定量感觉检查联合交感皮肤反应对早期糖尿病周围神经病诊断的价值

Diagnosis value of detection of quantitative sensory testing combined with sympathetic skin response to early diabetic peripheral neuropathy

[目的]探讨定量感觉检查联合交感皮肤反应对早期糖尿病周围神经病诊断的价值。[方法]对42例2型糖尿病患者,其中有症状组(有糖尿病周围神经损害主要表现者)13例,无症状组29例,进行定量感觉检查(QST)[包括温度觉阈值检查(QTT)和振动觉阈值检查(QVT)]及交感皮肤反应(SSR)检测,同时检查周围神经传导速度(NCV),并进行对比研究。[结果](1)无论是有症状组、无症状组,还是全部病例组,糖尿病患者QTT的异常率(分别为92.30%、72.41%及78.57%)均高于感觉神经传导速度(SNCV)的异常率(分别为76.92%、37.93%及50.00%),差异具有显著性意义(均P<0.05)。(2)无论是有症状组、无症状组,还是全部病例组,糖尿病患者QTT的异常率(分别为78.57%、92.30%及72.41%)均高于QVT的异常率(分别为42.86%、46.15%及41.40%),差异具有显著性意义(均P<0.05)。(3)无论是无症状组,还是全部病例组,QST联合SSR对糖尿病患者周围神经病变的检出率(分别为96.55%及92.85%)明显高于单独使用QST(分别为72.14%及78.57%)、SSR(分别为48.27%及51.72%)或SNCV(分别为37.93%及50.00%),差异具有显著性意义(均P<0.05)。[结论]QST联合SSR技术对糖尿病周围神经病变的检出率最高,可用于早期糖尿病周围神经病的筛选检查。

【Objective】 To evaluate the diagnosis value of united quantitative sensory testing（QST） and sympathetic skin response（SSR） in early diagnosis of diabetic peripheral neuropathy（DPN）.【Methods】 QST 【including quantitative thermal testing（QTT） and quantitative vibratory testing（QVT）】,SSR and nerve conductive velocity（NCV） were all measured in 42 diabetics（13 patients with symptoms,29 patients without symptoms）.The results were contrasted.【Results】（1） In patients with symptoms,without symptoms and all diabetics,the abnormal rate of QTT（92.30%,72.41%,78.57%） was higher than the one of SNCV（76.92%,37.93%,50.00%）.There was statistic difference（P〈0.05）.（2） In patients with symptoms,without symptoms and all diabetics,the abnormal rate of QTT（78.57%,92.30%,72.41%） was higher than the one of QVT（42.86%,46.15%,41.40%）.There was statistic difference（P〈0.05）.（3） In patients without symptoms and all diabetics,the abnormal rate of united QST and SSR（96.55%,92.85%） was higher than the one of separate using QST（72.14%,78.57%）,SSR（48.27%,51.72%） or SNCV（37.93%,50.00%）.There was statistic difference（P〈0.05）.[Conclusion]The united QST and SSR has higher sensitivity,which can be used in early screening of DPN.