人体定量电流感觉检测系统的研制
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摘要
临床上的许多疾病的过程往往伴随着人体感觉功能的变化，引起感觉迟钝或过敏。目前对人体感觉系统的检查多停留于定性的检查，不能满足医生深入了解感觉变化过程的需要。从上世纪70年代后期发展起来的定量感觉测量方法能够帮助医生定量的跟踪人体感觉的阈值的变化。我们研究的定量电流感觉测量方法就是一种定量感觉测量的新技术。
本文首先讨论了感觉神经功能评价的意义和当前神经系统检查手段的现状，回顾了定量感觉测量技术的发展和应用。然后详细论述了定量电流感觉测量系统的理论基础，包括三个方面：生理学基础；阈值检出算法(UDTR和Forced Choice方法)的理论基础；实验基础，即大量实验表明，5Hz，250Hz和2000Hz的正弦交流电流刺激分别可以代替加热，致冷和振动信号。
系统的设计部分是本文的重点。本系统有两种工作模式：下位机独立工作和通过RS232由上位机主控系统运行。下位机系统采用电池加DC／DC转换供电，CPU采用德州仪器的DSP，TMS320LF2407。下位机独立工作时，由DSP控制所有的接口和算法执行；模拟部分负责完成恒幅正弦电流输出的驱动和信号的反馈。系统采用软件硬件双重保护。
我们对系统进行了性能测试和初步的临床实验。结果表明，该系统能够稳定可靠的工作；在控制实验中得到的阈值数据有很好的可重复性。
最后，探讨了定量电流感觉测量方法的进一步研究和第二代系统需要改进的地方。
Lots of diseases come with dysfunctions to the sensory system, causing hypoesthesia or hyperesthesia. But most of the examinations for sensory system are not quantitative. By 1970th a novel method named Quantitative Sensory Testing makes it possible for doctors to trace the changes of the sensory threshold of patients. The Current Perception Threshold system we developed is one of these kinds of methods.
First, the significance to evaluate the sensory function and the current methods are discussed. The development and application history of Quantitative Sensory Testing technology is also reviewed. Then, Current Perception Threshold system is discussed in details including three main aspects: physiological background, theory of UDTR and Forced Choice method and experiment basis providing the evidence for us to substitute heating, cooling and vibration signals with 5Hz, 250Hz, 2000Hz sine current signals, respectively.
The most important part of this thesis is the design of the system. The CPT system has two work modes: the embedded system runs independently and system runs controlled by PC. The embedded system is powered up with a battery and DC/DC converters. And the CPU is TMS320LF2407. When the embedded system works independently, the DSP controls the interface and performances the algorithms while the analog part implements V/I converting, constant current output and feedback stage. The system has both software and hardware protections.
Performance testing of the system and the clinical experiments are carried out. It shows in the result that the system works stably. The experiment results are almost repeatable under the same conditions.
At last, future research of the method and system improvement is discussed.
本文首先讨论了感觉神经功能评价的意义和当前神经系统检查手段的现状，回顾了定量感觉测量技术的发展和应用。然后详细论述了定量电流感觉测量系统的理论基础，包括三个方面：生理学基础；阈值检出算法(UDTR和Forced Choice方法)的理论基础；实验基础，即大量实验表明，5Hz，250Hz和2000Hz的正弦交流电流刺激分别可以代替加热，致冷和振动信号。
系统的设计部分是本文的重点。本系统有两种工作模式：下位机独立工作和通过RS232由上位机主控系统运行。下位机系统采用电池加DC／DC转换供电，CPU采用德州仪器的DSP，TMS320LF2407。下位机独立工作时，由DSP控制所有的接口和算法执行；模拟部分负责完成恒幅正弦电流输出的驱动和信号的反馈。系统采用软件硬件双重保护。
我们对系统进行了性能测试和初步的临床实验。结果表明，该系统能够稳定可靠的工作；在控制实验中得到的阈值数据有很好的可重复性。
最后，探讨了定量电流感觉测量方法的进一步研究和第二代系统需要改进的地方。
Lots of diseases come with dysfunctions to the sensory system, causing hypoesthesia or hyperesthesia. But most of the examinations for sensory system are not quantitative. By 1970th a novel method named Quantitative Sensory Testing makes it possible for doctors to trace the changes of the sensory threshold of patients. The Current Perception Threshold system we developed is one of these kinds of methods.
First, the significance to evaluate the sensory function and the current methods are discussed. The development and application history of Quantitative Sensory Testing technology is also reviewed. Then, Current Perception Threshold system is discussed in details including three main aspects: physiological background, theory of UDTR and Forced Choice method and experiment basis providing the evidence for us to substitute heating, cooling and vibration signals with 5Hz, 250Hz, 2000Hz sine current signals, respectively.
The most important part of this thesis is the design of the system. The CPT system has two work modes: the embedded system runs independently and system runs controlled by PC. The embedded system is powered up with a battery and DC/DC converters. And the CPU is TMS320LF2407. When the embedded system works independently, the DSP controls the interface and performances the algorithms while the analog part implements V/I converting, constant current output and feedback stage. The system has both software and hardware protections.
Performance testing of the system and the clinical experiments are carried out. It shows in the result that the system works stably. The experiment results are almost repeatable under the same conditions.
At last, future research of the method and system improvement is discussed.
