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糖尿病神经病变 - 版本历史
2026-04-20T19:06:45Z
本wiki的该页面的版本历史
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2026年1月3日 (六) 01:03 77921020
2026-01-03T01:03:27Z
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<a href="https://www.yiliao.com/index.php?title=%E7%B3%96%E5%B0%BF%E7%97%85%E7%A5%9E%E7%BB%8F%E7%97%85%E5%8F%98&diff=312436&oldid=312435">显示更改</a>
77921020
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2026年1月3日 (六) 01:00 77921020
2026-01-03T01:00:56Z
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<table class="diff diff-contentalign-left diff-editfont-monospace" data-mw="interface">
<col class="diff-marker" />
<col class="diff-content" />
<col class="diff-marker" />
<col class="diff-content" />
<tr class="diff-title" lang="zh-Hans-CN">
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">←上一版本</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">2026年1月3日 (六) 01:00的版本</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l66" >第66行：</td>
<td colspan="2" class="diff-lineno">第66行：</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; white-space: nowrap;">多元醇通路激活<br>(Polyol Pathway)</td></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; white-space: nowrap;">多元醇通路激活<br>(Polyol Pathway)</td></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1;<del class="diffchange diffchange-inline">font-weight: </del>600; white-space: nowrap;"></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1;600; white-space: nowrap;"></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 高糖状态下，<strong>[[醛糖还原酶]]</strong>被激活，将葡萄糖转化为山梨醇。山梨醇在神经细胞内堆积，消耗 [[NADPH]]。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 高糖状态下，<strong>[[醛糖还原酶]]</strong>被激活，将葡萄糖转化为山梨醇。山梨醇在神经细胞内堆积，消耗 [[NADPH]]。</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td></tr>
</table>
77921020
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2026年1月3日 (六) 00:59 77921020
2026-01-03T00:59:04Z
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<table class="diff diff-contentalign-left diff-editfont-monospace" data-mw="interface">
<col class="diff-marker" />
<col class="diff-content" />
<col class="diff-marker" />
<col class="diff-content" />
<tr class="diff-title" lang="zh-Hans-CN">
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">←上一版本</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">2026年1月3日 (六) 00:59的版本</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l69" >第69行：</td>
<td colspan="2" class="diff-lineno">第69行：</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 高糖状态下，<strong>[[醛糖还原酶]]</strong>被激活，将葡萄糖转化为山梨醇。山梨醇在神经细胞内堆积，消耗 [[NADPH]]。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 高糖状态下，<strong>[[醛糖还原酶]]</strong>被激活，将葡萄糖转化为山梨醇。山梨醇在神经细胞内堆积，消耗 [[NADPH]]。</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1<del class="diffchange diffchange-inline">;font-weight: 600</del>; white-space: nowrap;"></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1;white-space: nowrap;"></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 引起细胞内高渗肿胀；NADPH 耗竭导致 [[谷胱甘肽]] 减少，削弱抗氧化能力。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 引起细胞内高渗肿胀；NADPH 耗竭导致 [[谷胱甘肽]] 减少，削弱抗氧化能力。</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </tr></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </tr></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1<del class="diffchange diffchange-inline">; font-weight: 600</del>; white-space: nowrap;">终末糖基化<br>(AGEs)</td></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1; white-space: nowrap;">终末糖基化<br>(AGEs)</td></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1;"></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1;"></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 蛋白质与葡萄糖发生非酶促反应，形成 <strong>[[AGEs]]</strong>。AGEs 与受体 RAGE 结合，激活 NF-κB 炎症通路。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 蛋白质与葡萄糖发生非酶促反应，形成 <strong>[[AGEs]]</strong>。AGEs 与受体 RAGE 结合，激活 NF-κB 炎症通路。</div></td></tr>
</table>
77921020
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2026年1月3日 (六) 00:56 77921020
2026-01-03T00:56:50Z
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<table class="diff diff-contentalign-left diff-editfont-monospace" data-mw="interface">
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<col class="diff-marker" />
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">←上一版本</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">2026年1月3日 (六) 00:56的版本</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l61" >第61行：</td>
