I-neuropathy yesifo sikashukela iyinkimbinkimbi yezinkinga zesifo sikashukela. Imiphumela emibi iba nezilonda zoMkhandlu Kazwelonke, kwesinye isikhathi izicubu. Kodwa-ke, ukuxilongwa kwalesi simo kunzima, ngoba kubonakaliswa inkambo ye-asymptomatic.
Ngokwezibalo, lapho ukubekezelelwa kwe-glucose kukhubazekile, izinkinga zenzeka ngamaphesenti ayi-11, kuthi ngesifo sikashukela sohlobo 2, isifo sikashukela sitholakale ku-28% weziguli. Ingozi yayo ukuthi cishe ama-80% abantu abanesifo sikashukela, uma bengalashwa, izilonda eziyinqaba ziyabonakala emilenzeni yabo.
Enye yezinhlobo ezingandile zesifo sikashukela i-lumbosacral radiculoplexitis. I-Amyotrophy iyisimo sohlobo 2 sikashukela.
Imvamisa, lesi sifo senzeka ezigulini ezingathembeli ku-insulin, ezineminyaka engama-40-60. Lokhu kwenzeka ngemuva kwesifo sikashukela se-microangiopathy ngenxa yomonakalo we-axonal.
Isici se-morphological sigxile endaweni yamaseli wezimpande neziqu zemithambo yethambo kanye nezimpondo zomgogodla.
Izici zokuvela nezimpawu
Imiphumela yezifundo eziningi ze-pathomorphological ikhombisile ukuthi i-amyotrophy yesifo sikashukela yenzeka ngokumelene nesizinda sokulimala kwe-autoimmune emithanjeni yezinzwa (i-perineuria, i-epineuria) ngokuvela kwe-perivasculitis ne-microvasculitis. Lezi zifo zifaka isandla ekulimaleni kwe-ischemic ezimpandeni nasemithanjeni yegazi.
Kunobufakazi bohlelo lokulekelela, ama-lymphocyte endothelial, ukubonakaliswa kwama-cytokines agonyiwe, nokuchayeka kumaseli we-cytotoxic T. Amacala okufakwa kwe-venule polynuclear (post-capillary) nawo aqoshwa. Ngasikhathi sinye, ukubhujiswa kanye nokungasebenzi kahle kwama-axons, ukunqwabelana kwe-hemosiderin, ukuqina kwe-perineuria, ukubulawa kwamalungu omhlaba kanye neovascularization kwembulwa ezimpandeni nasezinhlungwini.
Ngaphezu kwalokho, i-misuli atrophy kuma-diabetesics kungenxa yezizathu ezithile ezisobala:
- ubudala - ngaphezulu kweminyaka engama-40;
- ubulili - kuvame ukwenzeka izinkinga emadodeni;
- ukusetshenziswa kabi kotshwala, okwandisa inkambo ye-neuropathy;
- ukukhula - lesi sifo sivame kakhulu kubantu abade abanezinzwa zesisu ezinde.
I-Asymmetric motor proximal neuropathy iqala ngokungacacile noma ngokunqenqemeni. Izimpawu zayo zinobuhlungu, umuzwa wokukhasa kanye nomuzwa ovuthayo phambi kwethanga nasesifundeni esingaphakathi somlenze ophansi.
Ukubonakala kwezimpawu ezinjalo akuhlotshaniswa nomsebenzi wezimoto. Kaningi kwenzeka ebusuku.
Ngemuva kwe-atrophy kanye nobuthakathaka bezicubu zomlenze nethambo le-pelvic kukhula. Ngasikhathi sinye, kunzima esigulini ukuba sigobe okhalweni, futhi ukuhlangana kweedolo lakhe kungazinzi. Kwesinye isikhathi ama-adductors we-hip, ungqimba lwezicubu zamabhuzu neqembu le-peroneal bayabandakanyeka kwinqubo ye-pathological.
Ukuba khona noma ukuqunjelwa kwe-knee Reflex ngokwehla okuncane noma ukugcinwa kwe-Achilles kukhombisa ubukhona bokuphazamiseka kwe-Reflex. Ngezikhathi ezithile, i-atrophy yemisipha kushukela likashukela ithinta izingxenye ezingaphezulu zamalungu aphezulu kanye nebhande lamahlombe.
Ubukhulu bokuphazamiseka kwemizwa kuncane. Imvamisa, i-pathology ithola umlingiswa we-asymmetric. Kulokhu, akukho zimpawu zokulimala kwabaqhuba umgogodla.
Endabeni ye-proximal diabetesic neuropathy, ukuzwela imvamisa akuyona into ephazamisekile. Ngokuyisisekelo, izimpawu zobuhlungu ziyanyamalala emavikini angama-2-3, kepha kwezinye izimo ziphikelela kuze kube yizinyanga ezingama-6-9. I-Atrophy ne-paresis zihambisana nesiguli isikhathi esingaphezu kwenyanga.
Ngaphezu kwalokho, ngokubhekene nesizinda salezi zinkinga, ukuncipha kwesisindo okungachazwanga kungenzeka, okuyisisekelo sokuqhuba izifundo ngokuba khona kwamaqhubu amabi.
Ukuxilonga
I-amyotrophy yesifo sikashukela ingatholakala kuphela ngemuva kokuhlolwa okuningiliziwe kwesiguli. Ngemuva kwakho konke, ngisho ukungabi bikho kwezimpawu akusona isizathu sokukhipha ubukhona besifo.
