1型糖尿病患者周围神经病变及认知功能损害临床特点

发布时间：2018-05-07 13:52

本文选题：神经传导速度 + 电流感觉阈值　；参考：《苏州大学》2015年博士论文

【摘要】：第一部分1型糖尿病患者的周围神经病变特点及危险因素目的糖尿病周围神经病变(DPN)是糖尿病最常见的并发症之一,是糖尿病患者致残、致死的主要原因。DPN可累及不同直径的感觉运动神经纤维,小神经纤维受损比大神经纤维更常见。Neurometer CPT/C神经定量检测仪可反映细小神经纤维的功能。本研究应用神经传导速度和Neurometer CPT/C两种检测工具分析1型糖尿病患者的周围神经病变特点及其相关危险因素,为1型糖尿病患者DPN的早期诊断治疗提供依据。方法选取我院内分泌科确诊为1型糖尿病(T1DM)的住院和门诊患者70例,我院体检中心体检的健康人48例,行四肢神经传导速度和CPT检查,CPT包括双侧正中神经、腓肠神经在2000Hz、250Hz、5Hz电流频率刺激下的电流感觉阈值。对1型糖尿病患者进行神经症状及神经缺陷评分,并详细记录糖尿病患者的各项临床指标。比较1型糖尿病组和健康对照组在三个电流频率下的CPT值,并详细分析糖尿病患者CPT的变化特点及各频率各肢体CPT值间的相互关系,探讨影响DPN的相关危险因素。结果和正常对照组相比,1型糖尿病组在三个电流频率刺激下的CPT值均降低。以CPT值为标准,67例(95.7%)患者存在周围神经功能异常。同侧下肢腓肠神经功能异常率高于上肢正中神经(P0.001),除左侧肢体250Hz电流频率刺激下的CPT值外,其余电流频率刺激下的CPT值同侧下肢腓肠神经低于上肢正中神经(P0.05)。上肢正中神经在250及5Hz电流频率刺激下更易出现感觉减退,下肢腓肠神经在3个电流频率刺激下更易出现感觉过敏。左下肢在5Hz频率刺激下神经功能异常的发生率更高(P=0.001)。双侧正中神经异常率比较,在2000Hz时右侧异常率大于左侧(P=0.035),而双侧腓肠神经功能异常率比较发现在250Hz和5Hz时左侧神经功能异常率大于右侧(P=0.001,0.001),两组CPT值比较发现在5Hz时左侧腓肠神经CPT值小于右侧(P=0.040)。提示上肢神经中右侧Aβ粗有髓鞘神经纤维更易受损,下肢神经中左侧Aδ细有髓鞘和C类无髓鞘神经纤维更易受损。以神经传导速度异常与否为因变量进行logistic回归,结果发现病程、NDS评分和右正中神经2000Hz频率下CPT值是神经传导速度异常的危险因素。结论1型糖尿病周围神经损害以双下肢受累为主,以无髓和有髓小神经纤维为主,左右侧上下肢神经纤维损伤的特点不同,上肢神经更易出现感觉减退,下肢神经更易出现感觉过敏。病程、NDS评分和右正中神经2000Hz电流刺激的CPT值是神经传导速度异常的危险因素。CPT为DPN的小纤维神经损伤提供了一种新的客观定量评价手段,可与传统神经传导速度检测联合应用,能更全面、更早期评价1型糖尿病DPN的病变特点。第二部分1型糖尿病患者认知功能损害临床特点及危险因素目的糖尿病对认知功能的影响越来越引起人们的广泛重视,已有大量文献证实2型糖尿病与认知功能损害有关。而1型糖尿病患者认知功能的改变及影响因素的作用目前报道不一致。本研究应用MMSE、Mo CA等量表比较1型糖尿病患者和正常人群认知功能的差异,并详细分析1型糖尿病患者认知功能受损的情况及其相关危险因素。方法选取我院内分泌科确诊为TIDM的住院及门诊患者70例,在我院体检中心体检的健康人48例,对所有患者进行MMSE和Mo CA量表的评价,比较两组认知功能的差异,详细分析1型糖尿病患者认知功能受损的情况。详细记录糖尿病患者的各项临床指标,并探讨影响1型糖尿病患者认知功能的相关危险因素。结果1型糖尿病组Mo CA量表测试的异常率高于正常对照组(40.0%vs.11.1%,P=0.001)。MMSE和Mo CA量表的得分,1型糖尿病组均低于正常对照组(29.1±1.2vs.28.3±1.9,P=0.007;27.1±2.3 vs.25.8±2.9,P=0.006)。进一步分析受损认知域发现,MMSE量表中定向力和语言能力得分1型糖尿病组小于正常对照组(9.57±0.84vs.9.87±0.39,P0.001;8.55±0.65 vs.8.81±0.39,P0.001);Mo CA量表中视空间与执行功能、记忆力、语言功能、抽象思维和计算力得分,1型糖尿病组均低于正常对照组(4.27±0.92 vs.4.56±0.68,P=0.001;2.90±1.51 vs.3.75±1.27,P0.001;4.57±0.93vs.5.31±0.80,P=0.002;1.50±0.71 vs.1.74±0.56,P=0.001;2.81±0.63 vs.2.96±0.20,P=0.002)。以Mo CA得分为标准判断患者是否存在认知功能障碍,logistic回归显示患者年龄、C肽、文化程度和神经传导速度异常是患者发生认知障碍的危险因素(P=0.029,0.017,0.027,0.048)。结论T1DM成年患者存在认知功能减退,主要表现在记忆力、语言能力、抽象思维、计算力和视空间与执行功能方面。Mo CA量表可作为T1DM患者认知功能评价的主要筛查工具。糖尿病患者的年龄、C肽水平、文化程度和周围神经病变均对认知功能损害有重要影响。
[Abstract]:Partial diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (diabetic peripheral neuropathy). It is the main cause of diabetes in patients with diabetes. The main cause of death is that.DPN can involve the sensory motor nerve fibers of different diameters, and the damage of small nerve fibers is more common than that of the large nerve fibers. The Neurometer CPT/C nerve quantitative detector can reflect the function of the fine nerve fibers. In this study, the characteristics of peripheral neuropathy and related risk factors of type 1 diabetic patients were analyzed by two kinds of detection tools of nerve conduction velocity and Neurometer CPT/C, which provided the basis for the early diagnosis and treatment of DPN in type 1 diabetic patients. The Department of endocrinology was diagnosed as type 1 diabetes mellitus (T1DM) in 70 cases of hospitalization and outpatients. 