with a degree of spatial resolution and quantitative precision that should allow smaller temperature differences. Infrared thermography have been used to investigate the neuropathy of diabetic patient. In diabetic patient neuropathic extremity or ulceration was frequently associated with increased skin temperature but in extremity with an atherosclerotic component, it was generally hypothermic. For the evaluation of diabetic neuropathy, D.I.T.I.(digital infrared thermographic imaging) was performed in diabetic and control group. Methods: Eighty patients who suspected diabetic neuropathy and 50healthy control subjects were investigated. The subjects were free of vascular and neuromuscular diseases. In the diabetic group, Doppler ultrasound measurements of femoral popliteal artery were made to exclude diabetic patients associated with atherosclerotic change of these vessels. The thermographic examinations were performed on lower extremities by the computer aided thermography equipment in the standerized environmental condition(room temperature: 19-21℃) Results: 1) The mean temperaure of lower extremities showed significant differences between diabetic patients and control group. In diabetic group, it was significantly hotter than that of control group. On the mean temperature of diabetics, the anterior site was 29,7℃, the posterior site was 30.1℃. On the normal controls, the anterior site was 28.1℃, the posterior site was 28.2℃. (p<0.05) 2) In the anterior and posterior view, mean values of temperature differences of both leg (left-right) were statistically insignificant between the control and diabetic group.(p>0.05) 3) There were no significant differences of mean temperature of lower extremities for duration of diabetes. (p>O.D5) Conclusion: On the basis of the mean temperature of lower extremities, patients suspected diabetic neuropathy were significantly hotter than the control. This result indicates that thermographic screening could be a useful technique in identifying diabetic neuropathy.

Clinical Significance of the Presence of Autonomic and Vestibular Dysfunction in Diabetic Patients with Peripheral Neuropathy

Kim, Soo Kyoung,Lee, Kyeong Ju,Hahm, Jong Ryeal,Lee, Sang Min,Jung, Tae Sik,Jung, Jung Hwa,Kim, Sungsu,Kim, Deok Ryong,Ahn, Seong-Ki,Choi, Won-Hee,Chung, Soon Il Korean Diabetes Association 2012 Diabetes and Metabolism Journal Vol.36 No.1

<P><B>Background</B></P><P>We investigated the prevalence of diabetic autonomic neuropathy (DAN) and vestibular dysfunction (VD) in diabetic patients with peripheral neuropathy.</P><P><B>Methods</B></P><P>Thirty-five diabetic patients with peripheral neuropathy were enrolled from August 2008 to July 2009. All subjects underwent autonomic function tests. Nineteen of the patients (54.3%) underwent videonystagmography.</P><P><B>Results</B></P><P>Diabetic autonomic neuropathy was observed in 28 patients (80%). A mild degree of autonomic failure was observed in 18 patients (64.3%), and a moderate degree of autonomic failure was observed in ten patients (35.7%). Factors related to DAN included diabetic nephropathy (<I>P</I>=0.032), degree of chronic kidney disease (<I>P</I>=0.003), and duration of diabetes (<I>P</I>=0.044). Vestibular dysfunction was observed in 11 of 19 patients (57.9%). There was no significant association between DAN and VD.</P><P><B>Conclusion</B></P><P>Diabetic autonomic neuropathy was observed in 28 diabetic patients (80%) with peripheral neuropathy. Vestibular dysfunction was observed in nearly 60% of diabetic patients with peripheral neuropathy who complained of dizziness but showed no significant association with DAN. Diabetic patients who complained of dizziness need to examine both autonomic function and vestibular function.</P>

당뇨병 환자에서 Tc - 99m - DISIDA Scintigraphy 를 이용한 담낭의 기능분석

황인섭(In shup Hwang),류광현(Kwang Hyun Rhu),김홍남(Hong Nam Kim),노영호(Young Ho Rho),한신(Sin Han),김윤권(Youn Kwon Kim),김소연(So Yon Kim),조민구(Min Koo Cho),이권전(Gwon Jun Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

