电流感觉阈值和运动诱发电位在T2DM患者神经病变中的诊断应用

发布时间：2019-05-16 06:49

【摘要】：背景糖尿病神经病变(diabetic neuropathy,DN)是糖尿病(diabetic mellitus, DM)常见的慢性并发症,可累及中枢及周围神经系统,以后者多见。关于糖尿病周围神经病变(diabetic peripheral neuropathy, DPN)的研究,主要是基于临床神经症状、体征和神经传导速度(nerve conductionn velocity, NCV)。然而电流感觉阈值(region-current perception threshold, R-CPT)检查少见论及,有关中枢神经病变中锥体束损伤则罕有报道。本研究对T2DM患者行R-CPT、运动诱发电位(motor evoked potentials, MEP)、NCV和体感诱发电位(somatosensory evoked potential, SEP)检查,评价R-CPT和MEP在DN的诊断应用及其临床意义。目的1.应用感觉神经定量检测仪检测T2DM患者正中、尺、腓浅、腓深神经于2000Hz、 250Hz.5Hz的R-CPT,评估T2DM患者周围神经系统功能,尤其是细小神经纤维功能2.应用MEP里的中枢运动传导时间(central motor conduction time,CMCT)评估T2DM患者锥体束功能。3.探讨R-CPT和CMCT对T2DM患者DN诊断应用及其临床意义。方法1.研究对象：714例明确诊断的T2DM患者。2.研究分组：对714例T2DM患者联合测定R-CPT、NCV和SEP,以R-CPT结果分为感觉正常组(364例)和异常组(350例),根据有无症状分为有症状组(260例)和无症状组(454例)；在上述714例T2DM患者中选取166例血压控制良好无脑血管意外、癫痫和心脏病史患者加测MEP,计算出CMCT值,根据CMCT值分为正常组(136例)和异常组(30例)。3.资料收集：收集患者的性别、年龄、病程等一般情况,糖化血红蛋白(HbAlC)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等生化结果,R-CPT、MEP、NCV、SEP等检测结果和患者神经症状。4.统计分析：采用SPSS19.0进行统计分析,P0.05为差异有统计学意义。结果1以NCV为金标准,R-CPT的灵敏度为81.1%,特异度为98.9%,一致性(Kappa)为80.3%;SEP的灵敏度为95.3%,特异度为83.4%,一致性(Kappa)为71.8%。2.NCV、SEP、2000Hz、250Hz和5Hz检出异常率分别为：40.3%、25.6%、36.1%、40.8%、43.1%,NCV异常率明显高于SEP,低于250Hz和5Hz,2000Hz异常率明显低于5Hz,SEP异常率最低,且差异有统计学意义(P0.05),250Hz和5Hz之间无差异性。3.无DPN症状患者中NCV、SEP、2000Hz、250Hz和5Hz检出异常率分别为：23.3%、9.5%、25.3%、27.5%、30.4%,NCV异常率明显高于SEP,低于250HZ和5HZ,SEP异常率最低,且差异有统计学意义(P0.05)。4.上肢组2000 Hz、250 Hz和5Hz检出异常率为：17.6%、16.2%、24.5%,下肢组2000 Hz、250 Hz和5Hz检出异常率为：28.6%、34.2%、35.9%,2000Hz异常率低于250和5Hz,下肢组2000、250和5Hz异常率明显高于上肢组,差异有统计学意义(P0.05)。5.R-CPT正常组和异常组比较发现,年龄越大,病程时间越长,HbA1C越高其周围神经感觉功能异常率越高；异常组男性比例、年龄、病程、HbA1C、TC、HDL-C、 LDI-C均比正常组高,差异有统计学意义(P0.05)。6.166例患者中CMCT、R-CPT、NCV、SEP异常率分别为：18.1%(30例)、66.9%(111例)、50.0%(83例)、41.0%(68例),踝反射亢进者占3%(5例),经统计分析,异常率差异有统计学意义, (P0.05),且CMCT异常的患者其R-CPT、NCV、SEP均异常。7.左上肢、右上肢、左下肢、右下肢CMCT的异常率为：76.7%、66.7%、70.7%、96.7%,右下肢CMCT异常率明显高于双上肢和左下肢CMCT,且差异有统计学意义(P0.05)。8. CMCT正常组与异常组比较,病程时间越长,CMCT的异常率越高,异常组表现为年龄、病程、HbAlC、TG、LDL-C均高于正常组,差异有统计学意义(P0.05)。结论1.R-CPT可客观、定量诊断周围神经深、浅感觉功能异常特异性高,是对NCV检查的一种补充；DPN主要累及双下肢,以无髓鞘和细的有髓鞘感觉神经纤维为受累为主,患者年龄、病程及HbA1C是其危险因素。2.CMCT可以客观、定量的评价糖尿病中枢神经系统运动神经功能,T2DM患者锥体束功能存在异常,以下肢为重,其周围神经功能均出现异常,患者病程是其危险因素。
[Abstract]:Background Diabetic Neuropathy (DN) is a common chronic complication of diabetes (DM), which can involve the central and peripheral nervous system. The study of the diabetic peripheral neuropathy (DPN) is based on the clinical neurological symptoms, signs and nerve conduction velocity (NCV). However, the current perception threshold (R-CPT) is rare, and the damage of the pyramidal tract in the central nervous system is rarely reported. The diagnosis and clinical significance of R-CPT, motor-evoked potential (MEP), NCV and somatosensory evoked potential (SEP) in patients with T2DM were studied in this study. Objective 1. The sensory nerve quantitative detector was used to detect the R-CPT of median, ulnar, sural and sural nerve at 2000 Hz,250 Hz and 5 Hz in patients with T2DM, and to evaluate the function of peripheral nervous system in patients with T2DM, especially the function of fine nerve fiber 2. In the application of MEP, central motor-conduction time (CMCT) was used to evaluate the function of pyramidal tract in patients with T2DM. To investigate the clinical significance of R-CPT and CMCT in the diagnosis of DN in patients with T2DM. Method 1. Study object:714 patients with T2DM clearly diagnosed.2. Study group: The results of R-CPT, NCV and SEP in 714 patients with T2DM were divided into normal group (364 cases) and abnormal group (350 cases) according to the results of R-CPT, and the symptoms were divided