神经电生理指标与糖尿病周围神经病变病情分级的相关性分析
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摘要
目的探讨神经电生理指标与糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)病情分级的相关性。方法选择DPN患者90例作为观察组,健康体检者90例作为对照组,检测2组运动神经传导速度、远端潜伏期、波幅,记录皮肤交感反应(sympathetic skin response,SSR)、上肢躯体感觉诱发电位(somatosensory evokedpotential,SEP)和下肢SEP异常率。判定DPN分级情况,分析病情分级与神经电生理指标的相关性。结果观察组运动神经传导速度、波幅明显小于对照组,远端潜伏期以及SSR、上肢SEP、下肢SEP异常率较对照组明显增加(P<0.05)。DPN患者中Ⅰ级45例,Ⅱ级20例,Ⅲ级15例,Ⅳ级10例。随着DPN病情加重,运动神经传导速度、波幅均明显减小,远端潜伏期以及SSR、上肢SEP、下肢SEP异常率均明显增加(P<0.05)。DPN病情分级与运动神经传导速度、波幅呈负相关,与远端潜伏期、SSR、上肢SEP和下肢SEP呈正相关(P<0.05)。结论神经电生理指标可提高DPN的确诊率,并反映患者的病情状况,有助于DPN的早期发现和治疗。
Objective To investigate the correlation between neurophysiological parameters and the classification of diabetic peripheral neuropathy(DPN).Methods The 90 patients with DPN were selected as the observation group,and 90 healthy subjects were used as the control group.The motor nerve conduction velocity,distal latency and amplitude were measured.The sympathetic skin response(SSR),upper limb somatosensory evoked potential(SEP)and lower limb SEP abnormalities were recorded.The DPN grading situation was determined and the correlation between disease grading and neurophysiological indicators was analyzed.Results The motor nerve conduction velocity and amplitude of the observation group were significantly lower than those of the control group.The abnormal rate of distal latency,SSR,upper limb SEP and lower limb SEP was significantly higher than that of the control group(P<0.05).Among the 90 patients with DPN,45 patients were gradeⅠ,20 patients were gradeⅡ,15 patients were gradeⅢ,and 10 patients were grade Ⅳ.With the aggravation of DPN,the motor nerve conduction velocity and amplitude were significantly reduced,and the abnormal rates of distal latency,SSR,upper limb SEP and lower limb SEP were significantly increased(P<0.05).The grade of DPN were negatively correlated with motor nerve conduction velocity and amplitude,and were positively correlated with distal latency,SSR,upper limb SEP and lower limb SEP(P<0.05).Conclusion The application of neurophysiological indicators in patients with DNP can improve the diagnosis rate of DPN,reflect the patient's condition and contribute to the early detection and treatment of DPN.
Objective To investigate the correlation between neurophysiological parameters and the classification of diabetic peripheral neuropathy(DPN).Methods The 90 patients with DPN were selected as the observation group,and 90 healthy subjects were used as the control group.The motor nerve conduction velocity,distal latency and amplitude were measured.The sympathetic skin response(SSR),upper limb somatosensory evoked potential(SEP)and lower limb SEP abnormalities were recorded.The DPN grading situation was determined and the correlation between disease grading and neurophysiological indicators was analyzed.Results The motor nerve conduction velocity and amplitude of the observation group were significantly lower than those of the control group.The abnormal rate of distal latency,SSR,upper limb SEP and lower limb SEP was significantly higher than that of the control group(P<0.05).Among the 90 patients with DPN,45 patients were gradeⅠ,20 patients were gradeⅡ,15 patients were gradeⅢ,and 10 patients were grade Ⅳ.With the aggravation of DPN,the motor nerve conduction velocity and amplitude were significantly reduced,and the abnormal rates of distal latency,SSR,upper limb SEP and lower limb SEP were significantly increased(P<0.05).The grade of DPN were negatively correlated with motor nerve conduction velocity and amplitude,and were positively correlated with distal latency,SSR,upper limb SEP and lower limb SEP(P<0.05).Conclusion The application of neurophysiological indicators in patients with DNP can improve the diagnosis rate of DPN,reflect the patient's condition and contribute to the early detection and treatment of DPN.
引文
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[18] Chiu YC,Liao WT,Liu CK,et al.Reduction of spinal glycinereceptor-mediated miniature inhibitory postsynaptic currentsin streptozotocin-induced diabetic neuropathic pain[J].Neurosci Lett,2016,611:88-93.
[19] 刘平.TCSS评分在2型糖尿病周围神经病变筛查和治疗中的应用[J].海南医学,2012,23(17):21-23.
[20] Pitarokoili K,Kerasnoudis A,Behrendt V,et al.Facing thediagnostic challenge:Nerve ultrasound in diabetic patientswith neuropathic symptoms[J].Muscle Nerve,2016,54(1):18-24.
[21] Xu ZZ,Kim YH,Bang S,et al.Inhibition of mechanicalallodynia in neuropathic pain by TLR5-mediated A-fiberblockade[J].Nat Med,2015,21(11):1326-1331.
[22] Kharatmal SB,Singh JN,Sharma SS.Calpain inhibitor,MDL28170 confer electrophysiological, nociceptive andbiochemical improvement in diabetic neuropathy[J].Neuropharmacology,2015,97:113-121.
[23] 白亚娟,方桂珍.临床症状积分表在糖尿病周围神经病变筛查中的应用价值[J].解放军护理杂志,2015,32(4):20-22,26.