<td colspan="2" class="diff-lineno">第61行：</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr style="background-color: #f8fafc; border-bottom: 2px solid #0f172a;"></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr style="background-color: #f8fafc; border-bottom: 2px solid #0f172a;"></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 20%; white-space: nowrap;">机制维度</th></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 20%; white-space: nowrap;">机制维度</th></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af; width: <del class="diffchange diffchange-inline">45</del>%;">具体过程</th></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af; width: <ins class="diffchange diffchange-inline">40</ins>%;">具体过程</th></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">病理后果</th></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">病理后果</th></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </tr></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </tr></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <tr></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; white-space: nowrap;">多元醇通路激活<br>(Polyol Pathway)</td></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; white-space: nowrap;">多元醇通路激活<br>(Polyol Pathway)</td></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1;"></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1<ins class="diffchange diffchange-inline">;font-weight: 600; white-space: nowrap</ins>;"></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 高糖状态下，<strong>[[醛糖还原酶]]</strong>被激活，将葡萄糖转化为山梨醇。山梨醇在神经细胞内堆积，消耗 [[NADPH]]。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 高糖状态下，<strong>[[醛糖还原酶]]</strong>被激活，将葡萄糖转化为山梨醇。山梨醇在神经细胞内堆积，消耗 [[NADPH]]。</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1;"></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> <td style="padding: 10px; border: 1px solid #cbd5e1<ins class="diffchange diffchange-inline">;font-weight: 600; white-space: nowrap</ins>;"></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 引起细胞内高渗肿胀；NADPH 耗竭导致 [[谷胱甘肽]] 减少，削弱抗氧化能力。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> 引起细胞内高渗肿胀；NADPH 耗竭导致 [[谷胱甘肽]] 减少，削弱抗氧化能力。</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div> </td></div></td></tr>
</table>
77921020
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2026年1月3日 (六) 00:49 77921020
2026-01-03T00:49:28Z
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77921020
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77921020：建立内容为“<div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff…”的新页面
2026-01-03T00:47:42Z
<p>建立内容为“<div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff…”的新页面</p>
<p><b>新页面</b></p><div><div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff; max-width: 1200px; margin: auto;"><br />
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<div style="margin-bottom: 20px;"><br />
<h1 style="margin: 0 0 20px 0; color: #0f172a; font-size: 1.8em;">糖尿病神经病变</h1><br />
<p style="font-size: 1.1em; margin: 10px 0; color: #334155; text-align: justify;"><br />
<strong>糖尿病神经病变</strong>（Diabetic Neuropathy, <strong>DN</strong>）是糖尿病最常见的慢性并发症之一，涉及周围神经和自主神经系统。长期的高血糖会导致神经纤维的代谢紊乱和微血管损伤（神经营养血管缺血），进而引起神经结构和功能的丧失。临床表现极具异质性，最常见的是<strong>[[远端对称性多发性神经病变]]</strong>（表现为手脚麻木、疼痛），以及<strong>[[糖尿病自主神经病变]]</strong>（表现为心律失常、胃轻瘫等）。约 50% 的糖尿病患者在病程中会发生某种形式的神经病变，这也是导致<strong>[[糖尿病足]]</strong>溃疡和非创伤性截肢的主要原因。<br />
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<div style="background-color: #f8f9fa; border: 1px solid #a2a9b1; display: inline-block; padding: 12px 30px 12px 15px; margin-bottom: 35px; border-radius: 4px; min-width: 200px;"><br />
<div style="font-weight: bold; text-align: center; margin-bottom: 8px; color: #0f172a; border-bottom: 1px solid #e2e8f0; padding-bottom: 5px;">目录</div><br />
<ul style="list-style: none; padding: 0; margin: 0; font-size: 0.9em; line-height: 1.8; color: #1e40af;"><br />
<li><a href="#infobox" style="text-decoration: none; color: #1e40af;">1. 基本信息 (Infobox)</a></li><br />
<li><a href="#mech" style="text-decoration: none; color: #1e40af;">2. 致病机制：代谢与血管</a></li><br />
<li><a href="#class" style="text-decoration: none; color: #1e40af;">3. 临床分型与症状</a></li><br />
<li><a href="#manage" style="text-decoration: none; color: #1e40af;">4. 诊断与治疗策略</a></li><br />
<li><a href="#ref" style="text-decoration: none; color: #1e40af;">5. 学术参考文献</a></li><br />
<li><a href="#kg" style="text-decoration: none; color: #1e40af;">6. 知识图谱</a></li><br />
</ul><br />
</div><br />
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<div id="infobox" class="medical-infobox mw-collapsible mw-collapsed" style="width: 320px; margin: 0 auto 35px auto; border: 1.2px solid #bae6fd; border-radius: 12px; background-color: #ffffff; box-shadow: 0 8px 20px rgba(0,0,0,0.05); overflow: hidden;"><br />
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<div style="padding: 15px; color: #1e40af; background: linear-gradient(135deg, #e0f2fe 0%, #bae6fd 100%); text-align: center; cursor: pointer;"><br />
<div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">糖尿病神经病变</div><br />