into symptomatic group (260 cases) and asymptomatic group (454 cases) according to the presence or absence of symptoms. In the above 714 patients with T2DM,166 patients with T2DM had good blood pressure control, and MEP was added to the patients with history of epilepsy and heart disease. The CMCT value was calculated and divided into the normal group (136 cases) and the abnormal group (30 cases) according to the CMCT value. Data collection: collect the biochemical results such as sex, age and course of the patient, such as glycosylated hemoglobin (HbAlC), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), R-CPT, MEP, NCV, SEP and other test results and patient neurological symptoms. Statistical analysis: The statistical analysis was performed using SPSS19.0, and the difference was significant between P0.05. Results 1 With the NCV as the gold standard, the sensitivity of R-CPT was 81.1%, the specificity was 98.9%, the consistency (Kappa) was 80.3%, the sensitivity of SEP was 95.3%, the specificity was 83.4%, the consistency (Kappa) was 71.8%. 43.1%, the abnormal rate of NCV was significantly higher than that of SEP, less than 250 Hz and 5 Hz, the abnormal rate of 2000 Hz was lower than 5 Hz, the abnormal rate of SEP was the lowest, and there was no difference between 250 Hz and 5 Hz. The abnormal rates of NCV, SEP, 2000Hz, 250Hz and 5Hz in patients without DPN were 23.3%, 9.5%, 25.3%, 27.5%, 30.4%, and the abnormal rate of NCV was higher than that of SEP, lower than 250HZ and 5HZ, and the abnormal rate of SEP was the lowest. The abnormal rate was 28.6%, 34.2%, 35.9%, the abnormal rate of 2000Hz was lower than 250 and 5Hz, and the abnormal rate of 2000,250 and 5Hz in lower limb group was significantly higher than that of upper limb group. The higher the age, the longer the course of the disease, the higher the abnormal rate of the peripheral nerve sensory function, the higher the proportion of the male, the age, the course of the disease, the HbA1C, the TC, the HDL-C and the LDI-C than the normal group. The abnormal rates of CMCT, R-CPT, NCV and SEP in 6.166 patients were 18.1% (30 cases), 66.9% (111 cases), 50.0% (83 cases), 41.0% (68 cases) and 3% (5 cases) of the hyperreflexia group. SEP was abnormal.7. The abnormal rate of the left upper limb, the right upper limb, the left lower limb and the right lower limb CMCT was 76.7%, 66.7%, 70.7%, 96.7%, and the abnormal rate of the right lower limb CMCT was significantly higher than that of the two upper and left lower limbs (P0.05). Compared with the abnormal group, the longer the course of the disease, the higher the abnormal rate of the CMCT, the higher the age, the course of the disease, the HbAlC, the TG and the LDL-C in the normal group, and the difference was statistically significant (P0.05). Conclusion 1.R-CPT can objectively and quantitatively diagnose the peripheral nerve deep and the abnormal specificity of the superficial sensory function is high, it is a supplement to the NCV examination; the DPN mainly involves the double lower limbs, and is mainly affected by the non-medullary and fine pulpious sensory nerve fibers, and the patient's age, The course of the disease and HbA1C are the risk factors.2. The CMCT can objectively and quantitatively evaluate the motor nerve function of the central nervous system of the diabetes mellitus. The function of the cone-body beam in the patients with T2DM is abnormal, and the function of the peripheral nerves of the patients with T2DM is abnormal, and the course of the patient is the risk factor.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

【参考文献】