电流感觉阈值对糖尿病患者周围神经的评价作用

Effects of current perception threshold in evaluating the peripheral nerves in diabetic patients

目的：利用电流感觉阈值（ CPT ）检测技术与常规神经传导（ NCS ）及皮肤交感反应（SSR）比较，探讨CPT评价糖尿病周围神经大小纤维损害的可能优势。方法选取2014年8—12月天津市第三中心医院就诊糖尿病患者49例，健康对照者23名。采用Neurometer？CPT／C 测量仪对所有受试者的第一脚趾远端、膝部髌骨下方中线位、食指远端3个部位进行2000、250、5 Hz 3种刺激频率的CPT值检测。糖尿病患者行NCS及SSR检测，根据NCS结果将DM组分为神经传导异常组（NCSA组）20例、神经传导正常组（NCSN组）29例，另据SSR结果分为SSR异常组（SSRA组）32例、SSR正常组（ SSRN组）17例。结果在3个皮肤测试区以不同频率分别给予刺激，糖尿病患者NCSN组CPT值与对照组相比差异均无统计学意义；NCSA组CPT值（393.5±68.4、213.1±39.7、172.5±52.8、221.6±48.0、91.7±33.1、76.2±27.8、274.0±48.4、120.1±26.6、75.3±21.9）均高于对照组（278.1±53.6、128.9±46.7、78.7±28.7、149.3±54.6、52.3±23.2、41.9±18.7、214.2±46.0、96.0±29.3、48.6±17.0，F＝36.277、40.827、50.301、10.240、12.837、13.832、11.749、5.559、17.412，均P＜0.01）。以第一脚趾远端皮肤为刺激部位，SSRN组在250、5 Hz两种频率电刺激时所测CPT值（91.0±29.0，55.2±21.3）低于对照组（128.9±46.7，78.7±28.7，F＝23.071、22.646，均P＜0.05）。在3个皮肤测试区以不同频率给予刺激，SSRA组CPT值均高于对照组。结论 CPT检测可早期发现糖尿病周围神经小纤维致敏状态下损害，而对周围神经大纤维损害评价未见优势。

Objective To evaluate the impairment of large and small fibers of peripheral nerves in patients with diabetes mellitus according to the current perception threshold （ CPT ） comparing with nerve conduction studies （ NCS） and sympathetic skin response （ SSR）.Methods Fourty-nine diabetic patients were enrolled from August to December 2014 in Tianjin Third Central Hospital.The CPT was examined by the Neurometer？CPT/C in diabetic patients and 23 healthy subjects.Electrical stimulations of 2 000, 250 and 5 Hz were delivered respectively to the first toe distal section , the bottom of the knee-patella middle line and the index finger distal section.NCS and SSR were performed in diabetic patients.The patients were divided into normal NCS （ NCSN） group and abnormal NCS （ NCSA） group according to the results of the nerve conduction.According to the results of SSR , the patients were divided into normal SSR （ SSRN） group and abnormal SSR （ SSRA ） group.Results In three testing areas , the CPT in NCSN group had no significant difference compared with control group , which was tested by different frequency;NCSA group had increased CPT （393.5 ±68.4, 213.1 ±39.7, 172.5 ±52.8, 221.6 ±48.0, 91.7 ±33.1, 76.2 ±27.8, 274.0 ±48.4, 120.1 ±26.6, 75.3 ±21.9） compared with control group （278.1 ±53.6, 128.9 ±46.7, 78.7 ±28.7, 149.3 ±54.6, 52.3 ±23.2, 41.9 ±18.7, 214.2 ±46.0, 96.0 ±29.3, 48.6 ±17.0; F=36.277, 40.827, 50.301, 10.240, 12.837, 13.832, 11.749, 5.559, 17.412,all P〈0.01）.At the first＆amp;nbsp;toe section, CPT decreased in SSRN group （ 91.0 ±29.0, 55.2 ±21.3 ） compared with control group （128.9 ±46.7, 78.7 ±28.7;F=23.071, 22.646, both P〈0.05）, which was tested by the currents of 250 Hz and 5 Hz frequency.In three testing areas , the SSRA group had increased CPT compared with control group , which was tested by different frequency.Conclusion Hyperesthesia as an early manifestation of small fiber damage can be detected by CPT in diabetic patients; CPT has no advantage in the evaluation of large fiber damage.