定量温度阈值检测在糖尿病性小纤维神经病变诊断中的价值

Significance of quantitative thermal testing in diagnosis of diabetic small fiber neuropathy

目的探讨定量温度阈值检测(QTT)在糖尿病性小纤维神经病变的诊断应用。方法对120例糖尿病患者分别进行QTT,包括冷感觉阈值(CT)、热感觉阈值(TT)、冷痛觉阈值(CPT)、热痛觉阈值(HPT);神经传导研究(NCS)和皮肤交感反应(SSR)检测,并对其结果进行统计学分析。结果①QTT、NCS、SSR异常率分别为90.83%、25.83%和57.50%,3组比较差异均具有统计学意义(P<0.05)。②CT、TT、CPT、HPT异常率分别为39.58%、47.29%、64.58%、71.67%,TT异常率高于CT,HPT异常率高于CPT,差异有统计学意义(P<0.05)。③下肢CT、TT、CPT、HPT异常率分别为51.67%、94.58%、62.08%、85.00%;上肢CT、TT、CPT、HPT异常率分别为22.33%、34.59%、32.5%、58.33%,下肢CT、TT、CPT、HPT异常率均高于上肢,差异有统计学意义(P<0.05)。④糖尿病患者在无、轻、中、重症状4组中CT异常率分别为19.17%、31.25%、43.94%、76.19%;TT异常率分别为41.67%、58.33%、75.76%、90.48%;CT和TT异常率随临床症状递增,组间两两比较,差异具有统计学意义(P<0.05),CPT和HPT则无此现象。结论冷感觉阈值、热感觉阈值是诊断DPN,特别是细小有髓和无髓纤维神经病变的敏感指标。

Objective To investigate the significance of quantitative thermal testing（QTI＇） in the diagnosis of diabetic small fiber neuropathy. Methods Totally 120 diabetic patients were measured for nerve conduction studies（ NCS）, sympathetic skin reponse（SSR） and QTI＇, which included cold perception threshold （CT）, thermal perception threshold （TY）, cold pain threshold （CPT） and heat pain threshold （HPT）. Results （1）The abnormal rate of QTY, NCS and SSR was 90.83 % ,25.83 % and 57.50%, respectively, with significant difference （ P 〈 0.05 ）. （2）The abnormal rate of CT, TT, CPT and HPT was 39.58% ,47.29% ,64.58% and 71.67% ,respectively. The difference between them was statistically significant （P〈0.05）. （3）The abnormal rate of CT, TT, CPT and HPT in lower limb was 51.67% ,94.58% ,62.08% and 85.00% respectively; that in upper limbs was 22.33% ,34.59% ,32.5%, and 58.33% and that in lower limbs was higher than in upper limbs, with significant difference （ P 〈 0.05 ）. （4）The abnormal rate of CT in groups with no, mild, moderate or severe symptoms was 19.17% ,31.25% ,43.94% , and 76.19% respectively; that of TT was 41.67% ,58.33%, 75.76% ,and 90.48% respectively, and that of CT and TT increased with clinical severity, but not so in CPT and HPT. Conclusion CT and Tl＂ are sensitive indicators for diagnosis of diabetic peripheral neuropathy, especially for small myelinated and unmyelinated nerve fiber neuropathy.