神经阈值对亚临床糖尿病周围神经病变的诊断价值

The diagnositic significance of neural threshold in subclinical diabetic perpherical neuropa- thy

目的：探讨神经阈值对亚临床糖尿病性周围神经病的诊断价值。方法：糖耐量异常患者、病程2年或2年以内的糖尿病患者（简称短病程糖尿病）、病程5～10年的糖尿病患者（简称长病程糖尿病）及健康对照组各20名，分别检测每位受试者双侧正中神经、双侧尺神经、双侧腓神经远端运动神经阈值和腓肠感觉神经阈值，测量所有患者血清糖化血红蛋白（HbA1c）值；使用统计学软件SPSS进行分析。结果：①方差分析显示左右正中神经、右腓神经远端运动神经阈值和左右腓肠神经感觉阈值四组间差异有统计学意义（P〈0．05），左右侧尺神经和左侧腓神经四组间差异无统计学意义；在糖耐量异常组和健康对照组之间，右侧正中神经、右侧腓神经远端运动神经阈值和左右腓肠神经感觉阈值两组间差异有统计学意义（P〈0．05）；②Peason相关回归分析显示左侧正中神经、右侧尺神经、左右侧腓神经远端运动神经阈值和腓肠感觉神经阈值与血HbA1C水平呈正相关（P〈0．05），右侧正中神经、左侧神经远端运动神经阈值与血HbA1C无明显相关性（P〉0．05）。结论：神经阈值测量可早期发现糖代谢异常患者周围神经兴奋性的变化，有助于评估周围神经功能和亚临床糖尿病神经病变的诊断。

Objective： To explore the significance of neural threshold in diagnosing subclinical dia- betic peripheral neuropathy（DPN）. Methods： A total of 80 subjects were recruited,including 20 patients with impaired glucose tolerance（IGT）, 20 patients with Type 2 diabetes with a disease duration of two or less than two years ,20 patients with Type 2 diabetes with a disease duration of 5~10 years and 20 age- matched healthy subjects. The neural threshold of bilateral median nerves, ulnar nerves peroneal nerves and sural nerves in every subject were respectively measured using Medelec Synergy. The serum level of hemoglobin A1C（HbA1 C）in all patients were axamined. Then all data were analyzed with softwave SPSS. Results：（1） The distal motor neural threshold of bilateral median nerves, right peroneal nerves and the se- sory neural threshold of bilateral sural nerves were different among the four groups （P〈0.05）. The dis- tal motor neural thresholds of bilateral ulnar nerves, and left peronea nerves were not different among four groups. There were statistical difference in the distal motor neural threshold of right median nerves right peroneal nerves and the sesory neural threshold of bilateral sural nerves between IGT group and healthy group. （2）There was a positive linear correlation between the the distal neural threshold of left median nerves, right ulnar nerves bilateral peroneal nerves and the sensory neural threshold of bilateral sural nerves in all patients and the serum level of hemoglobin A1C（P〈0.05）;there were no correlation be- tween the distal motor neural threshold of right median nerves,left ulnar nervers and the serum level of hemoglobin A1C （P〉0.05）. Conclusion： Neural excitability threshold measurements may detect the chan-ges of peripheral nerve excitability of carbohydrate metabolic disorder earlier, and evaluate the functional status of peripheral nervrs provide help for the diagnosis of subelinic diabetic peripheral neuropathy.