糖调节受损及糖尿病患者周围神经的电生理评价
发布时间：2019-01-09 10:44
【摘要】：目的:应用神经电生理方法评价糖调节受损(Impaired glucose regulation,IGR)及糖尿病(diabetes mellitus,DM)患者的周围神经功能状态,为IGR患者神经损害的早期诊断提供可靠信息,并分析糖尿病及糖调节受损患者的神经电生理表现及相关危险因素。方法:选取2015年3月至2016年3月就诊于我院的IGR患者92例,DM患者68例,选择年龄性别相匹配的来我院进行体检的健康人36名为对照,对所有受试者均行密歇根神经病变筛查(Michigan Neuropathy Screening Instrument,MNSI)量表评分及体格检查并应用Keypoint.net肌电图检测仪器进行正中神经、尺神经、胫后神经、腓总神经常规神经传导(Nerve conduction studies,NCS),四肢交感皮肤反应(Sympathetic skin response,SSR)检测,应用运动单位数目估计(motor unit number estimation,MUNE)检测法计数小鱼际肌及趾短伸肌运动单位数目。结果:1、IGR组与对照组患者相比,双下肢SSR波幅减低分别为[0.55±0.54mv与0.75±0.34,p0.05],正中神经运动传导末端潜伏期延长[3.33±0.59ms与3.00±0.56ms,p0.05],感觉传导指1/3 SNAP波幅减低[20.69±8.61uv与25.51±10.48uv/13.46±6.56uv与17.64±7.09uv,p0.05],速度减慢[50.58±8.29m/s与54.41±7.24m/s/54.22±4.63m/s与57.69±7.01m/s],余尺神经、胫后神经、腓总神经感觉运动传导差异无统计学意义(p0.05)。2、DM组与对照组患者相比较,四肢SSR波幅减低,双下肢SSR潜伏期延长,差异有统计学意义(p0.05);正中神经指1/3、尺神经、胫后神经、腓总神经SNAP波幅减低,CMAP波幅下降(p0.05);并伴有正中神经感觉传导,速度指1/3减慢,运动传导末端潜伏期延长,均具有统计学差异(p0.05);小鱼际肌及趾短伸肌运动单位数目下降分别为104.98±32.66与152.31±46.33,72.63±24.17与95.43±23.88,差异具有统计学意义p0.05。3、DM组与IGR组患者相比,双下肢SSR潜伏期延长[1956±321ms与1851±254ms,p0.05],波幅减低[0.36±0.50mv与0.55±0.54mv,p0.05];正中神经、尺神经、胫后神经、腓总神经SNAP减低,胫后神经及腓总神经CMAP波幅下降,小鱼际肌与趾短伸肌运动单位数目减少,均有统计学差异(p0.05)。4、与正常对照组比较,IGR组患者临床症状(疼痛,麻木,烧灼感),踝反射、大脚趾振动觉及单丝压力觉减弱或缺失的比例较高,差异具有统计学意义(p0.05)。与IGR组比较,DM组患者踝反射、大脚趾振动觉及单丝压力觉减弱或缺失的比例更高(p0.05),在其他方面未见统计学差异。5、应用Logistic回归对IGR相关性神经病变的危险因素进行筛查分析,结果发现BMI、静脉血甘油三酯、低密度脂蛋白水平升高是IGR相关神经病变的危险因素。结论:IGR患者存在周围神经损害,主要累及下肢小纤维神经,随病情进展加重为糖尿病,大纤维也可受累,以轴索损害为主,下肢重于上肢。肥胖和血脂异常是IGR性神经病变的危险因素。
[Abstract]:Objective: to evaluate the peripheral nerve function in patients with impaired glucose regulation (Impaired glucose regulation,IGR) and diabetes mellitus (diabetes mellitus,DM) by neuroelectrophysiological method, and to provide reliable information for the early diagnosis of nerve damage in IGR patients. The electrophysiological manifestations and related risk factors of diabetes mellitus and impaired glucose regulation were analyzed. Methods: 92 patients with IGR and 68 patients with DM were selected from March 2015 to March 2016 in our hospital. The median nerve, ulnar nerve, posterior tibial nerve were measured by Keypoint.net electromyography. Common peroneal nerve (Nerve conduction studies,NCS), sympathetic skin reaction (Sympathetic skin response,SSR) of extremities and motor unit number (motor unit number estimation,MUNE) were used to count motor units in hypothenar muscles and extensor digitorum brevis. Results: 1 compared with the control group, the amplitude of SSR in both lower extremities was decreased [0.55 卤0.54mv vs 0.75 卤0.34 p0.05], and the latency of motor conduction of median nerve was prolonged [3.33 卤0.59ms and 3.00 卤0.56ms, respectively]. The amplitude of 1 / 3 SNAP of sensory conduction finger decreased [20.69 卤8.61uv vs 25.51 卤10.48uv/13.46 卤6.56uv vs 17.64 卤7.09uvanp0.05]. The velocities slowed down [50.58 卤8.29m/s vs 54.41 卤7.24m/s/54.22 卤4.63m/s vs 57.69 卤7.01m/s]. There was no significant difference in sensory motor conduction between the ulnar nerve, the posterior tibial nerve and the common peroneal nerve (p0.05). Compared with the control group, the amplitude of SSR was decreased and the latency of lower extremity SSR was prolonged in DM group (p0.05). The median nerve finger 1 / 3, ulnar nerve, posterior tibial nerve, common peroneal nerve SNAP amplitude