交感皮肤反应在诊断糖尿病小纤维神经病中的意义

Significance of sympathetic skin response in diagnosis diabetic small fiber neuropathy

目的探讨交感皮肤反应（SSR）在诊断糖尿病小纤维神经病中的意义。方法对主诉有感觉异常但神经传导检查正常的38例糖尿病患者及30名健康人四肢进行SSR检查，并分析、比较SSR潜伏期。结果38例患者的患肢中，37肢SSR潜伏期延长，21肢SSR未引出，94肢SSR正常。健康对照组30名（120肢）均引出SSR。患者组双上肢、双下肢SSR起始潜伏期、N波潜伏期、P波潜伏期明显长于健康对照组，差异有统计学意义（P〈0．05）。根据健康对照组SSR检查结果建立正常值，患者上肢SSR异常率38％，下肢异常率51％，下肢异常率高于上肢，但差异无统计学意义（P〉0．05）。38例患者中有28例至少有一肢SSR异常，异常率为74％（28／38）。结论SSR检查可发现糖尿病周围神经病小纤维功能异常．为糖尿病小纤维神绎病的诊断提供了客观依据和有效手段。

Objective To investigate the significance of sympathetic skin response （SSR） in the diagnosis of diabetic small fiber neuropathy. Methods 38 diabetic patients with paraesthesia and 30 healthy controls underwent SSR test on the 4 limbs. The latencies of the initiation and waves N and P of SSR were analyzed. The results of nerve conduction velocities of these patients with paraesthesia were normal. Results The latencies of the initiation and waves N or P in SSR were prolonged in 37 limbs of the 38 patients, and there was no SSR response in 21 limbs. The latencies of the initiation and waves N and P of SSR test in both upper extremity and lower extremities were prolonged significantly in the diabetic patients as compared to the controls （all P 〈 0. 05）. The frequency of abnormality in the latency of SSR was 51% in the lower extremities, and 38% in the upper extremities. The frequency of abnormal latency of SSR in the lower extremities was higher, however, not significantly, than that in the upper extremities （ P 〉 0.05）. Twentyeight of the 38 patients （74%） demonstrated abnormal SSR in at least one limbs. Conclusion SSR can be used to detect the early dysfunction of the small fibers in diabetic peripheral neuropathy, especially in the diabetic patients with normal nerve conduction velocities. SSR test may be a useful and sensitive neuroelectrophysiologic testing for the early diagnosis of diabetic small fiber neuropathy.