<div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">Diabetic Neuropathy (点击展开)</div><br />
</div><br />
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<div class="mw-collapsible-content"><br />
<div style="padding: 25px; text-align: center; background-color: #f8fafc;"><br />
<div style="display: inline-block; background: #ffffff; border: 1px solid #e2e8f0; border-radius: 12px; padding: 20px; box-shadow: 0 4px 10px rgba(0,0,0,0.04);"><br />
[[Image:Diabetic_Neuropathy_Nerve_Damage.png|100px|神经纤维受损示意图]]<br />
</div><br />
<div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">高血糖导致的神经损伤</div><br />
</div><br />
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<table style="width: 100%; border-spacing: 0; border-collapse: collapse; font-size: 0.85em;"><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 40%; white-space: nowrap;">ICD-10编码</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">E11.4 (2型)</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; white-space: nowrap;">所属科室</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[内分泌科]], [[神经内科]]</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; white-space: nowrap;">核心病因</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #b91c1c;">长期高血糖, 氧化应激</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; white-space: nowrap;">一线药物</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[普瑞巴林]], [[度洛西汀]]</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; white-space: nowrap;">主要风险</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #b91c1c;">[[糖尿病足]], [[截肢]]</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; white-space: nowrap;">筛查工具</th><br />
<td style="padding: 6px 12px; color: #1e40af;">10g单丝检测, 振动阈值</td><br />
</tr><br />
</table><br />
</div><br />
</div><br />
<br />
<h2 id="mech" style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">致病机制：代谢与血管的双重打击</h2><br />
<br />
<p style="margin: 15px 0;">高血糖对神经的损伤是多因素的，核心在于“葡萄糖毒性”引起的代谢紊乱和微循环障碍。</p><br />
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<div style="overflow-x: auto; margin: 20px auto; width: 100%;"><br />
<table style="width: 100%; border-collapse: collapse; border: 1px solid #cbd5e1; font-size: 0.95em; text-align: left;"><br />
<tr style="background-color: #f8fafc; border-bottom: 2px solid #0f172a;"><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; width: 20%; color: #0f172a;">机制维度</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; width: 45%; color: #1e40af;">具体过程</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">病理后果</th><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">多元醇通路激活<br>(Polyol Pathway)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
高糖状态下，<strong>[[醛糖还原酶]]</strong>被激活，将葡萄糖转化为山梨醇。山梨醇在神经细胞内堆积，消耗 [[NADPH]]。<br />
</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
引起细胞内高渗肿胀；NADPH 耗竭导致 [[谷胱甘肽]] 减少，削弱抗氧化能力。<br />
</td><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">终末糖基化<br>(AGEs)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
蛋白质与葡萄糖发生非酶促反应，形成 <strong>[[AGEs]]</strong>。AGEs 与受体 RAGE 结合，激活 NF-κB 炎症通路。<br />
</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
导致神经内膜微血管硬化，减少神经血供，引起神经脱髓鞘。<br />
</td><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">微血管缺血<br>(Ischemia)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
滋养神经的微血管（Vasa Nervorum）发生基底膜增厚和内皮功能障碍，一氧化氮 (NO) 合成减少。<br />
</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
神经纤维处于<strong>缺氧</strong>状态，能量代谢衰竭，导致轴突变性和神经传导速度减慢。<br />
</td><br />
</tr><br />
</table><br />
</div><br />
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<h2 id="class" style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">临床分型与症状</h2><br />
<br />
<p style="margin: 15px 0;">糖尿病神经病变的表现形式多样，最常见的是 DSPN，但最危险的往往是隐匿的自主神经病变。</p><br />
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<div style="overflow-x: auto; margin: 20px auto; width: 100%;"><br />
<table style="width: 100%; border-collapse: collapse; border: 1px solid #cbd5e1; font-size: 0.95em; text-align: left;"><br />
<tr style="background-color: #f8fafc; border-bottom: 2px solid #0f172a;"><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; width: 25%; color: #0f172a;">类型</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; width: 40%; color: #1e40af;">典型症状</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">特征描述</th><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">远端对称性多发性神经病变<br>(DSPN)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
• 感觉异常：麻木、蚁走感、烧灼痛。<br><br />
• 感觉丧失：对温度、疼痛、震动无知觉。<br><br />
• 夜间加重。<br />
</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
呈<strong>“手套-袜套”</strong>样分布（Stocking-glove pattern）。从脚趾开始向上发展，是糖尿病足溃疡的主要风险因素。<br />
</td><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">糖尿病自主神经病变<br>(DAN)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
