糖尿病前期周围神经病的神经电生理研究

Study on electrophysiology of prediabetic peripheral neuropathy

目的探讨神经电生理(神经传导、F波及皮肤交感反应)检查对糖尿病前期周围神经病的诊断价值。方法选取100例糖尿病前期患者、50例糖尿病患者及50例健康志愿者,糖尿病前期患者又分为糖耐量异常及空腹血糖受损组,分别为55例及45例;对上述对象进行四肢神经传导(Nerve conduction studies,NCS)、F波、皮肤交感反应(Skin sympathetic response,SSR)检查。结果(1)糖耐量异常组正中神经感觉动作电位(Sensory nerve active potential,SNAP)、胫后和腓总神经SNAP及感觉传导速度(Sensory nerve conduction velocity,SCV)均低于正常对照组及空腹血糖受损组,空腹血糖受损组腓总神经SNAP、胫后神经SCV均低于正常对照组(P均<0.05);(2)空腹血糖受损组、糖耐量异常组上肢及下肢SSR波幅均低于正常对照组(P均<0.05),糖耐量异常组下肢SSR波幅低于空腹血糖受损组(P均<0.05);(3)糖耐量异常组F波、感觉神经NCS,SSR异常的比例多于正常对照组,空腹血糖受损组SSR异常比例多于正常对照组,糖耐量异常组感觉神经NCS异常的比例多于空腹血糖受损组(P均<0.05)。结论糖尿病前期患者存在周围有髓鞘大感觉神经纤维及无髓鞘小神经纤维损害,其中糖耐量异常患者周围神经损害重于空腹血糖受损患者,电生理检查以感觉神经NCS及SSR异常为主,利用神经电生理技术利于其周围神经损害的早期诊断。

Objective To investigate the diagnostic value of nerve conduction studies(NCS),F wave and skin sympathetic response(SSR)in prediabetic peripheral neuropathy.Methods A total of 100 prediabetic patients,50 diabetic patients and 50 healthy volunteers were selected.The prediabetic patients were divided into abnormal glucose tolerance group and impaired fasting glucose group,including 55 cases and 45 cases respectively.NCS,F wave and SSR were performed on the limbs of the above-mentioned patients.Results(1)The sensory nerve active potential(SNAP)of median nerve,SNAP and sensory nerve conduction velocity(SCV)of posterior tibial nerve and common peroneal nerve in the abnormal glucose tolerance group were lower than those in the normal control group and the impaired fasting glucose group.The SNAP of the common peroneal nerve and SCV of the posterior tibial nerve in the impaired fasting glucose group were lower than those in the normal control group(P<0.05).(2)The amplitudes of SSR in upper and lower limbs in impaired fasting glucose group and abnormal glucose tolerance group were lower than those in the normal control group(P<0.05),while the amplitudes of SSR in lower limbs in abnormal glucose tolerance group were lower than those in impaired fasting glucose group(P<0.05).(3)The proportion of patients with abnormal F wave,sensory NCS and SSR in the abnormal glucose tolerance group was more than that in the normal control group(P<0.05);the proportion of patients with abnormal SSR in the impaired fasting glucose group was more than that in the normal control group(P<0.05);the proportion of patients with abnormal sensory NCS in the abnormal glucose tolerance group was more than that in the impaired fasting glucose group(P<0.05).Conclusion There are damaged myelinated large sensory nerve fibers and unmyelinated small nerve fibers in patients with prediabetes,especially damaged peripheral nerve in patients with abnormal glucose tolerance is more seriously than patients with impaired fasting glucose.Electrophysiological examination is mainly about abnormal NCS and SSR of sensory nerves.Neural electrophysiological technique is benefit for the early diagnosis of peripheral neuropathy in patients with prediabetes.