糖尿病病程对糖尿病下肢周围神经病变的影响

Influence of diabetes mellitus duration on diabetic peripheral neuropathy of lower extremity

目的探讨糖尿病病程对糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)严重程度及手术疗效的影响,以及DPN早期诊断、早期手术的意义。方法回顾性分析1526例DPN病人的临床资料,将病人分为短病程组(<5年)和长病程组(≥5年),各有715例和811例。采用Dellon术式对病人卡压的下肢神经进行显微减压。术前和术后1.5年行神经高频超声、定量感觉检查(quantitative sensory testing,QST)、感觉传导速度(nerve conduction velocity,NCV)检测,同时选取50例志愿者作为正常对照组行对比性研究。结果短病程DPN病人术前、术后1.5年神经横断面积(cross section area,CSA)、NCV、冷感觉阈值、热感觉阈值、振动觉阈值均优于长病程DPN病人(均P<0.05)。短病程DPN病人NCV和QST阳性检测率分别为71.5%、93.7%,两者间差异有统计学意义(P<0.05);长病程病人分别为90.3%、95.3%,两者间差异没有统计学意义(P>0.05)。结论糖尿病病程对DPN病人发病时严重程度至关重要,同时也对DPN病人的手术疗效和预后产生影响。DPN的早期诊断、早期手术具有重要临床价值。

Objective To investigate the influence of diabetes mellitus （DM） duration on severity and surgical outcome of diabetic peripheral neuropathy （DPN）. Methods Clinical data of 1526 DPN patients were analyzed retrospectively, who were divided into short DM duration group （shorter than 5 years） of 715 patients and long DM duration group （equal to and longer than 5 years） of 811 patients. Nerve crush of the lower extremity of 1526 patients with DPN were treated by microsurgical technique with Dellon nerve decompression. The high-resolution ultrasound, quantitative sensory testing （QST） and nerve conduction velocity （NCV） measure- ments were performed in all the patients before and 1.5 years after surgery, and the results were compared with those of 50 volunteers as normal control. Results The examination results of cross section area （CSA）, NCV, cold perception threshold （CPT）, warm perception threshold （WPT） and vibration perception threshold （VPT） of short DM duration group were better than those of long DM duration group （all P 〈 0.05）. NCV-positive and QST-positive rates of short DM duration group amounted to 71.5% and 93.7% respectively, and there was statistically significant difference between the above two rates （P 〈 0.05）. While the NCV-positive and QST-positive rates of long DM duration group were 90.3% and 95.3% respectively, and there was no statistically significant difference between the above two rates （P 〉 0.05）. Conclusions DM duration is critical for severity, surgical outcome and prognosis of DPN patients. And early diagnosis and surgery have important clinical value for DPN.