48 healthy people were examined in the physical examination center of our hospital. The nerve conduction velocity and CPT examination were performed. CPT included bilateral median nerve and gastrocnemius nerve under 2000Hz, 250Hz, 5Hz current frequency stimulation. The neurological deficit score and the detailed records of the clinical indexes of diabetic patients were recorded. The CPT values of type 1 diabetes and healthy controls at three current frequencies were compared, and the changes of CPT in diabetic patients and the relationship between the frequencies of each limb CPT were analyzed in detail, and the related risk factors of DPN were discussed. Results and normal controls were also discussed. In the group of type 1 diabetes, the CPT value decreased with three current frequency stimuli. In the CPT value, 67 cases (95.7%) had abnormal peripheral nerve function. The rate of abnormal sural nerve function of the lower extremities was higher than that of the upper middle median nerve (P0.001), except the CPT value of the left limb 250Hz current frequency stimulation, and the other current frequency stimulated by the frequency stimulation. The CPT value of the lower extremity was lower than the median nerve of the upper limb (P0.05). The median nerve of the upper limb was more susceptible to hyposensory stimulation under the 250 and 5Hz current frequency stimulation, and the lower extremity gastrocnemius was more susceptible to hypersensitivity under the 3 current frequency stimuli. The incidence of abnormal nerve function under the 5Hz frequency stimulation of the left lower extremities was higher (P=0.001). Bilateral median The abnormal rate of nerve abnormality was greater than that on the left side (P=0.035) at 2000Hz, while the abnormal rate of bilateral sural nerve function was higher than that on the right (P=0.001,0.001) at 250Hz and 5Hz. The two group CPT value found that the CPT value of the left gastrocnemius was less than the right (P=0.040) at 5Hz, suggesting the right side A of the upper limb nerve. The myelin nerve fibers were more vulnerable to beta myelin fibers. The left A delta of the lower extremity was more vulnerable to myelin myelin and C non myelinated nerve fibers. Logistic regression was used as a dependent variable for abnormal nerve conduction velocity. The outcome was found in the course of the disease, and the CPT value of the right median nerve 2000Hz was a risk factor for the abnormal conduction velocity of nerve conduction. Conclusion 1 The peripheral nerve damage of type 2 diabetes is mainly affected by double lower limbs, mainly with unmyelinated and myelinated small nerve fibers, and the characteristics of nerve fiber damage in the left and right lower limbs are different. The upper limb nerve is more susceptible to sensory degeneration, and the lower extremity nerve is more susceptible to hypersensitivity. The course of disease, the NDS score and the CPT value of the right median nerve 2000Hz current stimulation are nerve conduction. .CPT, a risk factor for velocity abnormalities, provides a new objective quantitative evaluation method for the small fiber nerve injury of