糖尿病性周围神经病的定量感觉检查

Application of quantitative sensory test in patients with diabetic peripheral neuropathy

目的:探讨定量感觉检查(QST)对糖尿病性周围神经病(DPN)诊断的临床应用价值。方法:应用QST仪检测118名正常人与136例DPN病人的冷觉(CS)、热觉(WS)和振动觉(VS)阈值及神经传导速度(NCV)。结果:DPN组和单纯糖尿病(DM)组与正常对照组比较,手指和足背QST的CS、WS、VS阈值差异均有统计学意义(P<0．05)。DPN组和单纯DM组之间比较,手指和足背CS、WS、VS阈值差异也有统计学意义(P<0．05)。DPN组和单纯DM组之间比较手指和足背不同部位的CS、WS、VS阈值差异均有显著意义(P<0．05)。DPN组CS、WS、VS的异常率高于运动神经传导速度(MCV)、感觉神经传导速度(SCV)的异常率(P<0．05),CS、WS的异常率高于VS的异常率(P<0．05); DPN组患者的MCV、SCV．CS、WS和VS异常牢均高于单纯DM组的异常率,其间差异有显著意义(P <0．01);病程>5年组的MCV、SCV、CS、WS和VS的异常率均高于病程≤5年组的异常率,其间差异亦有显著意义(P<0．01);HbAIC正常组和HBAIC异常组MCV、SCV、CS、WS和VS异常率之间比较差异均无统计学意义(P>0．05)。结论:QST能为DPN的早期诊断提供可靠依据,是常规NCV检查的必要补充。

Objective:To explore the early diagnostic value of quantitative sensory testing (QST) in patients with diabetic peripheral neuropathy(DPN). Methods: The nerve conduction velocity( NCV) and QST were examined in 136 diabetic patients and 118 normal controls , and their results were compared. Results: Significant difference was found in the thresholds of cool sense(CS), warm sense(WS), and vibration sense(VS) of both fingers and feet when tested among normal controls, diabetic patients with PNPCDPN. 60 cases)and diabetic patients without PNP(pure diabetes mellitus, DM,76 cases) (P< 0. 05). The abnormality rates of CS .WS and VS were higher than that of MCV and SCV (P<0. 05) in diabetic patients with DPN or pure DM. The abnormality rates of CS. WS were higher than that of VS (P <0. 05 ). The abnormality rates of CS. WS, VS. MCV and SCV in patients with DPN were higher than those in patients with pure DM(P<0. 05 ). The abnormality rales of CS,WS,VS,MCV and SCV in all diabetic patients were related to the duration and not related to glucose levels. Conclusions: QST is more sensitive than NCV in diagnosing DPN. Thermal testing is more abnormal than vibratory testing and NCV, which suggests that small nerve fibers are more vulnerable than large fibers.