166例健康人电流感觉阈值正常值研究
发布时间：2018-08-18 15:24
【摘要】：背景：皮肤内感觉神经纤维根据其粗细程度常被分为三类：粗有髓(Aβ)纤维(直径5-15gm)、细有髓(Aδ)纤维(直径1-41μm)、无髓(C)纤维(直径0.5-1.5μm)。随着多种检查方法和检测仪器的出现,可以实现对不同感觉神经纤维的定量检测,电流感觉阈值(current perception threshold, CPT)测试便是其中的一种检测手段。CPT检测仪通过皮肤表面电极向人体发出电刺激,可以测定身体一个或多个部位的感觉神经兴奋阈值,这一阈值我们用CPT来表示,它的定义为持续引起感觉的最小电刺激强度。检测仪可以发放三种不同频率的电流刺激,选择性刺激不同的感觉神经纤维亚群：5Hz测试无髓纤维,250Hz测试细有髓纤维,2000Hz测试粗有髓纤维。目前,基于中国人群大样本研究建立的CPT临床正常值较为少见,且性别、年龄等因素对检测结果的影响尚未形成统一结论。目的：对健康受试者的CPT数据进行分析,明确其影响因素,依据影响因素的不同建立适合于不同特征受试者的临床实用的CPT参考值范围。方法：本研究为前瞻性研究,作为2013-2015年期间“十二五”国家支撑计划课题“农村心脑血管病防治关键技术集成与应用示范研究”中的一部分,共收集CPT数据146例,另外以公开招募的形式招募健康志愿者20例。入组正常值研究的受试者要求无任何感觉障碍主诉及既往史,神经系统查体正常。采集的临床资料包括性别、年龄、职业、既往病史等。CPT数据采集部位为左手食指／手背和右足第一足趾,采用自动双盲CPT测试模式,分别记录每位受试者在两个部位2000Hz、250Hz、5Hz CPT值,最后进行统计分析。结果：全部受试者在2000Hz、250Hz、5Hz的CPT值(X±S),食指部位为226.8-4±63.7、100.0+34.8、57.2±21.8；手背部位为136.8±37.8、39.8±11.7、19.9±8.0；足趾部位为287.7±72.1、124.0±47.0、71.4±34.9。三种频率刺激下所得CPT值手背部位比足趾部位显著更低(p0.001),食指和足趾部位仅在2000Hz CPT值体现出显著性差异(p0.01)。影响因素分析：不同性别在2000Hz频率电流刺激下手背和足趾部位获得的CPT值表现出显著差异p0.01),男性比女性CPT值更高。年龄与250Hz频率电流刺激下食指部位p0.05)以及2000Hz频率电流刺激下手背(P0.001)和食指p0.05)部位所得CPT值呈正相关。体力劳动者相较于脑力劳动者在足趾部位250Hz频率电流刺激下所得CPT值更高(p0.01)。结论：年龄、性别及职业因素对CPT测定值有不同程度的影响,依据受试者特征建立了适用于不同情况的CPT正常值范围。
[Abstract]:Background: Intradermal sensory nerve fibers are often classified into three categories according to their thickness: coarse myelinated (A 尾) fibers (diameter 5-15gm) and fine myelinated (A 未) fibers (diameter 1-41 渭 m), unmyelinated (C) fibers (diameter 0.5-1.5 渭 m). With the emergence of various inspection methods and testing instruments, quantitative detection of different sensory nerve fibers can be realized. The current sense threshold (current perception threshold, CPT) test is one of the detection methods. CPT detector sends electrical stimulation to the human body through the skin surface electrode, which can measure the sensory nerve excitatory threshold of one or more parts of the body. This threshold is expressed in terms of CPT, which is defined as the minimum intensity of electrical stimulation that continues to cause sensation. The instrument can release three kinds of electric current stimuli with different frequencies, and selectively stimulate different sensory nerve fiber subsets: 5Hz to test unmyelinated fibers, 250Hz to fine myelinated fibers and 2000Hz to test coarse myelinated fibers. At present, the clinical normal value of CPT based on large sample study in Chinese population is relatively rare, and the influence of sex, age and other factors on the test results has not yet reached a unified conclusion. Objective: to analyze the CPT data of healthy subjects and determine the influencing factors, and establish the range of clinical CPT reference values suitable for different characteristic subjects according to the different influencing factors. Methods: this study is a prospective study. As a part of the "demonstration study on the Integration and Application of key Technologies for the Prevention and treatment of Cardiovascular and Cerebrovascular Diseases in Rural areas", a total of 146 cases of CPT data were collected. In addition, 20 healthy volunteers were recruited in the form of open recruitment. Subjects in the normal value study were asked to have no major complaints and previous history of sensory disorders and normal neurological examination. The clinical data collected included sex, age, occupation, medical history and so on. The first toe of left index finger / back of hand and right foot were collected. The data were recorded by automatic double-blind CPT test mode. Finally, statistical analysis is carried out. Results: the CPT values of all the subjects were 226.8-4 卤63.7100.0 34.8c57.2 卤21.8in the 2 000 Hz (X 卤S),) 250 Hz, 136.8 卤37.8 卤11.791 卤19.9 卤8.0 in the dorsal part of the hand, 287.7 卤72.1124.0 卤47.0 卤71.4 卤34.9in the toe. The CPT value of the dorsal part of the hand was significantly lower than that of the toe part (p0. 001), while the 2000Hz CPT value of the index finger and the toe was only significantly different (p0. 01). Analysis of influencing factors: the CPT values obtained from the dorsal and toe of the hand under 2000Hz frequency current stimulation showed significant difference (p0.01). The CPT value of male was higher than that of female. Age was positively correlated with the CPT values of the forefinger under the stimulation of 250Hz frequency current (p0.05) and that of the dorsal hand (P0.001) and the forefinger (p0.05) stimulated by the 2000Hz frequency current. The CPT value of manual workers was higher than that of mental workers stimulated by 250Hz frequency current (p0.01). Conclusion: age, sex and occupation factors have different influence on CPT. According to the characteristics of subjects, the normal range of CPT is established.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R33
