2型糖尿病周围神经病变和步态、平衡能力的关系研究

发布时间：2018-05-19 12:42

本文选题：型糖尿病 + 周围神经病变　；参考：《重庆医科大学学报》2017年03期

【摘要】：目的:探讨2型糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)与步态、平衡能力的关系。方法:收集年龄匹配住院2型糖尿病患者108例,根据DPN症状、体征和神经传导速度(nerve conduct velocity,NCV)分为3组。A组:无DPN症状体征和NCV异常,共35例;B组:无DPN症状体征但有NCV异常,共34例;C组:有症状体征和NCV异常,共39例。分析比较组间步态和平衡能力参数以及与NCV的关系。结果:(1)3组糖化血红蛋白水平依次增高[(8.01±2.13)vs.(9.10±1.83)vs.(9.25±2.19)](P㩳0.05),C组糖尿病视网膜病变明显高于其余2组(20.0%vs.14.7%vs.41.0%)(P㩳0.05)。(2)C组步速身高比明显低于其余2组[(0.49±0.14)vs.(0.52±0.10)vs.(0.44±0.11)](P㩳0.05),其他步态参数均无统计学差异。(3)无论睁眼还是闭眼,C组身体前后摇摆幅度均明显高于A组。在睁眼时,C组踝关节前后摇摆幅度明显高于A组[(1.10±0.41)vs.(1.26±0.52)vs.(1.46±0.62)](P㩳0.05),C组踝关节摇摆指数明显高于其余2组[(0.15±0.06)vs.(0.16±0.07)vs.(0.19±0.09)](P㩳0.05)。在闭眼时,C组髋关节摇摆区域明显高于其余2组[(1.21±0.74)vs.(1.31±0.81)vs.(2.36±0.78)](P㩳0.05);C组髋关节摇摆指数明显高于A组[(0.22±0.08)vs.(0.22±0.06)vs.(0.29±0.15)](P㩳0.05)。(4)3组患者闭眼身体摇摆率均明显高于睁眼,软地身体摇摆率明显高于硬地。改良感觉整合平衡测试提示,软地时无论睁眼还是闭眼,C组身体摇摆率明显高于A组。结论:中老年2型糖尿病合并临床显性周围神经病变可降身体平衡稳定性,踝关节和髋关节代偿策略可改善这种减弱以保持稳定。因此,采用新型监测技术为进一步干预防治提供依据,可能是早期预防跌倒的关键。
[Abstract]:Aim: to investigate the relationship between diabetic peripheral neuropathy (DPN) and gait and balance ability in type 2 diabetic peripheral neuropathy. Methods: one hundred and eight age-matched patients with type 2 diabetes mellitus were divided into three groups according to the symptoms, signs and nerve conduction velocity of nerve conduct velocity.A group was divided into three groups: no DPN symptoms and signs and abnormal NCV, and 35 patients in group B had no DPN symptoms and signs but had NCV abnormalities. In group C, there were 39 cases with symptoms and signs and abnormal NCV. Gait and balance ability parameters and their relationship with NCV were analyzed and compared. Results the level of glycosylated hemoglobin increased in turn [8.01 卤2.13)vs.(9.10 卤1.83)vs.(9.25 卤2.19] the diabetic retinopathy in group C was significantly higher than that in the other two groups (20.0vs.14.7vs.41.0) compared with the other two groups. The ratio of step velocity to height was significantly lower in group C than that in the other two groups [0.49 卤0.14)vs.(0.52 卤0.10)vs.(0.44 卤0.11], and there was no significant difference in other gait parameters. The amplitude of swaying in group C was significantly higher than that in group A. The rocking amplitude of ankle joint in group C was significantly higher than that in group A [1.10 卤0.41)vs.(1.26 卤0.52)vs.(1.46 卤0.62]. The rocking index of ankle joint in group C was significantly higher than that in group C [0.15 卤0.06)vs.(0.16 卤0.07)vs.(0.19 卤0.09], and that in group C was significantly higher than that in group A [0.15 卤0.06)vs.(0.16 卤0.07)vs.(0.19 卤0.09]. The rocking area of hip joint in group C was significantly higher than that in group A [1.21 卤0.74)vs.(1.31 卤0.81)vs.(2.36 卤0.78], group C was significantly higher than group A [0.22 卤0.08)vs.(0.22 卤0.06)vs.(0.29 卤0.15] when eyes closed. The rate of body swaying in soft ground was significantly higher than that in group A (P < 0.05 卤0.06)vs.(0.29 卤0.15), and the swaying rate of soft ground was significantly higher than that of hard ground. The improved sensory integration balance test showed that the body swaying rate of group C was significantly higher than that of group A when eyes were open or eyes closed. Conclusion: senile type 2 diabetes mellitus with clinical dominant peripheral neuropathy can reduce the stability of body balance. The compensatory strategy of ankle and hip joint can improve this weakening to maintain stability. Therefore, the use of new monitoring techniques for further intervention and prevention may be the key to early prevention of falls.
【作者单位】：第三军医大学西南医院内分泌科;重庆市急救医疗中心/重庆市第四人民医院内分泌肾内科;
【基金】：重庆市社会民生科技创新专项资助项目(编号:cstc2016shmszx130072)
【分类号】：R587.2

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