1型糖尿病患者糖尿病周围神经病变的临床特征及危险因素

Clinical features and risk factors of diabetic peripheral neuropathy in patients with type 1 diabetes

目的:探究1型糖尿病患者糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的临床特征及危险因素,为临床上早期诊断DPN提供理论支撑。方法:选择本院收治的42例1型糖尿病(T1DM)患者为T1DM组,将体检中心招募的38名健康者归为正常对照组,记录年龄、病程等资料,检测神经传导速度(NCV),用3个预定频率(5 Hz、250 Hz和2 000 Hz)测量双侧正中神经和腓肠神经感知阈值(CPT)。比较TIDM组和正常对照组CPT值。分析TIDM组不同神经CPT值,并进一步探讨了影响DPN的危险因素。结果:(1)T1DM组患者双侧正中神经和腓肠神经CPT值均低于正常对照组患者(P<0.05)。(2)下肢神经异常率较上肢神经显著增加(χ2=40.39,P<0.001);同时,同侧上下肢神经异常率比对发现,腓肠神经的异常率远高于同侧的正中神经(χ^2 1=25.93,P 1<0.001;χ^2 2=15.22,P 2<0.001)。除250 Hz频率左侧正中神经与左腓肠神经CPT值无显著性差异(0.296>0.05)外,在相同频率下,中位神经的CPT值明显高于同侧腓肠神经(P<0.05)。(3)在250 Hz频率刺激下,两侧正中神经易于感觉减退;在5 Hz频率刺激下,右正中神经易于感觉减退(P<0.05)。腓肠神经在三种频率下都趋于感觉过敏(P<0.01)。在2 000 Hz和250 Hz频率刺激下,右侧正中神经异常率较左侧显著性升高(P<0.05);而在250 Hz和5 Hz频率刺激下,左侧腓肠神经异常率远高于右侧,有显著性差异(P<0.05)。(4)病程(OR=1.05,95%CI:0.96~1.16,P=0.047)、2 000 Hz频率下右侧正中神经的CPT值(OR=1.86,95%CI:1.13~3.05,P=0.016)和250 Hz频率下右侧正中神经的CPT值(OR=1.86,95%CI:1.13~3.05,P=0.013)为NCV结果异常的危险因素。结论:T1DM的DPN主要是下肢神经损伤,且细有髓鞘神经(Aδ)纤维和无髓鞘神经(C)纤维更容易损伤,将CPT和传统的神经传导检查(NCS)相结合有利于更早、更精确诊断T1DM患者DPN。

Objective:To investigate the clinical features and risk factors of diabetic peripheral neuropathy (DPN) in patients with type 1 diabetes mellitus,and to provide theoretical support for the early diagnosis of DPN.Methods:A total of 42 patients with type 1 diabetes mellitus (T1DM) admitted to our hospital were enrolled in the T1DM group.38 healthy individuals enrolled in the physical examination center were assigned to the normal control group.Age,duration and other data were recorded to detect nerve conduction velocity (NCV).The bilateral median nerve and sural nerve sensing threshold (CPT) were measured at three predetermined frequencies (5 Hz,250 Hz and 2000 Hz).The CPT values of the TIDM group and the normal control group were compared.Different nerve CPT values in the TIDM group were analyzed,and the risk factors affecting DPN were further explored.Results:The CPT values of the median nerve and sural nerve in the T1DM group were lower than those in the normal control group ( P <0.05).The abnormal rate of lower limb nerves was significantly higher than that of upper limb nerves (χ^2=40.39, P <0.001).At the same time,the abnormal rate of ipsilateral upper and lower limb nerve abnormalities was found to be much higher than that of the ipsilateral median nerve (χ1^2 = 25.93, P 1<0.001;χ2^2 = 15.22, P 2 <0.001).Except for the CPT values of the left median nerve and left sural nerve at 250 Hz,there was no significant difference ( P =0.296>0.05).At the same frequency,the CPT value of the median nerve was significantly higher than that of the ipsilateral sural nerve ( P <0.05).Under the stimulation of 250Hz frequency,the median nerves on both sides were prone to fainting.Under the stimulation of 5Hz frequency,the right median nerve was prone to sensation ( P <0.05).The sural nerves tend to be allergic at all three frequencies ( P <0.01).At 2000Hz and 250Hz frequency stimulation,the right median nerve abnormality rate was significantly higher than the left side ( P <0.05),while at 250 and 5Hz frequency stimulation,the left sural nerve abnormal rate was much higher than the right side,the difference was statistically significant( P <0.05).Course of disease ( OR =1.05,95% CI:0.96~1.16, P = 0.047),CPT value of right median nerve at 2000 Hz ( OR = 1.86,95% CI:1.13~3.05, P =0.016) and the CPT value of the right median nerve at 250 Hz ( OR =1.86,95% CI:1.13~3.05, P =0.013) was a risk factor for abnormal NCV results.Conclusion:The DPN of T1DM is mainly caused by lower limb nerve injury,and the fine myelinated nerve (Aδ) fiber and unmyelinated nerve (C) fiber are more likely to be damaged.Combining CPT with traditional nerve conduction test (NCS) is beneficial to more.Early and more accurate diagnosis of DPN in patients with TIDM.