肌电图多参数检测对2型糖尿病患者无症状性周围神经病变的诊断价值分析

Diagnostic Value of Multi-parameter Detection of Electromyography in Asymptomatic Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus

目的:探讨肌电图对无症状糖尿病周围神经病变(DPN)的诊断价值。方法:选取2020年1月~2022年12月就诊于本院的2型糖尿病(T2DM)患者142例,根据是否伴随DPN将患者分为DPN组(n=68)与单纯T2DM组(n=74)。患者均进行神经肌电图检测,包括神经传导(NCS)F波、H反射的检测;比较两组各项肌电图参数和NCS、F波、H反射异常率,并应用受试者工作特征(ROC)曲线评价NCS异常、F波异常、H反射异常及其联合对DPN的诊断效能。结果:相比单纯T2DM组,DPN组正中神经、尺神经等神经的远端运动潜伏期(DML)显著延长(P<0.05),复合肌肉动作电位显著降低(P<0.05);同时DPN组感觉传导参数感觉传导速度(SNCV)、感觉神经动作电位(SNAP)低于单纯T2DM组(P<0.05)。相比单纯T2DM组,DPN组尺神经和胫后神经的平均潜伏期(Fmean)和F波离散度(Fchd)均显著延长(P<0.05)。DPN组胫后神经的最短潜伏期(Hmin)相比单纯T2DM组显著延长(P<0.05)。DPN组NCS异常率、F波异常率以及H反射异常率均显著高于单纯T2DM组(P<0.05)。ROC曲线分析显示,NCS、F波、H反射诊断DPN的曲线下面积分别为0.659、0.614.0.671,三者联合的AUC为0.753,相比各单一指标均显著提高(P<0.05)。结论:肌电图对于无症状DPN有着重要诊断作用,NCS、F波、H反射三项联合检测有助于提高DPN的早期诊断效能。

Objective:To investigate the diagnostic value of electromyography in asymptomatic diabetic peripheral neuropathy(DPN).Methods:142 patients with type 2 diabetes mellitus(T2DM)who were treated in our hospital from January 2020 to December 2022 were selected.According to whether they were accompanied by DPN,the patients were divided into DPN group(n=68)and simple T2DM group(n=74).All patients underwent nerve muscle point map detection,including nerve conduction(NCS),F wave and H reflex detection.The EMG parameters and abnormal rates of NCS,F wave and H reflex were compared between the two groups.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of NCS abnormality,F wave abnormality,H reflex abnormality and their combination for DPN.Results:Compared with T2DM group,the distal motor latency(DML)of median nerve and ulnar nerve in DPN group was significantly increased(P<0.05),and the compound muscle action potential was significantly decreased(P<0.05).At the same time,the sensory conduction parameters of sensory conduction velocity(SNCV)and sensory nerve action potential(SNAP)in DPN group were lower than those in simple T2DM group(P<0.05).Compared with T2 DM group,the mean latency(Fmean)and F wave dispersion(Fchd)of ulnar nerve and posterior tibial nerve in DPN group were significantly prolonged(P<0.05).The shortest latency(Hmin)of posterior tibial nerve in DPN group was significantly longer than that in T2DM group(P<0.05).The abnormal rates of NCS,F wave and H reflex in DPN group were significantly higher than those in T2 DM group(P<0.05).ROC curve analysis showed that the areas under the curve of NCS,F wave and H reflex in the diagnosis of DPN were 0.659,0.614 and 0.671,respectively.The AUC of the combination of the three was 0.753,which was significantly higher than that of each single index(P<0.05).Conclusion:Electromyography plays an important role in the diagnosis of asymptomatic DPN.The combined detection of NCS,F wave and H reflex is helpful to improve the early diagnosis of DPN.