上下肢神经F波在糖尿病周围神经病变中的诊断价值

The value of F waves of the upper and lower limbs in the diagnosis of diabetic peripheral neuropathy.

目的:探讨上下肢神经F波对糖尿病周围神经病变(DPN)的诊断价值。方法:对82例糖尿病患者(DM组)和22名年龄、身长相匹配的健康志愿者(对照组)进行上肢正中神经和下肢胫神经F波检测,观察参数为F波出现率(Fpresent)、传导速度(Fcv)和平均潜伏期(Flme)。将DM组根椐有无周围神经病变症状分为有症状组和无症状组;根椐神经传导检测(NCD)结果分为正常组和异常组。结果:与对照组比较,DM有症状组上肢Fpresent减少、Fcv减慢、下肢Fpresent减少、Flme延长(P<0.05～P<0.01),无症状组仅上肢Fpresent减少(P<0.01)。与DM无症状组比较,有症状组上肢Fcv减慢、下肢Fpresent减少、Flme延长(P<0.05～P<0.01),而上肢Fpresent差异无统计学意义(P>0.05)。与对照组比较,NCD异常组上肢Fpresent减少、Fcv减慢、下肢Fpresent减少、Flme延长(P<0.05～P<0.01),NCD正常组上肢Fpresent减少、Fcv减慢(P<0.01和P<0.05),而下肢Fpresent、Flme差异均无统计学意义(P>0.05)。与NCD正常组比较,NCD异常组上肢Fcv减慢、下肢Fpresent减少、Flme延长(P<0.05～P<0.01),而上肢Fpresent差异无统计学意义(P>0.05)。结论:上肢F波(尤其Fpresent)可作为早期诊断DPN的敏感指标,并可发现亚临床病变,上肢近端神经损害早于远端;下肢F波参数变化与临床症状、NCD相一致,DPN中下肢远、近端神经同步受累。

Objective：To explore the value of F waves of the upper and lower limbs in the diagnosis of diabetic peripheral neuropathy（DPN）. Methods：The F waves of the median and tibial nerves of lower limbs and upper limbs of 82 cases with diabetes（D group） and 22 healthy volunteers with age-and height-matched（Control group） were detected.The data of the appearance rate（F present）,conduction velocity（Fcv）,mean latency（Flme） of F waves were analyzed.The cases of group D were divided into symptom group and nosymptom according to the peripheral neuropathy symptoms,and normal and abnormal group according to nerve conduction detection（NCD）. Results：Compared with the control group,group D with symptoms had less Fpresent and slower Fcv in upper limbs and less Fpresent and longer Flme in lower limbs（P〈0.05 to P〈0.01）,less Fpresent was only detected in nosymptoms.Compared with group D with nosymptoms,slower Fcv in the upper,and less Fpresent and longer Flme in the lower limbs were detected in symptoms group（P〈0.05 to P〈0.01）,the differences of Fpresent of two groups were not statistical significant（P〉0.05）.Compared with the control group,the slower Fcv in upper limbs,slower Fcv of upper limbs and the less Fpresent and longer Flme of lower limbs were detected in diabetes with abnormal NCD,while for diabetes with normal NCD,the less Fpresent and slower Fcv in upper limbs and no obvious difference in lower limbs were detected.Compared with diabetes with normal NCD,slower Fcv in upper limbs and slower Fcv and longer Flme of lower limbs were detected in diabetes with abnormal NCD,and no obvious difference in upper limbs were detected（P〉0.05）. Conclusions：F wave（especially Fpresent） of upper limbs can be used as a sensitive diagnostic means for earlier DPN,and discover subclinical lesions.The proximal nerve damage of the upper limbs occurs sooner than the distal end.The parameter variation of the F waves are consistent to the clinical symptoms and NCD.Both proximal and distal nerves of the lower limbs can be involved synchronally in the DPN.