• 心血管：静息心率快、体位性低血压。<br><br />
• 胃肠道：<strong>[[胃轻瘫]]</strong> (恶心/早饱)、便秘/腹泻。<br><br />
• 泌尿生殖：尿潴留、勃起功能障碍 (ED)。<br />
</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
常被忽视，但增加了无痛性心肌梗死和猝死的风险（心脏自主神经病变）。<br />
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</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">局灶性神经病变<br>(Mononeuropathy)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
• 腕管综合征 (正中神经)。<br><br />
• 动眼神经麻痹 (眼睑下垂、复视)。<br />
</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><br />
起病急，通常有自限性，但在糖尿病患者中更常见。<br />
</td><br />
</tr><br />
</table><br />
</div><br />
<br />
<h2 id="manage" style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">诊断与治疗策略</h2><br />
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<div style="margin-bottom: 25px; border: 1px solid #e2e8f0; border-radius: 8px; padding: 20px; background-color: #f8fafc;"><br />
<h3 style="margin-top: 0; color: #1e40af; font-size: 1.1em; border-bottom: 1px solid #e2e8f0; padding-bottom: 10px;">治疗原则</h3><br />
<p style="text-align: justify; color: #334155; font-size: 0.95em;"><br />
目前尚无 FDA 批准的能逆转神经损伤的药物。治疗主要分为三步：<br />
<br>1. <strong>病因治疗</strong>：严格控制血糖是基础，可能延缓病情进展。<br />
<br>2. <strong>对因治疗（机制性）</strong>：使用抗氧化剂（如[[硫辛酸]]）或醛糖还原酶抑制剂（如[[依帕司他]]）改善神经代谢。<br />
<br>3. <strong>对症治疗（止痛）</strong>：缓解神经痛，改善生活质量。<br />
</p><br />
</div><br />
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<div style="overflow-x: auto; margin: 20px auto; width: 100%;"><br />
<table style="width: 100%; border-collapse: collapse; border: 1px solid #cbd5e1; font-size: 0.95em; text-align: left;"><br />
<tr style="background-color: #f8fafc; border-bottom: 2px solid #0f172a;"><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; width: 20%;">药物类别</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; width: 30%;">代表药物</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1;">作用与建议</th><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">一线止痛药</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;">[[普瑞巴林]] (Pregabalin)<br>[[度洛西汀]] (Duloxetine)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;"><strong>ADA 指南推荐首选</strong>。普瑞巴林调节钙通道；度洛西汀抑制 5-HT/NE 再摄取。需注意嗜睡、头晕副作用。</td><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">神经营养药</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;">[[甲钴胺]] (Mecobalamin)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;">活性维生素 B12，促进髓鞘修复。在中国和日本广泛应用。</td><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">抗氧化剂</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;">[[α-硫辛酸]] (ALA)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;">强效抗氧化剂，能改善神经血流和传导速度。部分国家批准用于治疗 DSPN。</td><br />
</tr><br />
<tr><br />
<td style="padding: 12px; border: 1px solid #cbd5e1; font-weight: bold;">酶抑制剂</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;">[[依帕司他]] (Epalrestat)</td><br />
<td style="padding: 12px; border: 1px solid #cbd5e1;">醛糖还原酶抑制剂，阻断多元醇通路。主要在亚洲国家使用。</td><br />
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<span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评</span><br />
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[1] <strong>Pop-Busui R, et al. (2017).</strong> <em>Diabetic Neuropathy: A Position Statement by the American Diabetes Association.</em> <strong>[[Diabetes Care]]</strong>. 2017;40(1):136-154.<br><br />
<span style="color: #475569;">[学术点评]：权威指南。ADA 发布的关于糖尿病神经病变分类、诊断和治疗的官方立场声明，确立了普瑞巴林和度洛西汀的一线地位。</span><br />
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[2] <strong>Feldman EL, et al. (2019).</strong> <em>Diabetic neuropathy.</em> <strong>[[Nature Reviews Disease Primers]]</strong>. 2019;5(1):41.<br><br />
<span style="color: #475569;">[学术点评]：综述巅峰。全面解析了从分子发病机制（氧化应激、线粒体功能障碍）到临床管理的最新进展，强调了生活方式干预的重要性。</span><br />
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[3] <strong>Tesfaye S, et al. (2010).</strong> <em>Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments.</em> <strong>[[Diabetes Care]]</strong>. 2010;33(10):2285-2293.<br><br />
<span style="color: #475569;">[学术点评]：多伦多共识。专家组对糖尿病神经病变的定义和分级进行了标准化，是临床试验设计的重要参考。</span><br />
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糖尿病神经病变 · 知识图谱<br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">上游疾病</td><br />
<td style="padding: 10px 15px; color: #334155;">[[2型糖尿病]] • [[1型糖尿病]] • [[代谢综合征]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">常用药物</td><br />
<td style="padding: 10px 15px; color: #334155;">[[普瑞巴林]] • [[度洛西汀]] • [[甲钴胺]] • [[硫辛酸]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">主要并发症</td><br />
<td style="padding: 10px 15px; color: #334155;">[[糖尿病足]] (溃疡/坏疽) • [[夏科氏关节]] • [[无痛性心梗]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">检查项目</td><br />
<td style="padding: 10px 15px; color: #334155;">[[肌电图]] (NCS) • [[单丝检测]] • [[神经活检]]</td><br />
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