神经肌电图在诊断糖尿病早期周围神经病变中的应用

Clinical application of electroneuromyogram to diagnosis of diabetic peripheral neuropathy in early stage

目的探讨几种神经肌电图检测方法在早期糖尿病患者诊断周围神经损害中的敏感指标。方法对271例不同病程糖尿病患者的正中神经、尺神经、腓浅神经、腓总神经运动神经传导速度(MCV)与感觉神经传导速度(SCV)、尺神经f波、胫神经H反射等,采用神经电生理方法进行测定。结果271例患者胫神经的H反射平均异常率为77.5%,且随着病程的增加,异常率明显增加;双下肢腓总神经MCV与腓浅神经SCV≥10年组中异常率超过40%,其他组的异常率均在20%～30%之间。本组患者中,伴腕管综合征的有37例、65侧,总检出率13.7%。综合几项神经肌电图检测方法对糖尿病周围神经病的诊断异常率,随病程延长,异常发生率逐渐增加,在<1年组中,异常发生率达63.2%;在>10年组中,异常率更是高达95.6%。结论胫神经H反射是糖尿病早期周围神经病变最敏感指标,且随病程延长,肌电图检查的异常率随之增高。此外,不应忽视糖尿病腕管综合征的诊断,在报告结果的时候,要综合神经肌电图几项检查结果,正确评价糖尿病周围神经功能状态。

Objective To explore a sensitive indicator for the diagnosis of early diabetic peripheral neuropathy. Methods 271 patients with different disease course of diabetes were enrolled in this study. Their motor nerve conduction velocity（MCV） and sensory nerve conduction velocity （SCV）of median nerve, ulnar nerve, superficial peroneal nerve and common peroneal nerve, as well as f wave of ulnar nerve, Hoffman reflex of tibial nerve were detected by electroneuromyogram（EMG）. Results Among 271 cases,abnormal rate of H - reflex of tibial nerve was 77.5% ,which rose significantly with the extension of disease course. The abnormal rate of common peroneal nerve MCV, superficial peroneal nerve SCV were beyond 40% in the group of disease course over 10 years,while those in other groups were 20% - 30%. Meanwhile,37 cases had carpal tunnel syndrome with damage of 65 hands （ 13.7% ）. The abnormal rate of diabetic , peripheral neuropathy determined by combined ECM results increased with the extension of disease course;in the group of disease course below 1 year, abnormal rate was more than 63.2% , while in the group over 10 years, it reached up to 95.6%. Conclusion H - reflex appears to be the most sensitive indicator in the diagnosis of early diabetic peripheral neuropathy,and the abnormal rate of EMG increases with the extension of disease course. Diagnosis of carpal tunnel syndrome in diabetes should not be overlooked,and ECM results of several nerves should be integrated to assess function of diabetic peripheral neuropathy before making a final diagnostic report.