糖尿病と自己免疫性ニューロパチー

Diabetes Mellitus and Autoimmune Neuropathy

糖尿病性末梢性ニューロパチーは，全身性と局所性・多巣性に大別される。全身性の定型的な病型が高血糖による代謝異常や虚血と関連するのに対し，腰仙部，胸部，頸部に起こる糖尿病性神経根・神経叢ニューロパチー（DRPN）は，炎症または免疫異常に関連する病態が想定され，免疫療法の有効性が報告されている。他方，糖尿病では慢性炎症性脱髄性多発根ニューロパチーを比較的高頻度に併発する（DM-CIDP）。DRPNやDM-CIDPなどの治療可能な病型を理解し，糖尿病性感覚運動性多発ニューロパチーと鑑別することが臨床上重要である。

Abstract

The term "diabetic neuropathy" refers to many varieties of neuropathies, including diabetic peripheral neuropathies (DPNs).　DPNs are categorized into generalized and focal/multifocal varieties.　Diabetic sensorimotor polyneuropathy (DSPN) and diabetic autonomic neuropathy (DAN) are typical DPNs, and their development is clearly linked to hyperglycemia and subsequent metabolic and ischemic change.　On the other hand, other forms of neuropathy, including multifocal diabetic neuropathies (e.g., lumbosacral, thoracic, and cervical radiculoplexus neuropathies) are thought to be associated with inflammatory or immune processes.　Diabetic patients can also develop chronic inflammatory demyelinating polyneuropathy (CIDP).　CIDP in diabetic patients (DM-CIDP) should be ruled out, especially in patients with advanced DSPN.　Recently, it was reported that diabetic radiculoplexus neuropathies as well as CIDP respond favorably to immunotherapy.　Thus, these immune-mediated diabetic neuropathies are treatable, and should be differentiated from advanced DSPN.