神经阈值在糖尿病周围神经病诊断中的应用

Neural thresholds in the diagnosis of diabetic peripheral neuropathy

目的探讨神经阈值在糖尿病周围神经病变诊断中的应用价值。方法选取糖尿病患者42人纳入病变组,健康志愿者21人纳入健康对照组,其中,将病变组按照糖尿病病程长短分为两个亚组,病程<10年组(23人)、病程≥10年组(19人)。按照HbA1c水平将病变组分为两个亚组,HbA1c<9组(23人)和HbA1c≥9组(19人)。检测正中神经、尺神经及腓浅神经感觉支的神经阈值,并进行统计学分析。结果从健康对照组、病程<10年组至病程≥10年组,神经阈值逐渐增高,病变组神经阈值明显高于健康对照组(P<0.05),病程≥10年组又明显高于病程<10年组(P<0.05)。从健康对照组、HbA1c<9组至HbA1c≥9组,神经阈值逐渐增高,病变组神经阈值明显高于健康对照组(P<0.05),HbA1c≥9组又明显高于HbA1c<9组(P<0.05)。相关性分析提示,尺神经的运动神经阈值和腓浅神经感觉支的感觉神经阈值与HbA1c水平呈正相关(P<0.05),而正中神经的运动神经阈值与HbA1c水平之间无显著相关性(P>0.05)。3条神经的运动/感觉神经阈值与病程均呈正相关(P<0.05)。结论神经阈值随糖尿病病程及HbA1c水平变化而变化,反映了神经兴奋性的动态变化情况,有助于糖尿病神经病变的诊断及周围神经功能评估。

Objective To explore the value of neural thresholds in diagnosing and treating diabetic peripheral neuropathy.Methods A total of 42 type 2 diabetics and 21 healthy counterparts were recruited,and grouped according to the patients'illness duration and level of hemoglobin A1c(HbA1C).The neural thresholds of their median,ulnar and superficial peroneal nerves were measured.Results The neural thresholds increased with the disease's duration.The average neural threshold of those living with the disease for 10 years or more was significantly higher than that with a duration of less than 10 years.The nerve thresholds also increased with the level of hemoglobin A1c(HbA1C),and they were significantly higher in the group with an HbA1C level ≥9 than those in the group with HbA1C<9.There was a positive linear correlation between the neural threshold of the ulnar and superficial peroneal nerves and the HbA1C level(P<0.05).However,there was no significant correlation between the neural thresholds of the median nerves and the level of HbA1C(P>0.05).There was also a positive linear correlation between the neural thresholds of the median,ulnar and superficial peroneal nerves and the duration of the disease(P<0.01).Conclusion The neural threshold changes with the duration of diabetes and the level of HbA1C.Evaluating the peripheral nerve function of diabetics may have clinical utility.