DPN. It can be combined with traditional nerve conduction velocity detection. It can be more comprehensive and more early evaluation of the pathological features of type 1 diabetes DPN. The clinical characteristics and risk factors of cognitive impairment in type 1 diabetes patients are in the second part. The effect of diabetes on cognitive function has attracted more and more attention. A large number of literatures have proved that type 2 diabetes is related to cognitive impairment. The changes of cognitive function and influence factors in type 1 diabetic patients are not consistent. This study compared type 1 diabetes and normal people with MMSE, Mo CA isometric scale. The cognitive function difference and the related risk factors of cognitive function in type 1 diabetes patients were analyzed in detail. Methods 70 cases of hospitalized and outpatient patients with TIDM in Department of endocrinology in our hospital were selected and 48 healthy people were examined in the physical examination center of our hospital. All patients were evaluated by MMSE and Mo CA scale, and the cognitive function was compared. A detailed analysis of the impairment of cognitive function in type 1 diabetic patients. A detailed record of various clinical indicators of diabetic patients and related risk factors affecting cognitive function of type 1 diabetic patients were discussed. Results the abnormal rate of the Mo CA scale test in type 1 diabetes was higher than that of the normal control group (40.0%vs.11.1%, P=0.001).MMSE and Mo CA The score of the type 1 diabetes group was lower than that of the normal control group (29.1 + 1.2vs.28.3 + 1.9, P=0.007; 27.1 + 2.3 vs.25.8 + 2.9, P=0.006). Further analysis of the impaired cognitive domain was found that the orientation and language ability score of type 1 diabetes group in the MMSE scale was less than that of the normal control group (9.57 + 0.84vs.9.87 + 0.39, P0.001; 8.55 + 0.65 vs.8.81 + 0.39, P0.001); M. The visual space and executive function, memory, language function, abstract thinking and computing power score in the o CA scale were lower than that of the normal control group (4.27 + 0.92 vs.4.56 + 0.68, P=0.001; 2.90 + 1.51 vs.3.75 + 1.27, P0.001; 4.57 + 0.93vs.5.31 + 0.80, P=0.002; 1.50 + 0.71 vs.1.74 + 0.56, P=0.001; 2.81 + vs.2.96 + P=0.002). Mo CA scores were used to determine whether patients had cognitive impairment. Logistic regression showed that patients' age, C peptide, educational level, and abnormal nerve conduction velocity were risk factors for cognitive impairment (P=0.029,0.017,0.027,0.048). Conclusion T1DM adult patients were characterized by cognitive impairment, mainly in memory and language ability. The.Mo CA scale of abstract thinking, computational power, visual space and executive function can be used as the main screening tool for the evaluation of cognitive function in T1DM patients. The age, C peptide level, educational level, and peripheral neuropathy of diabetic patients have important effects on cognitive impairment.

【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R587.2

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