[Abstract]:Background: Intradermal sensory nerve fibers are often classified into three categories according to their thickness: coarse myelinated (A 尾) fibers (diameter 5-15gm) and fine myelinated (A 未) fibers (diameter 1-41 渭 m), unmyelinated (C) fibers (diameter 0.5-1.5 渭 m). With the emergence of various inspection methods and testing instruments, quantitative detection of different sensory nerve fibers can be realized. The current sense threshold (current perception threshold, CPT) test is one of the detection methods. CPT detector sends electrical stimulation to the human body through the skin surface electrode, which can measure the sensory nerve excitatory threshold of one or more parts of the body. This threshold is expressed in terms of CPT, which is defined as the minimum intensity of electrical stimulation that continues to cause sensation. The instrument can release three kinds of electric current stimuli with different frequencies, and selectively stimulate different sensory nerve fiber subsets: 5Hz to test unmyelinated fibers, 250Hz to fine myelinated fibers and 2000Hz to test coarse myelinated fibers. At present, the clinical normal value of CPT based on large sample study in Chinese population is relatively rare, and the influence of sex, age and other factors on the test results has not yet reached a unified conclusion. Objective: to analyze the CPT data of healthy subjects and determine the influencing factors, and establish the range of clinical CPT reference values suitable for different characteristic subjects according to the different influencing factors. Methods: this study is a prospective study. As a part of the "demonstration study on the Integration and Application of key Technologies for the Prevention and treatment of Cardiovascular and Cerebrovascular Diseases in Rural areas", a total of 146 cases of CPT data were collected. In addition, 20 healthy volunteers were recruited in the form of open recruitment. Subjects in the normal value study were asked to have no major complaints and previous history of sensory disorders and normal neurological examination. The clinical data collected included sex, age, occupation, medical history and so on. The first toe of left index finger / back of hand and right foot were collected. The data were recorded by automatic double-blind CPT test mode. Finally, statistical analysis is carried out. Results: the CPT values of all the subjects were 226.8-4 卤63.7100.0 34.8c57.2 卤21.8in the 2 000 Hz (X 卤S),) 250 Hz, 136.8 卤37.8 卤11.791 卤19.9 卤8.0 in the dorsal part of the hand, 287.7 卤72.1124.0 卤47.0 卤71.4 卤34.9in the toe. The CPT value of the dorsal part of the hand was significantly lower than that of the toe part (p0. 001), while the 2000Hz CPT value of the index finger and the toe was only significantly different (p0. 01). Analysis of influencing factors: the CPT values obtained from the dorsal and toe of the hand under 2000Hz frequency current stimulation showed significant difference (p0.01). The CPT value of male was higher than that of female. Age was positively correlated with the CPT values of the forefinger under the stimulation of 250Hz frequency current (p0.05) and that of the dorsal hand (P0.001) and the forefinger (p0.05) stimulated by the 2000Hz frequency current. The CPT value of manual workers was higher than that of mental workers stimulated by 250Hz frequency current (p0.01). Conclusion: age, sex and occupation factors have different influence on CPT. According to the characteristics of subjects, the normal range of CPT is established.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R33
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