decreased, CMAP wave amplitude decreased (p0.05); The sensory conduction of the median nerve was accompanied by a decrease of 1 / 3 of the velocity index and the prolongation of the terminal latency of motor conduction (p0.05). The number of motor units in the hypothenar muscles and extensor digitorum brevis decreased by 104.98 卤32.66 and 152.31 卤46.33, 72.63 卤24.17 and 95.43 卤23.88, respectively. The difference was statistically significant between the DM group and the IGR group. The latency of SSR in both lower limbs was prolonged [1956 卤321ms vs 1851 卤254 Ms p0.05], and the amplitude decreased [0.36 卤0.50mv vs 0.55 卤0.54 mvp0.05]. The SNAP of median nerve, ulnar nerve, posterior tibial nerve, common peroneal nerve decreased, the amplitude of CMAP of posterior tibial nerve and common peroneal nerve decreased, and the number of motor units of hypothenar muscle and extensor digitorum brevis decreased (p0.05). Compared with the normal control group, the clinical symptoms (pain, numbness, burning sensation), ankle reflex, big toe vibration and monofilament pressure in IGR group were significantly decreased or absent (p0.05). Compared with IGR group, the proportion of malleolus reflex, big toe vibration sensation and monofilament pressure perception in DM group was decreased or missing (p0.05), but there was no statistical difference in other aspects. 5. Logistic regression was used to screen and analyze the risk factors of IGR related neuropathy. The results showed that the elevated level of triglyceride and low density lipoprotein (LDL) in venous blood of BMI, was the risk factor of IGR related neuropathy. Conclusion: there is peripheral nerve damage in patients with IGR, mainly involving the small fibrous nerve of lower extremity. With the progression of the disease, it is diabetes mellitus, and the large fiber can also be involved. The axonal injury is the main lesion, and the lower extremity is more serious than the upper limb. Obesity and dyslipidemia are risk factors for IGR neuropathy.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
本文编号：2405518
[Abstract]:Objective: to evaluate the peripheral nerve function in patients with impaired glucose regulation (Impaired glucose regulation,IGR) and diabetes mellitus (diabetes mellitus,DM) by neuroelectrophysiological method, and to provide reliable information for the early diagnosis of nerve damage in IGR patients. The electrophysiological manifestations and related risk factors of diabetes mellitus and impaired glucose regulation were analyzed. Methods: 92 patients with IGR and 68 patients with DM were selected from March 2015 to March 2016 in our hospital. The median nerve, ulnar nerve, posterior tibial nerve were measured by Keypoint.net electromyography. Common peroneal nerve (Nerve conduction studies,NCS), sympathetic skin reaction (Sympathetic skin response,SSR) of extremities and motor unit number (motor unit number estimation,MUNE) were used to count motor units in hypothenar muscles and extensor digitorum brevis. Results: 1 compared with the control group, the amplitude of SSR in both lower extremities was decreased [0.55 卤0.54mv vs 0.75 卤0.34 p0.05], and the latency of motor conduction of median nerve was prolonged [3.33 卤0.59ms and 3.00 卤0.56ms, respectively]. The amplitude of 1 / 3 SNAP of sensory conduction finger