无症状2型糖尿病周围神经病变的早期诊断方法研究

Early diagnosis of asymptomatic type 2 diabetic peripheral neuropathy

目的 探讨无症状2型糖尿病(T2DM)周围神经病变(DPN)的早期诊断方法.方法 选取T2DM患者100例,根据神经传导速度(NCV)测定结果诊断为单纯T2DM非DPN患者20例,无症状DPN患者80例.对无症状DPN患者进行多伦多临床评分系统(TCSS)评估,轻度DPN 39例,中度DPN 41例,重度DPN 0例.比较轻度DPN组、中度DPN组、单纯T2DM非DPN组TCSS评分、腓浅神经及腓肠神经的感觉NCV(SCV)、腓总神经及胫神经的运动NCV(MCV)、振动感觉阈值(VPT).结果 3组患者TCSS评分比较,差异有统计学意义(P<0.05).与单纯T2DM非DPN组比较,轻、中度DPN组两侧腓浅神经及腓肠神经的SCV、腓总神经及胫神经的MCV均明显减慢,差异均有统计学意义(均P<0.05);中度DPN组均明显低于轻度DPN组,差异均有统计学意义(均P<0.05).根据VPT检测结果,单纯T2DM非DPN组均为低风险,轻度DPN组均为中风险,中度DPN组均为高风险.与单纯T2DM非DPN组比较,轻、中度DPN组左右足VPT均明显增高(均P<0.05);中度DPN组均明显高于轻度DPN组(均P<0.05).结论 临床上T2DM患者早期无症状DPN的发病率较高,应引起重视.NCV联合VPT检测结果与TCSS评分具有高度一致性,对早期诊断无症状DPN具有重要意义.

Objective To explore the early diagnostic methods of asymptomatic diabetic peripheral neuropathy(DPN)in type 2 diabetes mellitus(T2DM).Methods One hundred T2DM patients were enrolled in the study.According to nerve conduction velocity(NCV)measurements there were 80 cases with asymptomatic DPN(DPN group)and 20 cases without DPN(non-DPN group).As assessed with Toronto clinical scoring system(TCSS),there were 39 patients with mild DPN and 41 cases with moderate DPN in DPN group.The TCSS scores,sensory NCV(SCV)of sural nerve and superficial peroneal nerve,motor NCV(MCV)of common peroneal nerve and tibial nerve,and vibration perception threshold(VPT)results were compared among the patients of mild DPN group,moderate DPN group,and non-DPN group.Results There were significant differences in TCSS scores among the three groups(P<0.05).Compared with the non-DPN group,the SCV of the superficial peroneal nerve and sural nerve and the MCV of the common peroneal nerve and tibial nerve were significantly slower in the mild and moderate DPN groups(all P<0.05).The above indicators in moderate DPN group was significantly lower than those in the mild DPN group(all P<0.05).Based on the results of the VPT examination,the non-DPN group was low risk,the mild DPN group was intermediate risk,and the moderate DPN group was high risk.Compared with the non-DPN group,the VPT results of the left and right feet were significantly higher in the mild and moderate DPN group(all P<0.05).The VPT results of moderate DPN group were significantly higher than those of the mild DPN group(all P<0.05).Conclusion Clinically,the incidence of early asymptomatic DPN in patients with T2DM is high.The combination of NCV and VPT is highly consistent with the clinical score of TCSS,which is of significant value for the early diagnosis of asymptomatic DPN in T2DM patients.