糖尿病前期患者周围神经的电诊断学研究

发布时间：2018-07-09 18:11

本文选题：葡糖耐受不良 + 神经纤维　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的：通过神经传导(NCS)、皮肤交感反应(SSR)和接触性热痛诱发电位(CHEP)三种电生理方法评价糖耐量异常(IGT)和早期糖尿病(eDM)患者周围神经大小纤维的功能状态,以期探讨IGT者周围神经功能损害特点。方法：选取eDM患者100例,IGT者50例,健康对照者50例,应用Keypoint. net(Medoc Ltd)肌电图仪对受试者行右侧正中神经、尺神经、胫后神经、腓总神经NCS检测及四肢SSR检测,测定电生理参数包括运动末端潜伏期(DML)、复合肌肉动作电位波幅(CMAP)、感觉神经传导速度(SCV)、感觉神经动作电位的波幅(SNAP)、SSR波幅、SSR起始潜伏期等；应用CHEP刺激器,刺激受试者右侧前臂、小腿皮肤,于Cz点记录N波潜伏期及N-P波波幅。结果： 1.IGT组和对照组NCS结果比较：IGT组和对照组正中神经、尺神经、胫后神经、腓总神经的DML、CMAP、SCV、SNAP差异均无统计学意义(P0.05)。 2.eDM组中经NCS检测有32例异常,将NCS正常的68例纳入DM-NCN组。IGT组、DM-NCN组和对照组SSR结果比较：IGT组和对照组比较,IGT组下肢SSR波幅减低,差异有统计学意义(P0.05)；上肢SSR波幅及上、下肢SSR潜伏期差异均无统计学意义(P0.05)；DM-NCN组和对照组比较,DM-NCN组上、下肢SSR波幅减低,差异均有统计学意义(P0.05)；下肢SSR潜伏期延长,差异有统计学意义(P0.05)；上肢SSR潜伏期差异无统计学意义(P0.05)。IGT组和DM-NCN组上、下肢SSR潜伏期、波幅差异均无统计学意义(P0.05)。 3.IGT组、DM-NCN组和对照组CHEP结果比较：IGT组和对照组比较,IGT组CHEP前臂和小腿刺激点N-P波波幅减低,差异均有统计学意义(均P0.05)；两组前臂刺激点、小腿刺激点N波潜伏期差异无统计学意义(P0.05)；DM-NCN组和对照组比较,DM-NCN组CHEP前臂和小腿刺激点N-P波波幅减低,差异均有统计学意义(均P0.05)；前臂刺激点、小腿刺激点N波潜伏期延长,差异均有统计学意义(均P0.05)；IGT组和DM-NCN组CHEP前臂刺激点、小腿刺激点N-P波波幅以及N波潜伏期差异均未见统计学意义(均P0.05)。结论： 1、IGT者存在周围神经损害,小神经纤维受累为著,下肢较上肢易受累,尚不提示周围神经大神经纤维受累证据。 2、早期糖尿病患者周围神经大、小神经纤维均可受累,下肢较上肢易受累,在周围神经大神经纤维尚未损害前可存在周围神经小神经纤维受累,提示损害首先累及小神经纤维,损害特点与IGT者相似,重于IGT者。 3、神经电生理诊断方法对于发现IGT及糖尿病阶段周围神经大小神经纤维损害具有重要价值,SSR和CHEP是对周围神经小纤维损害的重要检测方法,CHEP是比SSR更敏感的电生理方法。
[Abstract]:Objective:
The functional state of the peripheral nerve fiber in patients with impaired glucose tolerance (IGT) and early diabetes (eDM) was evaluated by three electrophysiological methods, nerve conduction (NCS), skin sympathetic response (SSR) and contact heat pain evoked potential (CHEP), in order to explore the characteristics of peripheral nerve function damage in IGT patients.
Method:
100 patients with eDM, 50 cases of IGT and 50 healthy controls were used to test the right median nerve, ulnar nerve, posterior tibial nerve, the posterior tibial nerve, the common peroneal nerve NCS detection and the extremities SSR detection by Keypoint. net (Medoc Ltd) electromyography. The electrophysiological parameters including the terminal latent period (DML), the complex muscle action potential amplitude (CMAP), and the sensory nerve were measured. The conduction velocity (SCV), the amplitude (SNAP) of the sensorineural action potential (SNAP), the amplitude of SSR, the initial incubation period of the SSR, and so on; the CHEP stimulator was used to stimulate the right forearm, the calf skin, and the N wave latency and N-P wave amplitude at Cz point.
Result:
The results of NCS in group 1.IGT and control group were compared: there was no significant difference between group IGT and control group with median nerve, ulnar nerve, posterior tibial nerve, DML of peroneal nerve, CMAP, SCV, and SNAP (P0.05).
In group 2.eDM, 32 cases were detected by NCS, and 68 cases of normal NCS were included in group.IGT of group DM-NCN. The results of SSR in group DM-NCN and control group were compared. Compared with the control group, the amplitude of SSR wave in the lower extremities decreased in the group IGT and the difference was statistically significant (P0.05). Compared with group DM-NCN, the SSR amplitude of lower extremities decreased, the difference was statistically significant (P0.05), and the latency of lower extremity SSR prolonged, the difference was statistically significant (P0.05); there was no statistical significance (P0.05).IGT group and DM-NCN group in the upper limb SSR latency (P0.05), and there was no statistical significance (P0.05) in the latency period of lower extremity SSR.
3.IGT group, DM-NCN group and control group CHEP results: IGT group and control group, IGT group CHEP forearm and leg stimulation point N-P wave amplitude decreased, the difference was statistically significant (all P0.05); two groups of forearm stimulation point, the leg stimulation point N wave latency difference was not statistically significant (P0.05); DM-NCN group and control group, DM-NCN group forearm The amplitude of N-P wave in the stimulating point of the calf decreased, the difference was statistically significant (P0.05), and the latency of the forearm stimulation point and the N wave of the leg stimulation was prolonged, the difference was statistically significant (P0.05), and there was no significant difference between the CHEP forearm stimulation points, the N-P wave amplitude of the calf stimulation point and the N wave latency (all P0.05) in the IGT and DM-NCN groups.
Conclusion:
1, there were peripheral nerve damage in IGT patients. Small nerve fibers were involved. The lower extremities were more easily affected than the upper limbs.
2, the peripheral nerve of the early diabetic patients is large, the small nerve fiber can be involved, the lower limb is more susceptible to the upper limb, and the peripheral nerve fibers may be involved before the nerve fibers of the peripheral nerve are not damaged. It is suggested that the damage first involve the small nerve fibers. The damage characteristics are similar to those of the IGT, which is heavier than the IGT.
3, the method of electrophysiological diagnosis is of great value for the detection of nerve fiber damage around IGT and diabetic peripheral nerve. SSR and CHEP are important detection methods for the damage of small peripheral nerve fibers. CHEP is a more sensitive electrophysiological method than SSR.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R745

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