改良的下肢SLSEP检测方法对糖尿病近端神经病的诊断意义

The dianostic value of improved SLSEP in proximal diabetic neuropathy

目的：探讨改良的短潜伏期体感诱发电位（SLSEP）（改变记录点）的检测方法对糖尿病性近端神经病的诊断意义。方法：排除脑卒中、腰颈椎病及其它疾病引起的神经肌肉疾病，肌电图检查排除有神经病变体征同时常规神经传导检测异常的糖尿病（DM）患者，将符合标准的61例2型DM患者分为3组：有神经病体征而常规神经传导检测正常（Ⅰ组）20例，无神经病体征且常规神经传导检测正常（Ⅱ组）21例和无神经病体征而常规神经传导检测异常（Ⅲ组）20例，与30例正常人均行改良的SLSEP测定。结果：改良的胫神经SLSEP反映下肢感觉神经近端功能的参数总异常率以DM有神经病变症状肢体亚组（Ⅰ组）（n=27）所占的比例最高（85％，23／27），SLSEP反映神经近端功能的N13、N24峰的感觉神经传导速度（SCV）和N13N24、N9-N24峰间SCV，与对照组比较差异均有显著意义（P〈0．01）；DMⅡ组虽然无神经病变体征并且神经传导测定无异常，但与对照组比较，N13-N24峰间SCV异常肢体率却有显著差异（P〈0．01）。DMⅢ组SLSEP各参数异常率普遍较高（20％～72．5％），但以反映神经远端功能的N9峰SCV异常率最高。结论：改良的SLSEP检测是对常规SCV检测的一种补充，可以提供感觉纤维近端信息，对有周围神经损害症状而常规SCV测定正常的DM患者其诊断意义尤为显著。SLSEP还有利于发现DM患者亚临床症状。

Objective： To investigate the diagnostic value of improved short-latency somatosensory evoked potential（SLSEP） in patients with proximal diabetic neuropathy. Methods： Excluding stroke, spi nal disease and other diseases caused by cervical nerve-muscle diseases,and using EMG examination rule out Type 2 diabetes mellitus （DM）patients with nerve conduction abnormality and clinical signs of neuropathy, and eventually the remaining 61 patients with Type 2 DM.. There are clinical signs of neuropa thy （CSN） and normal routine nerve conduction test（RNCT） （Group Ⅰ） in 20 cases,without CSN with normal RNCT （ Group Ⅱ ）in 21 cases,and without SCN but RNCT abnormality （Group Ⅲ ） in 20 cases. Improved SLSEP were measured in 61 patients with Type 2 DM and 30 normal persons. Results： In Group I subgroup-neuropathy symptom limb（n=27） , the total abnormality rate of SLSEP parameter for reflection tibial sensory nerve proximal function was the highest（85% ）. SI.SEP to reflect proximal nerve function parameter sonsony eonduhion velocity（SCV） of N13, N24, N13-N24 and N9-N24 were significantly different from the control group （P〈0.01）; Despite the patients of Group Ⅱ had not CSN and RNCT was abnormal, the percentage of limb with anomalous N13-N24 was significantly different （P〈 0.01） from the control group. In Group Ⅲ the abnormality rate of all SI.SEP parameters was ratber high （20%-73%）,but the abnormality rate of N9 to reflect distal sensory nerve segment function was the highest. Conclusions： Improved SLSEP is supplement to sensory conduction test,and can provide informa tion of proximal sensory nerve segment. The diagnostic value of improved SLSEP to the diabetes patients with CSN without abnormal RNCT is particularly significant. Improved SLSEP can be used to detect sub clinical neuropathy.