感觉定量检测在血液透析患者周围神经病变的应用

Application of quantitative sensory testing in diagnosis of hemodialysis patients with peripheral neuropathy

目的探讨感觉定量检测（QST）在血液透析（HD）患者周神经病变诊断方面的应用。方法对40例维持性HD患者（无症状组18例；有症状组22例）和40例正常人，分别对手指、小鱼际、足背、小腿四个部位进行QST和感觉神经传导速度（SCV）测定，然后进行比较分析。结果对照组、无症状组，有症状组的四个部位的四个温度觉阈值、振动觉阈值有依次增大趋势，无症状组与对照组比较均差异有统计学意义（P〈0．05）；尤其是有症状组手指的温觉、振动觉阈值，小鱼际的热痛觉阂值，足背的热痛觉、振动觉阈值，小腿的冷痛觉、振动觉阈值与对照组比较均差异有统计学意义（P〈0．01）；有症状组与无症状组比较，手指的冷觉、温觉阈值，足背的热痛觉阈值，小腿的温觉、冷痛觉、热痛觉及4个部位的振动觉阈值均差异有统计学意义（P〈0．05）。HD患者与对照组正中神经、胫神经、腓总神经SCV比较均差异有统计学意义（P〈0．05）。HD患者QST总异常率为65％，有症状组异常率77．27％；SCV总异常率为55．0％，有症状组68．18％；QST的总异常率明显高于SCV，两者比较差异有统计学意义（P〈0．05）。结论QST在诊断维持性HD患者多发性周围神经病变方面较敏感，可作为疗效及预后观察的客观指标。

Objective To evaluate the application of quantitative sensory testing（QST） in hemodialysis （HD） patients with peripheral neuropathy. Methods The values of the quantitative sensory testing and sensory conduction velocity at different locations of extremities in 40 cases of the HD patients and 40 normal persons were recorded. Results According to the control group, without symptoms group and with symptoms group, the thermal threshold（TT） and vibratory threshold （VT） at the four different locations of extremities were increased ,thresholds of the later two groups were significantly higher than those of normal controls （P 〈 0. 05 ）. Especially finger warm and vibratory thresholds, hypothenar heat pain thresholds, instep heat pain and vibratory thresholds, calf cold pain and vibratory thresholds were significantly difference between with symptoms group and normal control group （P 〈 0.01 ）. Finger cool and warm thresholds, instep heat pain thresholds, thresholds of calf warm, cold pain and heat pain ,and vibratory thresholds at the four different locations of extremities were significantly difference between wthout symptoms group and with symptoms group （P 〈 0.05 ）. The SCV values of the median nerve, tibial nerve and lateral popliteal nerve were significantly difference between HD patients group and normal control（P 〈 0.05 ）. The total abnormal rate of QST was 65% ,with symptoms group was 77.27% ,total abnormal rate of SCV was 55.0% , with symptoms group was 68.18%. The total abnormal rate of QST were significantly higher than those of SCV （P 〈 0.01 ）. Conclusion QST is a sensitive method for diagnosis of uremic neuropathy.