糖尿病周围神经病肌电图检查与临床分析

Analysis of electromyography examination in patients with type Ⅱ diabetes mellitus and its clinical relating factors

目的研究Ⅱ型糖尿病周围神经病神经电生理检查与临床相关因素的关系。方法使用肌电图仪检测神经传导速度和肌电图,使用自动生化分析仪测定血糖、血脂,对110例Ⅱ型糖尿病患者据神经电生理检测结果分为神经传导速度(NCV)阳性组,和NCV阴性组,与正常对照组60例进行相关因素分析,比较Ⅱ型糖尿病亚组与年龄、病程、血糖、血脂,是否患高血压的关系。结果Ⅱ型糖尿病患者运动神经传导速度(MCV),感觉神经传导速度(SCV)、波幅、潜伏期与健康人比较存在明显差异(P<0.05),有周围神经症状者更显著(P<0.01)。Ⅱ型糖尿病患者NCV阳性组和NCV阴性组之间年龄和病程存在显著差异(P<0.01和P<0.001),两组间血脂、血糖水平、是否患高血压无明显差异。SCV均值全低于正常,MCV均值在正常范围,SCV与MCV之间有显著差异(P<0.05)。病程越长,NCV的变化越明显。感觉神经与运动神经的受损程度之间密切相关,各条神经NCV之间存在显著相关性。NCV阳性组中8例肌电图异常(12%),均有明显临床表现,且与临床症状正相关。110例病人中单纯正中神经损害8例(7.27%),损害部位均为腕部,较文献报道腕管综合征的发病率2.54%高。结论在Ⅱ型糖尿病患者中,周围神经传导速度、波幅、潜伏期和肌电图的变化及其程度与病程显著相关,与年龄有一定相关性,而与血糖血脂水平、是否患高血压无相关性,感觉神经与运动神经的受损程度之间密切相关。糖尿病单纯正中神经腕部损害率明显高于一般人群。肌电图检查对糖尿病周围神经病早期诊断有重要价值。

Objective To study the relationship between electromyogram examination in patients with type Ⅱ diabetes mellitus and its clinical relating factors. Methods Using Dantec Keypoint to measure nerve conduction velocity （NCV） and electromyography （EMG） . Using BAYER 7150 Hitachi full automatic biochemical analyzer to measure blood glucose and lipids. A total of 110 type Ⅱ diabetic patients were divided into two groups as NCV-positive group and NCV-negative group according to the results of NCV. 60 normal health controls were included. Relating factors such as course of disease, age, blood glucose, blood lipids and blood pressure were contrasted in patients and controls. Results There was a significant difference of NCV between patients and controls （P 〈 0.05） . An obvious difference of age and disease course was noted between NCV-positive and NCV-negative groups （P 〈 0.01, P 〈 0.001） . No obvious difference of blood glucose and blood lipids level was found between the two groups. In NCV-positive group, the average value of SCV was less than the normal value. The MCV was normal and significant difference was observed between SCV and MCV （P 〈 0.05） .The longer the disease course, the more obvious the changes of NCV. A close correlation was noted between the degree of sensory nerve damage and motor nerve damage. In the NCV-positive group, eight patients with abnormal EMG change were found with obvious clinical peripheral nerve symptoms.Among the 110 patients, 8 （7.27%） had simple carpal tunnel syndrome （CTS） . Conclusion The changes of peripheral nerve conduction velocity, amplitude, potential and EMG are correlated with the course of disease significantly. It has certain correlation with ages, but has not correlated with the level of blood glucose, blood lipid and blood pressure. A close correlation is noted between the degree of sensory nerve damage and motor nerve damage. The rate of CTS in patients is higher than that of average people. Electromyography examination plays an important role in the diagnosis of diabetic peripheral neuropathy in early stage.