Ukuxilongwa okunokwethenjelwa, kunconywa ukuba khona kwezilonda okungenani ezimbili zemizwa. Isibonelo, izinguquko emiphumeleni yokuhlolwa okuzimele noma izimpawu zokungasebenzi kahle ngezinga lokucashunwa emithanjeni yezinzwa.
Ukubona i-polyradiculoneuropathy yesifo sikashukela, kwenziwa izifundo eziningi zaselebhu, kufaka phakathi:
- ukuhlaziywa okujwayelekile komchamo negazi;
- izivivinyo rheumatic;
- ukutadisha kwezinto ezihambisanayo;
- I-MRI yomgogodla (i-lumbosacral);
- ukukhuthaza electroneuromyography kanye nenaliti electromyography.
Nge-amyotrophy yesifo sikashukela ku-cerebrospinal fluid, kukhuphuka ukuqina kwamaprotheni. Ngemuva kwe-EMG, ukubekwa phansi kwe-multifocal noma i-fasciculation kuqondiswe emisipha yokuqina yemikhawulo ephansi.
Futhi, i-polyradiculoneuropathy yesifo sikashukela ihlukaniswa ne-demyelinating polyneuropathy, ekhula ezigulini eziningi ezinezifo ezingamahlalakhona zesistimu ye-endocrine.
Ngalesi sifo, kanye ne-amyotrophy, izinga lamaprotheni ku-cerebrospinal fluid liyakhuphuka. Ukususa noma uqinisekise ubukhona bayo, i-electromyography iyenziwa.
Ukwelapha
Ukwelashwa kwe-atrophy yemisipha sikashukela kungahlala iminyaka emibili. Futhi ijubane lokululama lincike ngqo ekunxephezelweni kwesifo esikhona.
Izimiso eziholayo zokwelashwa okuphumelelayo kwe-neuropathy yilezi:
- ukuqapha njalo kwe-glycemia;
- ukwelashwa okubonisa izimpawu zobuhlungu;
- izinyathelo zokwelapha ze-pathogenetic.
Okokuqala, ikhambi lokwelapha i-pulse usebenzisa i-methylprednisolone, elawulwa ngaphakathi, likhonjisiwe. Ushukela wegazi uzinzwa ngokudlulisela isiguli kwi-insulin.
Ukuqeda izinhlungu ze-neuropathic, kubekwa iPregabalin (2 r. Ngosuku, i-150 mg ngayinye). Ngaphezu kwalokho, i-amitriptyline ithathwa kumthamo ophansi.
Odokotela abaningi baphawula ukuthi i-glucocorticoids iyasebenza nge-amyotrophy. Kepha lesi sifo singalashwa ngale ndlela kuphela ezinyangeni ezi-3 zokuqala zokukhula kwaso.
Uma ukwelashwa ngama-anticonvulsants ne-glucocorticoids bekungasebenzi, khona-ke kuthathelwa indawo ukuphathwa kwe-iv kwe-immunoglobulin. I-Cytostatics ne-plasmapheresis nazo zingasetshenziswa.
Ngalesi sikhathi, kubalulekile ukugcina izinga elijwayelekile le-glycemia. Lokhu kuzosiza ukunciphisa umphumela wokucindezela kwe-oxidative, kwandise umsebenzi wama-antioxidants wemvelo futhi kuthuthukiswe ukusebenza kwemizwa ye-autonomic ne-somatic nerves.
Ukwelashwa kakhulu kwe-insulin yesifo sikashukela kunciphisa ingozi ye-DPN nokuphazamiseka kwemithambo. Kepha ukwethulwa kwe-hormone ngeke kuqinisekise ukukhutshwa kwezinkinga noma ukufaka isandla ekubonakaleni kwezimpawu okubalulekile. Kodwa ukulawula okunekhono kwesifo sikashukela kuyimo ebalulekile edingekayo ekusetshenzisweni kokwelashwa kwe-pathogenetic.
Kuyaphawuleka ukuthi ukuthatha i-corticosteroids kuholela ekukhuleni kweglucose yegazi. Ngakho-ke, ukuze unciphise ubungozi be-glycemia ephezulu, kuyalulekwa ukuba udlulisele iziguli kwi-insulin.
Imvamisa ukubonakala kwe-amyotrophy yesifo sikashukela kukhuthaza ukucindezelwa kwe-oxidative. Kwenzeka nge-radicals yamahhala ngokweqile kanye nokwenza buthaka kohlelo lwe-antioxidant lomzimba.
Ngakho-ke, indima ehamba phambili ekwelashweni kwe-DPN idlalwa ngama-antioxidants - ama-ejenti anciphisa ukucindezela kwe-oxidative futhi athinte i-pathogeneis. Ngenxa yalokhu, izidakamizwa zisetshenziselwa izinhloso ze-prophylactic nezokwelapha uma kunezinkinga ezenzeka ngemuva kwesikhathi sikashukela.
Enye yezindlela ezinhle kakhulu zesifo sikashukela polyradiculoneuropathy yiAlpha Lipoic Acid. Lesi sidakamizwa sinciphisa izimpawu ezingezinhle nezinhle ze-neuropathic.
I-Thioctic acid iyi-antioxidant enamandla ye-lipophilic evimbela amandla okuya mahhala. Kufakazelwe ukuthi ukwethulwa kwe-ALA kuvimbela ukuhlanganiswa kwe-platelet, kusebenze ukuhamba kwegazi okungapheli, kukhuphula ukugcwala kwe-nitric oxide futhi kuvuse ukuhlanganiswa kwamaprotheni okushisa ukushisa. Ividiyo ekulesi sihloko izoqhubeka nesihloko sezinkinga ze-SL.
