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Ⅰ.はじめに
糖尿病性神経障害は四肢末端に起こりやすいことから,“手袋,靴下型のしびれ”といわれることも多い.糖尿病性神経障害には国内外で統一された診断基準はないものの,本邦で用いられている「糖尿病性多発性神経障害の外来診断基準」をみると,特に下肢末端に両側性に症状が出やすいことが示されている(Table 1)15).一方,糖尿病患者は,末梢神経障害,循環不全などを合併するため末梢神経が脆弱となり,外的な圧迫を受けやすい部位では容易に絞扼性末梢神経障害を来すことが知られている.絞扼性末梢神経障害はcommon diseaseでありその罹患率は高く,正中神経や尺骨神経などの障害により上肢末端にしびれや痛みが生じ,腓骨神経障害や脛骨神経障害などの障害により下肢末端にしびれや痛みが生じることもあり,糖尿病性神経障害との鑑別に注意を要する10).
糖尿病性神経障害が発症した場合にはその治療は難しく,対症療法が主となってしまうが,こういった四肢末端のしびれや痛みの中に,上記のような治療可能な絞扼性末梢神経障害などが含まれている可能性も否めない.そこで今回われわれは,糖尿病患者にみられる四肢のしびれに着目し,そのしびれの原因について前向きに検討したため報告する.
Purpose:Many patients with diabetes mellitus(DM)experience numbness in the extremities. This DM neuropathy may be complicated by peripheral entrapment neuropathy. We prospectively investigated the cause(s)of limb numbness in DM patients.
Materials and Methods:We enrolled 23 patients with uni- or bilateral limb numbness who were treated in our DM clinic. They were 10 men and 13 women;their average age was 63 years. The average duration of their neurological symptoms was 28.3 months.
Results:Numbness was located in the upper limb in 7 patients, the lower limb in 11, and both the upper and lower limbs in 5. Among the 12 patients with upper-limb numbness, 9 manifested carpal tunnel syndrome and one each cervical OPLL or cervical spondylosis. Of the 16 cases of lower limb numbness, 10 were attributable to tarsal tunnel syndrome, 7 to lumbar spinal disease, 3 to restless leg syndrome, 2 to piriformis syndrome, and 1 to peroneal nerve entrapment neuropathy.
Conclusions:In 21 of the 23 patients with uni- or bilateral limb numbness, the cause was attributable to several kinds of etiology such as entrapment neuropathy. Consequently, other treatable peripheral nerve disorders, e.g. tarsal tunnel syndrome, must be considered when diagnosing DM patients with limb numbness. Our findings suggest that therapeutic intervention to address such diseases will affect the quality of life of DM patients with limb numbness.
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