F波对糖尿病周围神经病变的早期诊断价值

Diagnostic value of F wave in early stage diabetic peripheral neuropathy

目的探讨F波在糖尿病周围神经病变(DPN)中的早期诊断价值。方法检测100例2型糖尿病患者,无周围神经损害症状组(无症状组)50例、有周围神经损害症状组(有症状组)50例和正常对照组50例上肢正中神经和下肢胫后神经F波,检测指标包括F波最短潜伏期(Flmin)、平均潜伏期(Flmean)、F波离散度(Fchd)、F波出现率。结果无症状组正中神经Flmin、Flmean、Fchd均明显高于对照组,FImin(21.33±2.22)ms vs(20.27±1.14)ms;Flmean(23.53±2.01)ms vs(22.15±1.70)ms;Fchd(5.37±3.50)ms vs(2.74±1.02)ms,F波出现率明显低于对照组(84.45±15.55)%vs(92.25±7.78)%,无症状组胫后神经Flmin、Flmean、Fchd均明显高于对照组,Flmin(45.91±4.25)ms vs(43.79±2.98)ms;Flmean(49.48±3.61)ms vs(45.48±2.96)ms;Fchd(7.35±4.77)ms vs(3.85±0.81)ms、F波出现率明显低于对照组(90.75±18.41)%vs(98.75±2.70)%,差异均有统计学意义(P<0.05或P<0.01);有症状组正中神经和胫后神经的Flmin、Flmean、Fchd又比无症状组明显升高(P<0.05或P<0.01);糖尿病患者正中神经、胫后神经运动传导正常者中的F波总异常率达58.2%;在上下肢远端运动神经传导正常的糖尿病患者中,Fchd异常率均高于F波出现率、Flmean和Flmin异常率,差异均有统计学意义(均P<0.05)。结论糖尿病患者远、近端周围神经均可受累,F波(尤其是Fchd)可作为早期诊断DPN的敏感指标,并有助于发现亚临床DPN患者。

Objective To investigate the diagnostic value of F wave in early-stage diabetic peripheral neuropathy （DPN）. Methods F wave of the median and posterior tibial nerves were measured in 100 patients with type 2 diabetes mellhus （involving 50 patients without the symptom of peripheral neuropathy, 50 patients with the symptom of peripheral neuropathy）, and 50 normal control subjects. F latency minimum （Flmin）, F latency mean （Flmean）, F chronodispersion（Fchd）, and the appearance rate of F wave were analyzed. Results Flmin, Flmean and Fchd of the median nerves of 50 patients without the symptom of peripheral neuropathy were significantly higher than those in normal controls（P〈0.01）,（21.33±2.22） ms vs （20.27±1.14） ms,（23.53±2.01） ms vs （22.15±1.70） ms, （5.37±3.50） ms vs （2.74±1.02） vs （92. 25±7.78）% （ P 〈0.01）. In the same way,Flmin,Flmean and Fchd of the posterior tibial nerves of 50 patients without the symptom were significantly higher than those in normal controls（ P 〈0.01）, （45.91±4.25） msvs （43.79±2.98） ms,（49.48±3.61） ms vs （45.48±2.96） ms,（7.35±4.77） ms vs （3.85± 0.81） ms,and the appearance rate of F wave was significantly lower than that in normal controls（90. 75±18.41）% vs （98.75± 2.70）% （ P 〈0.05 or 〈0.01）;Flmin, Flmean and Fchd of the median nerves and the posterior tibial nerves of the patients with the symptom were significantly higher than the patients without the symptom（ P 〈0.05 or 0.01）. In the diabetic group, the abnormal rate of F wave was 58.2 % in patients with normal motor nerve conduction of median and posterior tibial nerves. The abnormal rate of Fchd was higher than the appearance rate of F wave, Flmean and Flmin in diabetes mellitus of patients with normal distal motor nerve conduction,there were significantly statistical differences in above items（all P 〈0.01）. Conclusion Both proximal and distal nerve could be affected by DPN. F wave could be a sensitive index for the early diagnosis of DPN,and beneficial for detecting subclinical DPN.