接触性热痛诱发电位对糖尿病患者颅神经脊神经小纤维功能的评价

The roles of the contact heat evoked potential in evaluating the small nerve fibers of cranial and spinal in elderly diabetic patients

的 探讨接触性热痛诱发电位（CHEP）对老年糖尿病患者颅神经和脊神经小纤维功能的评价作用,分析小纤维损害特点,为老年人糖尿病神经病变（DN）的早期诊断提供理论依据.方法 选取糖尿病患者50例,根据有无神经传导异常分为神经传导正常组17例和神经传导异常组33例,另设健康对照组40例,分别行眉弓、前臂、小腿CHEP检测,并测定糖尿病组患者上下肢感觉和运动神经传导. 结果 糖尿病组与对照组比较,CHEP眉弓、前臂、小腿刺激点N波潜伏期延长,N-P波波幅减低（均P＜0.01）；与对照组比较,神经传导正常组CHEP前臂、小腿N-P波波幅对数值减低（分别为1.70±0.10比1.60±0.14,1.65±0.078比1.54±0.15,t=2.33、3.09,P＜0.05）,眉弓N波潜伏期延长[（343.1±18.2）ms比（385.4±26.5）ms,t=5.31,P＜0.05]；与神经传导正常组比较,神经传导异常组小腿N-P波波幅对数值下降[（1.54±0.15）比（1.44±0.15）,t=2.60,P＜0.05].结论 CHEP可早期发现老年糖尿病患者小纤维病变；糖尿病小纤维病变可累及脊神经和颅神经,早期损害脊神经可能以轴索损害为主,颅神经可能以脱髓鞘为主.

Objective To study the roles of the contact heat evoked potential （CHEP） in evaluating the small nerve fibers of cranial and spinal in elderly diabetic patients,and to analyze the feature of the small fibers in order to provide scientific foundations for early diagnosis of diabetic neuropathy （DN）.Methods Totally 50 diabetic patients and 40 healthy subjects were included in this study.The diabetic patients were divided into the normal nerve conduction group （n=17） and the abnormal nerve conduction group （n=33）.CHEP was determined and thermal stimuli was given to the area of eyelid,forearm and peroneal.Sensory and motor nerve conduction velocity in the upper and lower limbs were tested in all diabetic patients.Results Compared with the healthy group,the N wave latencies were prolonged and the N-P amplitudes were reduced in the area of eyelid,forearm and peroneal in diabetic patients （all P〈0.01）.Compared with the healthy group,the logarithm of N-P amplitudes were reduced in areas of forearm and peroneal [（1.70±0.10） vs.（1.60±0.14）,（1.65±0.078） vs.（1.54±0.15）,both P〈0.05] and N wave latencies were prolonged in eyelid area [（343.1±18.2） ms vs.（385.4±26.5） ms,P〈0.05] in normal nerve conduction group.Compared to group with normal nerve conduction velocity,the logarithm of N-P amplitudes was reduced in peroneal area [（1.54±0.15） vs.（1.44±0.15）,P〈0.05] in abnormal nerve conduction group.Conclusions CHEP can detect the early impairment of the small fibers in elderly diabetic patients.The early smallfiber impairments in diabetic neuropathy may be axon-oriented in spinal nerves and myelin-oriented in cranial nerves.