decreased [20.69 卤8.61uv vs 25.51 卤10.48uv/13.46 卤6.56uv vs 17.64 卤7.09uvanp0.05]. The velocities slowed down [50.58 卤8.29m/s vs 54.41 卤7.24m/s/54.22 卤4.63m/s vs 57.69 卤7.01m/s]. There was no significant difference in sensory motor conduction between the ulnar nerve, the posterior tibial nerve and the common peroneal nerve (p0.05). Compared with the control group, the amplitude of SSR was decreased and the latency of lower extremity SSR was prolonged in DM group (p0.05). The median nerve finger 1 / 3, ulnar nerve, posterior tibial nerve, common peroneal nerve SNAP amplitude decreased, CMAP wave amplitude decreased (p0.05); The sensory conduction of the median nerve was accompanied by a decrease of 1 / 3 of the velocity index and the prolongation of the terminal latency of motor conduction (p0.05). The number of motor units in the hypothenar muscles and extensor digitorum brevis decreased by 104.98 卤32.66 and 152.31 卤46.33, 72.63 卤24.17 and 95.43 卤23.88, respectively. The difference was statistically significant between the DM group and the IGR group. The latency of SSR in both lower limbs was prolonged [1956 卤321ms vs 1851 卤254 Ms p0.05], and the amplitude decreased [0.36 卤0.50mv vs 0.55 卤0.54 mvp0.05]. The SNAP of median nerve, ulnar nerve, posterior tibial nerve, common peroneal nerve decreased, the amplitude of CMAP of posterior tibial nerve and common peroneal nerve decreased, and the number of motor units of hypothenar muscle and extensor digitorum brevis decreased (p0.05). Compared with the normal control group, the clinical symptoms (pain, numbness, burning sensation), ankle reflex, big toe vibration and monofilament pressure in IGR group were significantly decreased or absent (p0.05). Compared with IGR group, the proportion of malleolus reflex, big toe vibration sensation and monofilament pressure perception in DM group was decreased or missing (p0.05), but there was no statistical difference in other aspects. 5. Logistic regression was used to screen and analyze the risk factors of IGR related neuropathy. The results showed that the elevated level of triglyceride and low density lipoprotein (LDL) in venous blood of BMI, was the risk factor of IGR related neuropathy. Conclusion: there is peripheral nerve damage in patients with IGR, mainly involving the small fibrous nerve of lower extremity. With the progression of the disease, it is diabetes mellitus, and the large fiber can also be involved. The axonal injury is the main lesion, and the lower extremity is more serious than the upper limb. Obesity and dyslipidemia are risk factors for IGR neuropathy.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
【参考文献】
相关期刊论文 前10条
1 陈明月;蔡慧敏;陈江云;张宁;王蕊;;糖尿病合并腕管综合征患者神经传导速度的分析[J];中华内分泌代谢杂志;2016年04期
2 张云茜;杨晓平;罗丽华;刘姚;王建林;;皮肤交感反应早期诊断糖尿病周围神经病的价值分析[J];临床荟萃;2014年06期
3 赵蕾;崔丽英;;小纤维神经病诊断方法进展[J];中华神经科杂志;2012年12期
4 薛春燕;邵加庆;陆成伟;吴艳;丁丽丽;黄振平;;角膜激光共焦显微镜对糖尿病周围神经病变的早期诊断[J];中国糖尿病杂志;2010年09期
5 李兆妍;张哲成;刘娜;王渝;朱炬;张静;;糖尿病感觉神经病患者的运动单位数目估计[J];中华神经科杂志;2010年02期
6 沈琴;贾伟平;包玉倩;陆俊茜;陆惠娟;左玉华;杜颉;吴晓岭;顾惠琳;项坤三;;上海社区糖尿病及糖调节受损人群周围神经病变的横断面调查[J];上海医学;2009年05期
7 崔丽英;重视糖尿病周围神经病的诊治[J];中华老年医学杂志;2005年07期
8 刘明生,胡蓓蕾,崔丽英,汤晓芙,杜华,李本红;糖尿病周围神经病700例临床与神经电生理分析[J];中华内科杂志;2005年03期
9 栾松,崔丽英;糖尿病性周围神经病发病机制和电生理研究进展[J];临床神经电生理学杂志;2005年01期
10 贾志荣,石昕,黄一宁,孙相如;皮肤交感反应在糖尿病周围神经病早期诊断中的价值[J];中华神经科杂志;2003年03期
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