神经肌电图联合超声检查对糖尿病合并腕管综合征的预后评估价值

Evaluation of Clinical Prognosis of Diabetic Patients with Carpal Tunnel Syndrome by Nero-Electromyography Combined with Iltrasonography

【目的】分析神经肌电图（Electromyography，EMG）联合超声检查对糖尿病合并腕管综合征（Carpal tunnel syndrome，CTS）患者临床预后评估价值。【方法】选取本院2014年2月至2017年2月收治的96例糖尿病合并CTS患者作为观察组，另选取80名同期健康体检正常者作为对照组。检测两组受试者正中神经运动传导速度（MCV）、末端运动潜伏期（DML）、复合肌肉动作电位（CMAP）和感觉传导速度（SCV）、相同距离正中神经与尺神经潜伏期差值（ML）、感觉神经动作电位（SNAP），观察其超声图像正中神经截面积（CSA）变化，并比较不同分期CTS患者治疗前后EMG、超声检查结果。应用Pearson相关性分析，探讨EMG参数、CSA与CTS患者治疗前后Levine评分、手功能评分的相关性。【结果】观察组MCV、CMAP、SCV、SNAP低于对照组，其DML、ML高于对照组，差异有统计学意义（P〈0.05）；随着患者病情分期的加重，其MCV、CMAP、SCV、SNAP逐渐下降，DML、ML逐渐升高，差异有统计学意义（P〈0.05）。观察组CSA为（0.19±0.03）cm2，高于对照组的（0.09±0.02）cm2，差异有统计学意义（t=4．183，P〈0.05）；观察组早期、中期、晚期CSA分别为（0.12±0.02）cm2、（0.21±0.05）cm2、（0.26±0.05）cm2，随着患者病情分期的加重，其CSA逐渐升高，差异有统计学意义（F=11．965，P〈0.05）。CTS患者治疗2个月后Levine评分均较治疗前下降，手功能评分均上升，差异有统计学意义（P〈0.05）。Pearson相关性分析显示，EMG参数、CAS均与CTS患者自测评分具有相关性（P〈0.05）。【结论】EMG联合超声检查能够准确评价糖尿病合并CTS患者正中神经功能状态及其与周围组织解剖关系变化，为患者临床预后的评估有重要的参考价值，值得临床推广应用。

[Objective]To evaluate the clinical value of electromyography （EMG） combined with ultrasonography in the clinical prognosis of Carpal tunnel syndrome （CTS） patients with diabetes mellitus. [Methods]A total of 96 patients with diabetes mellitus complicated with CTS in our hospital from February 2014 to February 2017 were enrolled in this study as the observation group and 80 healthy subjects during the same period were recruited in the control group. Median motor conduction velocity （MCV）, end-exercise latency （DML）, combined muscle action potential （CMAP） and sensory conduction velocity （SCV）, mean distance between median nerve and ulnar nerve latency （ML）, and sensory nerve action potential SNAP） were detected by EMG. Observation of the median nerve cross-sectional area （CSA） was measured by ultrasound image between the two groups of subjects. The parameters of EMG and ultrasonic examination before and after treatment in different stages of CTS patients were compared. Pearson correlation analysis was used to determine the relationship between EMG parameters, CSA and Levine score, and functional score of CTS before and after treatment. [Results]The levels of MCV, CMAP, SCV and SNAP in the observation group were lower than those in the control group; the levels of DML and ML were higher than those in the control group. The differences were statistically significant （ P 〈0.05）. With the aggravation of CTS stage, the levels of MCV, CMAP, SCV, DML and SNAP decreased while the levels of DML and ML increased; the difference was statistically significant （ P 〈0.05）. The CSA of the observation group was （0.19 ± 0.03） cm2 , which was higher than that of the control group （0.09 ± 0.02） cm2; the difference was statistically significant （ t = 4.183,P〈0.05）. The CSA of early, middle and late stage in the observation group were （0.12±0.02） cm2, （0.21 ±0.05） cm2 and （0.26±0.05） cm2 , respectively. With the increasing of the staging of patients, the CSA gradually increased; the difference was statistically significant （F=11.965, P 〈0.05）. After 2 months of treatment, the Levine scores of CTS patients were lower than those before treatment, and the scores of hand function increased; the differences were statistically significant （ P 〈0.05）. Pearson correlation analysis showed that the EMG pa- rameters and CAS were correlated with the self-rated score of CTS patients （ P 〈0.05）. [Conclusion]EMG combined with ultrasound can accurately evaluate the functional status of the median nerve and its anatomic relationship with surrounding tissues in patients with diabetes mellitus complicated with CTS as well as provide reference for the evaluation of clinical prognosis of patients with diabetes mellitus.