糖调节受损周围神经病变的神经电生理特征性分析研究

Neuroelectrophysiological Characteristics of Peripheral Neuropathy with Impaired Glucose Regulation

目的:探讨糖调节受损周围神经病变的神经电生理特征性分析,联合多伦多临床评分系统对糖调节受损合并周围神经病变的诊断价值,为临床医师提供早期发现糖调节受损患者的周围神经病变资料。方法:选取2021年1月至2022年12月我院收治的200例受试者资料作为研究组,所有受试者的多伦多临床评分系统均不低于6分。其中空腹血糖受损患者68例,糖耐量异常患者66例,2型糖尿病患者66例。将其分为三组,即空腹血糖受损+周围神经病变-A组,糖耐量异常+周围神经病变-B组和糖尿病周围神经病变-C组。同时选取同期200例健康体检者作为对照组。结果:感觉神经传导检测中可见,研究组正中神经SCV、SNAP波幅明显低于对照组,经统计学分析差异有统计学意义(P<0.05);C组正中神经SCV、SNAP波幅较A组、B组和对照组均显著降低;研究组腓肠神经和腓浅神经SNAP波幅显著降低,与对照组比较差异有统计学意义(P<0.05);B组和C组的腓浅神经和腓肠神经SCV均降低,与对照组比较有统计学意义(P<0.05);对照组与A组腓肠神经及腓浅神经SCV比较无统计学意义(P>0.05);C组正中、腓浅、腓肠神SNAP波幅及SCV均显著低于A组,经统计下分析有统计学意义(P<0.05);A组、B组、C组及对照组尺神经SNAP及SCV波幅经统计学分析无统计学意义(P>0.05)。运动神经传导检测中可见;C组正中神经、胫神经以及腓总神经MCV、CMAP波幅相比对照组有显著降低,DML与对照组比较可见延长(P<0.05);B组与对照组相比可见,正中神经、胫神经、腓总神经CMAP波幅显著降低,DML可见延长,腓总神经、正中神经MCV显著降低(P<0.05);A组正中神经MCV、胫神经CMAP波幅明显低于对照组,有统计学意义(P<0.05);C组正中神经和腓总神经CMAP波幅、胫神经MCV、DML延长相比A组,明显减慢(P<0.05);B组费用神经CMAP波幅与A组相比较显著降低,DML有延长(P<0.05)。A组、B组、C组中尺神经、胫神经F波平均潜伏期明显高于对照组,经统计学分析有统计学意义(P<0.05);A组、B组、C组中尺神经、胫神经F波出现率明显低于对照组(P<0.05);C组尺神经F波出现率、胫神经F波平均潜伏期有所延长,均明显下降;A组胫神经与B组相比较,有统计学意义(P<0.05);A组尺神经、胫神经及F波出现率与C组相比,有统计学意义(P<0.05)。结论:糖调节受损合并周围神经病变者,其脂代谢的异常和血脂异常与DPN的患者相似,均已甘油三酯和低密度脂蛋白水平的升高为主。周围神经病变早期表现不明显,故应早期结合患者的临床表现进行神经电生理的检查,以便及早发现和治疗。

Objective:To investigate the characteristic neurophysiological analysis of peripheral neuropathy with impaired glucose regulation and the diagnostic value of the Toronto Clinical Scoring System for the combination of peripheral neuropathy with impaired glucose regulation,and to provide clinicians with information for the early detection of peripheral neuropathy in patients with impaired glucose regulation.Methods:The data of 200 subjects admitted to our hospital from January 2021 to December 2022 were selected as the study group,and all subjects had a score of no less than 6 on the Toronto Clinical Scoring System.There were 68 patients with impaired fasting glucose,66 patients with abnormal glucose tolerance and 66 patients with type 2 diabetes mellitus.They were divided into three groups,namely impaired fasting glucose+peripheral neuropathy-group A,abnormal glucose tolerance+peripheral neuropathy-group B and diabetic peripheral neuropathy-group C.Meanwhile,200 cases of healthy physical examiners were selected as the control group during the same period.Results:As seen in the sensory nerve conduction test,the SCV and SNAP wave amplitudes of the median nerve in the study group were significantly lower than those of the control group,and the difference was statistically significant by statistical analysis(P<0.05);the SCV and SNAP wave amplitudes of the median nerve in group C were significantly lower than those of groups A,B and the control group;the SNAP wave amplitudes of the gastrocnemius and superficial peroneal nerve in the study group were significantly lower,and the difference was statistically significant when compared with the control group(P<0.05);superficial peroneal nerve and peroneal nerve SCV were reduced in both groups B and C,which were statistically significant when compared with the control group(P<0.05);there was no statistically significant difference between the control group and group A in terms of peroneal nerve and superficial peroneal nerve SCV(P>0.05);median,superficial peroneal and peroneal nerve SNAP wave amplitude and SCV in group C were significantly lower than those in group A,which were statistically significant by sub-statistical analysis(P<0.05);the ulnar nerve SNAP and SCV wave amplitudes in group A,group B,group C and control group were not statistically significant by statistical analysis(P>0.05).In the motor nerve conduction test,it was seen that the MCV and CMAP wave amplitudes of the median nerve,tibial nerve and common peroneal nerve were significantly lower in group C compared with the control group,and the DML was seen to be prolonged compared with the control group(P<0.05);in group B compared with the control group,it was seen that the CMAP wave amplitudes of the median nerve,tibial nerve and common peroneal nerve were significantly lower,the DML was seen to be prolonged,and the MCV of the common peroneal nerve and median nerve were significantly lower(P<0.05);CMAP wave amplitude of median nerve and tibial nerve in group A was significantly lower than that in the control group,which was statistically significant(P<0.05);CMAP wave amplitude of median nerve and common peroneal nerve,MCV of tibial nerve and DML prolongation in group C were significantly slower compared with group A(P<0.05);CMAP wave amplitude of costal nerve in group B was significantly lower compared with group A,and DML had prolongation(P<0.05).The mean latency of F waves of ulnar nerve and tibial nerve in groups A,B and C was significantly higher than that in the control group,which was statistically significant by statistical analysis(P<0.05);the emergence rate of F waves of ulnar nerve and tibial nerve in groups A,B and C was significantly lower than that in the control group(P<0.05);the emergence rate of F waves of ulnar nerve and the mean latency of F waves of tibial nerve in group C were prolonged and all decreased significantly;the tibial nerve in group A was compared with group B There was statistical significance(P<0.05)when comparing the tibial nerve in group A with group B;there was statistical significance(P<0.05)when comparing the appearance rate of ulnar nerve,tibial nerve and F wave in group A with group C.Conclusion:In patients with impaired glucose regulation combined with peripheral neuropathy,the abnormalities of lipid metabolism and dyslipidemia are similar to those of patients with DPN,with elevated levels of triglycerides and low-density lipoproteins predominating.The early manifestations of peripheral neuropathy are not obvious,so neurophysiological examination should be performed early in conjunction with the clinical manifestations of the patient to facilitate early detection and treatment.