[24] Lovblom LE,Halpern EM,Wu T,et al.In vivo cornealconfocal microscopy and prediction of future-incidentneuropathy in type 1diabetes:apreliminary longitudinalanalysis[J].Can J Diabetes,2015,39(5):390-397.
[25] Petropoulos IN,Ferdousi M,Marshall A,et al.The inferiorwhorl for detecting diabetic peripheral neuropathy usingcorneal confocal microscopy[J].Invest Ophthalmol Vis Sci,2015,56(4):2498-2504.
[2] 车春晖,魏笑凡,黄华品,等.糖尿病周围神经病患者神经电生理与临床症状相关分析[J].中华全科医师杂志,2016,15(5):366-370.
[3] Trivedi JR,Phillips L,Chhabra A.Hereditary and acquiredpolyneuropathy conditions of the peripheral nerves:clinicalconsiderations and MR neurography imaging[J].SeminMusculoskelet Radiol,2015,19(2):130-136.
[4] Morales-Vidal S,Morgan C,McCoyd M,et al.Diabeticperipheral neuropathy and the management of diabeticperipheral neuropathic pain[J].Postgrad Med,2012,124(4):145-153.
[5] Deshmukh V,Deshmukh C.Achieving good glycaemiccontrol-effective use of self monitoring of blood glucose(SMBG)[J].J Indian Med Assoc,2012,110(3):161-163.
[6] 杨丹,鲍海萍,黄山.糖尿病周围神经病变患者的电生理检查结果及患病危险因素分析[J].中国糖尿病杂志,2016,24(6):540-542.
[7] Witzel II,Jelinek HF,Khalaf K,et al.Identifying commongenetic risk factors of diabetic neuropathies[J].FrontEndocrinol(Lausanne),2015,6:88.
[8] 李蕾,张红霞,李清楚,等.运动诱发电位对2型糖尿病马尾神经近端损害的诊断价值[J].郑州大学学报:医学版,2016,51(3):401-405.
[9] Misra SL,Craig JP,Patel DV,et al.In vivo confocalmicroscopy of corneal nerves:an ocular biomarker forperipheral and cardiac autonomic neuropathy in type 1diabetes mellitus[J].Invest Ophthalmol Vis Sci,2015,56(9):5060-5065.
[10] Cheng C,Kobayashi M,Martinez JA,et al.Evidence forepigenetic regulation of gene expression and function inchronic experimental diabetic neuropathy[J].J NeuropatholExp Neurol,2015,74(8):804-817.
[11] 庞国明,郑晓东,朱璞,等.糖尿病周围神经病变的中医证型与神经电生理的相关性研究[J].中医临床研究,2014,6(33):17-20.
[12] Wiessman MP,Liberty IF,Segev RW,et al.Clinicalcharacteristics and survival of patients with diabetes mellitusfollowing non-traumatic lower extremity amputation[J].IsrMed Assoc J,2015,17(3):145-149.
[13] Yan LH,Mu B,Guan Y,et al.Assessment of the relationshipbetween non-alcoholic fatty liver disease and diabeticcomplications[J].J Diabetes Investig,2016,7(6):889-894.
[14] 张娜,段伟松,高长玉.糖尿病周围神经病病情分级与电生理的相关性[J].脑与神经疾病杂志,2010,18(6):436-438.
[15] Won JC,Park TS.Recent Advances in Diagnostic Strategiesfor Diabetic Peripheral Neuropathy[J].Endocrinol Metab(Seoul),2016,31(2):230-238.
[16] Erbas O,Oltulu F,Ylmaz M,et al.Neuroprotective effects ofchronic administration of levetiracetam in a rat model ofdiabetic neuropathy[J].Diabetes Res Clin Pract,2016,114:106-116.
[17] 朱祖福,张慧萍,孔玉,等.以眩晕失衡为主要表现的糖尿病神经病变30例分析[J].中国实用神经疾病杂志,2016,19(1):108-109.
[18] Chiu YC,Liao WT,Liu CK,et al.Reduction of spinal glycinereceptor-mediated miniature inhibitory postsynaptic currentsin streptozotocin-induced diabetic neuropathic pain[J].Neurosci Lett,2016,611:88-93.
[19] 刘平.TCSS评分在2型糖尿病周围神经病变筛查和治疗中的应用[J].海南医学,2012,23(17):21-23.
[20] Pitarokoili K,Kerasnoudis A,Behrendt V,et al.Facing thediagnostic challenge:Nerve ultrasound in diabetic patientswith neuropathic symptoms[J].Muscle Nerve,2016,54(1):18-24.
[21] Xu ZZ,Kim YH,Bang S,et al.Inhibition of mechanicalallodynia in neuropathic pain by TLR5-mediated A-fiberblockade[J].Nat Med,2015,21(11):1326-1331.
[22] Kharatmal SB,Singh JN,Sharma SS.Calpain inhibitor,MDL28170 confer electrophysiological, nociceptive andbiochemical improvement in diabetic neuropathy[J].Neuropharmacology,2015,97:113-121.
[23] 白亚娟,方桂珍.临床症状积分表在糖尿病周围神经病变筛查中的应用价值[J].解放军护理杂志,2015,32(4):20-22,26.
[24] Lovblom LE,Halpern EM,Wu T,et al.In vivo cornealconfocal microscopy and prediction of future-incidentneuropathy in type 1diabetes:apreliminary longitudinalanalysis[J].Can J Diabetes,2015,39(5):390-397.
[25] Petropoulos IN,Ferdousi M,Marshall A,et al.The inferiorwhorl for detecting diabetic peripheral neuropathy usingcorneal confocal microscopy[J].Invest Ophthalmol Vis Sci,2015,56(4):2498-2504.