糖尿病周邊神經病變評估與新進展

10.6666/ClinMed.202110_88(4).0104

沈宜靜；賴冠霖

糖尿病周邊神經病變（diabetic peripheral neuropathy, DPN） ； 遠端對稱性多發性神經病（distal symmetric polyneuropathy, DSPN） ； 臨床即時檢測儀器（point-of-care devices, POCDs）

臨床醫學月刊

88卷4期（2021 / 10 / 29）

624 - 636

繁體中文

糖尿病周邊神經病變是最常見的糖尿病併發症之一，可以在疾病很早期就發生，且與足部潰瘍，截肢等嚴重併發症密切相關。其診斷方式包括症狀、徵候、身體檢查、電生理檢測等。整體糖尿病周邊神經病變盛行率約30%～50%：最常見的表現類型是遠端對稱性多發性神經病變，約佔所有糖尿病神經病變的75%。此外，在糖尿病周邊神經病變的患者中，約有30%～50%會合併神經病變疼痛，故疼痛型的糖尿病周邊神經病變，在整體糖尿病患者中約占10%～25%。評估遠端對稱性多發性神經病變的臨床常用篩檢工具，包括針對大纖維神經的128 Hz音叉（震動覺）與10公克單股纖維（壓覺）；以及評估小纖維神經的神經學檢查針、牙籤（針刺覺）與感溫器、金屬湯匙（溫覺），另有密西根神經病變篩檢量表（Michigan neuropathy screening instrument, MNSI）。疼痛型的糖尿病周邊神經病變評估，依據目的不同，可以各式問卷量表進行篩檢評估與追蹤。複雜的檢查，評估主觀、也很耗費人力與時間，以至篩檢對象與環境受限、落實普遍篩檢困難。近年來發展出一些非侵入性、客觀、簡便的臨床即時檢測儀器（point-of-care devices, POCDs），如：DPNCheck、Sudoscan等，希望經由這些儀器的使用，建構適當的篩檢流程，更早期介入糖尿病周邊神經病變，扭轉目前因診斷病變太晚期，以致錯失病程可逆時機困境，進一步達到糖尿病足部病變、以及後續截肢等嚴重併發症的有效防治。

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