Objectives : Diabetic autonomic neuropathy is a common complication of long standing diabetes mellitus and is well known to induce the motor dysfunction of cardiovascular system, genitourinary system and digestive system. Although many studies have done to evaluate the diabetic autonomic neuropathy, gallbladder motor function and biliary dynamic study to evaluate the change of gallbladder function in diabetic patients is relatively rare. This study was performed to measure the gallbladder ejection fraction using Tc- 99m-DISIDA with fatty meal in order to evaluate the gallbladder motor function in diabetic patients and to examine the usefulness of it in analyzing diabetic autonomic neuropathy. Methods : 51 diabetic patients(males 31, females 18, mean age 57yr(36-77yr)) and 1H control subjects(males 14, females 4, mean aged 47yr(31-70yr)) without gallstone and impaired liver function were enrolled in our study. Also the diabetic patients were categorized by age, disease duration, body weight and diabetic complications such as retinopathy, peripheral neuropathy and cardiovascular autonomic neuropathy accompanying with or not. Results : 1) Median value and interquartile range of gallbladder ejection fraction(%) were 66%(48-79%) in diabetic patients group and 75%(64-80%) in control subjects. There was no statistically significant difference between the two groups, but the mean value of diabetic patients was slightly lower than that of control subjects. 2) There was no significant difference between the two groups in mean value of gallbladder ejection fraction in every age group(P>0.05). 3) Median value of gallbladder ejection fraction in diabetic groups with less than 10 years of duration (both under 5 years and 5 to 10 years groups) was similar to that of control subjects. However in patients whose diabetic conditions last more than 10 years, the median range of gallbladder ejection fraction was significantly lower than that of control subjects(P<0.05). 4) Median range of gallbladder ejection fraction in obese diabetic patients group was significant lower than those of control subjects and non- obese diabetic patients(p<O.C6). 5) Median value of gallbadder was lower in diabetic patients group with complications like retinopathy, peripheral neuropathy or cardiovascular autonomic neuropathy (p<0.05) in comparison with those of control subjects and diabetic patients group without diabetic complication (p>0.05). Also seven diabetic patients whose gallhladder ejection fraction was reduced under,35% have had at least two diabetic complications. Conclusion : We observed that gallbladder ejection fraction of diabetic patients was reduced compared with that of control subjects. This is due to the reduced gallbladder muscle contractility resulting from diabetic autonomic dysfunction. These results suggest that the assessment of gallbladder ejection fraction using 99m- Tc-DISIDA would be useful to diagnose diabetic autonomic neropathy.

The effect of α-lipoic acid on symptoms and skin blood flow in diabetic neuropathy

Jin, H. Y.,Joung, S. J.,Park, J. H.,Baek, H. S.,Park, T. S. Blackwell Publishing Ltd 2007 Diabetic medicine Vol.24 No.9

<P>Abstract</P><P>Aims </P><P>Multiple pathogenic pathways are involved in diabetic neuropathy and diverse treatments have been tried without success. The aim of this study was to assess the effect of α-lipoic acid on skin blood flow in patients with diabetic neuropathy.</P><P>Methods </P><P>We measured skin blood flow in 13 control subjects and 19 patients with diabetic neuropathy using the laser Doppler blood flow technique. Skin blood flow and the extent of skin blood flow changes were compared before and after diabetic patients received 600 mg/day α-lipoic acid intravenously for 14 days.</P><P>Results </P><P>Although no significant differences in absolute values of skin blood flow or in the extent of changes were noted, symptoms were reduced after α-lipoic acid treatment.</P><P>Conclusions </P><P>This study suggests that α-lipoic acid, a potent antioxidant, improves symptoms of diabetic neuropathy. Larger studies are needed to determine whether improvements in skin blood flow also occur in patients with diabetic neuropathy.</P>