定量温度觉阈值对2型糖尿病患者的小纤维性感觉神经病变诊断的研究

The significance of quantitative temperature sense thresholds in diagnosis of small fibrous sensory neuropathy in patients with type 2 diabetes

目的:运用定量温度觉检查技术对2型糖尿病患者的小纤维感觉神经病变早期诊断。方法:选取无周围神经受损症状的20例2型糖尿病患者和年龄与性别相匹配的20例健康对照者,进行双侧上肢的手掌部大鱼际区的冷觉阈值(CST)、温觉阈值(WST)、冷痛觉阈值(CPT)、热痛觉阈值(HPT)测定。结果:患者组与对照组的冷觉、温觉、冷痛觉和热痛觉4种温度觉阈值自身左右侧比较,差异无统计学意义;患者组与对照组的冷觉、温觉、冷痛觉和热痛觉4种温度觉阈值的右侧比较,差异具有统计学意义(P<0.05);患者组与对照组的冷觉和温觉2种温度觉阈值的左侧比较,差异具有统计学意义(P<0.05),但冷痛觉和热痛觉2种温度觉阈值的左侧比较,差异无统计学意义;2型糖尿病患者中同时符合冷热痛觉过敏诊断标准的有9/20例。结论:定量温度觉阈值测定不但可以反映痛觉阈值升高,还可以反映痛觉阈值降低即痛觉过敏,有助于小纤维性周围神经病的诊断识别。

Objective： To evaluate the small fiber function in patients with type 2 diabetes mellitns of the early stage by measuring the sensory threshold with the quantitative temperature testing technology. Methods： Twenty cases of patients with type 2 diabetes with no neuro- logical deficit （ DM group ） and twenty age and sex-matched healthy controls underwent the detecting of cold sensory threshold （ CST ）, warm sensory threshold （ WST ）, cold pain threshold （ CFT ）, heat pain threshold （ HPF ） in both inside of their hands. Results： There was no significant difference in CST, WST, CPT and HPT between left and right inside of hand of the same sample among all the testers. But the four kinds of threshold showed significant difference in the right inside of hand between patients and healthy people （ P 〈 0.05）. In addition, the CST and WST differed significantly in the left inside of hand between the patients and healthy controls while the CPT and HPT showed no signif- icant difference in the left inside of hand between them. Patients group and control group with CST and WST on the left side of the comparison difference was statistically significant （P 〈 0. 05）. Conclusion： Quantitative ana/ysis of temperature sense threshold can not only reflect in- crease of the pain threshold value, also can reflect its decrease, i.e. hyperalgesia, which may help to diagnose small fibrous peripheral neu- ropathy recognition, especially in early diabetic peripheral neuropathy.