电流感觉阈值评估2型糖尿病患者早期周围神经受损的临床意义

Clinical significance of evaluation of current perception threshold in early diagnosis and intervention of type 2 diabetic peripheral neuropathy

目的通过测定2型糖尿病患者电流感觉阈值(CPT),筛出早期感觉神经受损者,分析大小纤维神经受损的程度,为早期诊断和干预糖尿病周围神经病变(DPN)提供理论支持。方法 130例2型糖尿病患者均空腹抽血查血脂(TC、TG、HDL、LDL)、糖代谢(FBG、HbA1c),并行感觉神经定量检测,分别记录四肢2 000 Hz、250 Hz、5 Hz时的CPT值。根据有无CPT异常分组,分析比较2组糖脂代谢及CPT值,用Logistic回归分析影响早期DPN的独立因素。结果 130例2型糖尿病患者中感觉神经受损者85例;感觉神经受损组BMI、TC、LDL、FBG、HbA1c较感觉神经正常组明显升高(P<0.05或0.01),双侧正中/尺神经、腓浅和腓深神经在250 Hz、5 Hz时的CPT值亦明显升高(P<0.01);二元Logistic回归分析显示,TC及HbA1c与是否发生早期感觉神经受损独立相关(OR值分别为45.052和13.499,P均<0.01)。结论 CPT测定可以早期发现2型糖尿病患者的感觉神经受损,其早期多以小纤维神经受损为主,且高TC、高HbA1c是发生早期DPN的独立危险因素。

Objective To detect current perception threshold（ CPT） of patients with type 2 diabetes mellitus to screen out the patients with early diabetic peripheral neuropathy（ DPN）,and to analyze the severity of large and small fiber nerve damage in order to provide theoretical basis for early diagnosis and intervention of DPN. Methods A total of 130 patients with type 2 diabetes mellitus were enrolled in the study. The serum levels of TC,TG,HDL,LDL,FBG,HbA1c were detected,and sensory nerve was quantitatively detected. Moreover the CPT value in four limbs at 2,000 Hz,250Hz,5Hz were measured. Accoeding to CPT,these patients were divided into two groups： normal CPT group and abnormal CPT group. Then the blood lipid levels,glycometabolism parameters and CPT value were observed and compared between two groups to analyze the influencing factors on early DPN. Results Among 130 patients,85 patients had sensory nerve damages,and the levels of BMI,TC,LDL,FBG,HbA1c in sensory nerve damage group were significantly higher than those in control group（ P 〈0. 05 or P 〈0. 01）,moreover the CPT values in four limbs at 250 Hz and 5Hz frequency were significantly higher than those in control group（ P 〈0. 01）. Binary Logistic regression analysis showed that TC and HbA1c were independently related to the DPN（ OR = 45. 052,13. 499,respectively,P 0. 01）. Conclusion The CPT detection can early find out sensory nerve damages of patients with type 2 diabetes mellitus,which often display damages of small fiber nerve. Moreover the higher levels of TC and HbA1c are independent risk factors of early DPN.