电流感觉阈值检测对糖尿病患者大小纤维损害的对比性研究

发布时间：2019-06-22 18:57

【摘要】：目的2型糖尿病周围神经病变可以有小神经纤维和（或）大神经纤维受累，但Aδ类细有髓神经纤维和C类无髓鞘神经纤维比Aβ类粗有髓神经纤维受损更常见,NeurometerCPT/C神经测量检测仪可反映细小神经纤维的功能，本研究应用该仪器对早期无周围神经受损症状的糖尿病患者感觉神经进行检测，在不同参数的条件下分析神经纤维受损的情况。方法选取我院内分泌科确诊为2型糖尿病（T2DM）的住院患者共76例，测定双侧正中神经、腓肠神经在2000Hz、250Hz、5Hz电流下的电流感觉阈值（CPT），分析患者的CPT值属于感觉过敏，感觉正常或感觉减退，分析其阳性率及各频率间相互关系。详细记录糖尿病患者的各项临床指标，，并分析病程及糖化血红蛋白、空腹血糖值等与CPT值的关系。结果左侧正中神经在2000Hz、250Hz和5Hz电流下阳性率分别为27.6%、48.7%、34.2%；右侧正中神经在2000Hz、250Hz和5Hz电流下阳性率分别为32.9%、55.3%、40.8%；左侧腓肠神经在2000Hz、250Hz和5Hz电流下阳性率分别为36.8%、55.3%、38.2%；右侧腓肠神经在2000Hz、250Hz和5Hz电流下阳性率分别为46.1%、65.8%、47.4%。同侧正中神经和腓肠神经同频率下CPT值相比存在统计学意义（P0.01）。同侧正中神经及腓肠神经同频率下CPT值与对侧相比差异无统计学意义（P0.05）。双侧正中神经和腓肠神经均以250Hz电流下神经敏感性高于5Hz电流下神经敏感性，并高于2000Hz电流下神经敏感性，差异具有统计学意义（P0.05）。病程越长，CPT值越高，且差异存在统计学意义（P0.05）；糖化血红异常组较正常组CPT值明显增高，差异存在统计学意义（P0.05）；空腹血糖异常组较正常组CPT值增高，差异存在统计学意义（P0.05）。结论该研究验证得出糖尿病周围神经损害以对称性损害为主，双下肢受累为主，以无髓和有髓小纤维神经为主，病程及高血糖是糖尿病周围神经病神经损害的重要危险因素，该检测方法为糖尿病周围神经病变的小纤维神经损害提供了一种新的客观定量评价手段，弥补了周围神经传统检查技术的不足，具有潜在的临床应用前景，也可作为治疗及预后观察的客观指标，使临床早期诊断糖尿病周围神经病并监测治疗结果和病变演变情况成为可能。
[Abstract]:Objective Type 2 diabetic peripheral neuropathy can have small nerve fibers and / or large nerve fibers involved, but A 未 fine myelinated nerve fibers and C class unmyelinated nerve fibers are more common than A 尾 crude myelinated nerve fibers. NeurometerCPT/C nerve measurement instrument can reflect the function of small nerve fibers. In this study, this instrument was used to detect the sensory nerves of diabetic patients without symptoms of early peripheral nerve injury. The damage of nerve fibers was analyzed under different parameters. Methods 76 inpatients with type 2 diabetes mellitus (T2DM) diagnosed in Endocrinology Department of our hospital were selected to determine the current sensory threshold of sural nerve at 2000Hz, 250Hz and 5Hz current. (CPT), analysis showed that the CPT value of the patients was allergic, normal or hyposensory. The positive rate and the relationship between the positive rate and each frequency were analyzed. The clinical indexes of diabetic patients were recorded in detail, and the relationship between the course of disease, glycosylated hemoglobin, fasting blood glucose and CPT was analyzed. Results the positive rates of left median nerve under 2000Hz, 250Hz and 5Hz current were 27.6%, 48.7%, 34.2%, 32.9%, 55.3% and 40.8%, respectively, and the positive rate of left sural nerve was 36.8%, 55.3% and 38.2% respectively at 2000Hz, 250Hz and 5Hz current, respectively. The positive rates of right sural nerve under 2000Hz, 250Hz and 5Hz currents were 46.1%, 65.8% and 47.4%, respectively. There was significant difference in CPT between ipsilateral median nerve and sural nerve at the same frequency (P 0.01). There was no significant difference in CPT value between ipsilateral median nerve and sural nerve at the same frequency between ipsilateral median nerve and sural nerve (P 0.05). The nerve sensitivity of bilateral median nerve and sural nerve under 250Hz current was higher than that under 5Hz current and higher than that under 2000Hz current, the difference was statistically significant (P 0.05). The longer the course of disease, the higher the CPT value, and the difference was statistically significant (P 0.05). The CPT value in the glycosylated blood red abnormal group was significantly higher than that in the normal group (P 0.05), and the CPT value in the abnormal fasting blood glucose group was significantly higher than that in the normal group (P 0.05). Conclusion the main risk factors of diabetic peripheral nerve damage are symmetrical damage, bilateral lower extremity involvement, unmyelinated and myelinated small fiber nerve. The course of disease and hyperglycemia are the important risk factors of diabetic peripheral neuropathy. This method provides a new objective quantitative evaluation method for diabetic peripheral neuropathy and makes up for the shortcomings of traditional peripheral nerve examination techniques. It has potential clinical application prospect and can also be used as an objective index of treatment and prognosis observation, which makes it possible to diagnose diabetic peripheral neuropathy in the early stage and monitor the treatment results and pathological changes.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R745

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