定量感觉检查在糖尿病周围神经病诊断中的应用价值

Value of quantitative thermal testing in the diagnosis of diabetic peripheral neuropathy

目的探讨定量感觉检查（QST）在糖尿病周围神经病变（DPN）诊断中的应用价值。方法对139例T2DM患者（T2DM组）和48名正常人（NC组）分别进行QST和神经传导速度（NCV）测定。结果病程≤3年T2DM组QST阈值与NC组比较，差异有统计学意义（P〈0．05）；病程≤3年T2DM组QST阈值与病程〉3年T2DM组比较，差异有统计学意义（P〈0．05）。NCV正常T2DM组冷觉、温觉、热痛觉的阈值与NC组比较，差异有统计学意义（P〈0．01）；T2DM组QST异常率高于NCV的异常率（x^2=18．019，P％0．01）；病程〉3年T2DM组QST的异常率高于病程≤3年T2DM组异常率（x^2=9．181，P〈0．01）；病程〉3年T2DM组NCV的异常率高于病程≤3年T2DM组异常率（x^2=8．53，P〈0．01）。结论DPN早期以小纤维受累为主，QST可为DPN的早期诊断提供可靠依据。QST较常规NCV测定在DPN诊断中具有更高的灵敏度，可作为常规NCV的必要补充。

Objective To investigate the value of quantitative sensory testing（QST） in the diagnosis of diabetic peripheral neuropathy（DPN）. Methods A total of 139 patients with type 2 diabetes mellitus （T2DM） and 48 healthy controls were enrolled in this study. QST and nerve conduction velocity（NCV） were tested in all the subjects. Results QST threshold had statistical significance between DM group with duration ≤3 years and controls （P〈0. 05）. The threshold of cold sensation, warm sensation, hot sensation and pain were significantly different between DM group with normal NCV and control group （P 〈0.01）. QST abnormal rate was higher in DM group than in NCV group （x^2=18. 019,P〈0. 01）. QST abnormal rate was higher in DM group with duration 〉 3 years than with duration 43 years （x^2 =9. 181, P〈0.01）. NCV abnormal rate was higher in DM group with duration 〉 3 years than with duration 43 years （x^2= 8.53, P〈0.01）. Conclusion Small nerve fibers are involved in early stage of DPN. QST is reliable for the early diagnosis of DPN. QST has higher sensitivity in the diagnosis of DPN than conventional NCV, and it can be used as a necessary complement of conventional NCV.