引文
[1]江自强等。神经外科学基础与临床。南昌：江西科学出版社，1991。
[2] 杨树源等。最新神经内外科诊疗手册。天津：天津科学技术出版社，1997。
[3] (美)梅欧医院神经科。李海峰等译。梅欧医院神经科检查法。北京：科学出版社，2002。
[4] 叶山东。糖尿病诊断治疗学。安徽：安徽科学技术出版社，2000。
[5] 衡先培。糖尿病性神经性变诊断与治疗。北京：人民卫生出版社，2002。
[6] R．F．施密特，J．杜德尔等。神经生理学基础。科学山版社，1983。
[7] 王伯扬。神经电生理学。北京：高等教学出版社．1982。
[8] 北京师范大学等。人体解剖生理学。北京：人民教育出版社，1982。
[9] 上海第一医学院。人体解剖生理学。北京：人民卫生出版社，1979。
[10] 杨治良。实验心理学。杭州：浙江教育出版社，1998。
[11] 孟庆茂等。实验心理学。北京：北京师范大学出版社，1999。
[12] 孟常庆，常建华。实验心理学。北京：北京师范大学出版社，1999。
[13] B．H．坎特威茨，H．L．罗迪格(Ⅲ)，D．G．埃尔姆斯。实验心理学——掌握心理学的研究。上海：华东师范大学出版社，2001。
[14] 朱滢。实验心理学。北京：北京大学出版社，2000。
[15] 刘世龙，姚海锋，李光等。人体神经定量电流感觉检测系统的研制。中国医学物理学杂志，2003，20(3)：173-175。
[16] AAEM.Technology Review:The Neurometer Current Perception Threshold (CPT).Muscle And Nerve. 1999, 22:523-531.
[17] American Electroencephalographic Society.Technology and equipment review: Quantitative Sensory Testing systems.Journal of Clinical Neurophysiology. 1995,12:192-202.
[18] A consensus report from the Peripheral Neuropathy Association.Quantitative Sensory Testing.Neurology. 1993,43:1050-1052.
[19] American Diabetes Association, American Academy of Neurology. Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy. Diabetes Care. 1988, 11 (7):592-597.
[20] Dotson R M. Clinical neurophysiology laboratory tests to assess the noeiceptive system in humans. Journal of Clinical Neurophysiology. 1997, 14:32-45.
[21] Dyck P J.Comparison of algorithms of testing for use in automated evaluation of sensation.Neurology. 1990,40:1607-1613.
[22] Dyck P J. Quantitative Sensory Testing: methodology, application and future directions.J Journal of Clinical Neurophysiology. 1994, 11:568-581.
[23] Dyck P J, Zimmerman I R, et al. Introduction of automated systems to evaluate touch-pressure, vibration, and thermal cutaneous sensation in man. Ann Neurol.1978,4: 502-510.
[24] Dyck P J, O'Brien P C, Kosanke J L, et al. A 4, 2, and 1 stepping algorithm for quick and accurate estimation of cutaneous sensation threshold. Neurology. 1993, 43:1508-1512.
[25] Dyck P J, Kratz K M, Lehman K A ,et al. The Rochester Diabetic Neuropathy Study: design, criteria for types of neuropathy, selection bias, and reproducibility of neuropathic tests. Neurology .1991, 41: 799-807.
[26] Dyck P J, Larson T S, Dyck P J B, et al. Patterns of quantitative sensation testing of hypoesthesia and hyperalgesia are predictive of diabetic polyneuropathy. Diabetes Care. 2000, 23:510-517.
[27] Dyck P J, Bushek W, Spring E M, et al. Vibratory and cooling detection thresholds compared with other tests in diagnosing and staging diabetic neuropathy. Diabetes Care.1987, 10 (4):432-440.
[28] Dyck P J, Dyck P J B, Kennedy W R, et al. Limitations of quantitative sensory testing when patients are biased toward a bad outcome. Neurology .1998, 50: 893-895.
[29] Dyck P J, Zimmerman I, Gillen D A.Cool, warm, and heat-pain detection thresholds:Testing methods and inferences about anatomic distribution of receptors. Neurology.1993, 1500-1507.
[30] Jamal G A, Hansen S.An improved automated method for the measurement of thermal thresholds. 2. patients with peripheral neuropathy. Journal of Neurology, Neurosurgery, and Psychiatry. 1985, 48:361-366.
[31] Jamal G A, Weir A I, Ballantyne J P. The neurophysiologic investigation of small fiber neuropathies. Muscle & Nerve. 1987, 10:537-545.
[32] Katims J J.Limitation of Quantitative Sensory Testing when patients are biased towards a bad outcome.(Letter;Com ment).N eurology. 1998,50:1214.
[33] O'Brien P C, Dyck P J. Procedures for setting normal values. Neurology. 1995, 45:17-23.
[34] Richard K.Quantitative Sensory Testing.Muscle And Nerve. 1992,1155-1157.
[35] Shy M E, Frohman E M, So Y T. Quantitative sensory testing. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2003, 60:898-904.
[36] Yarnitsky D.Quantitative Sensory Testing.Muscle And Nerve. 1997,20:198-204.
[37] Zaslansky R.Clinical application of Quantitative Sensory Testing.Journal of Neurological Science. 1998, 153:215-238.
[38] Zwislocki J J, Relkin E M. On a psychophysical transformed-ruled up and down method converging on a 75% level of correct responses. PNAS. 2001, 98(8): 4811-4814.
[39] 毛思中，董为伟。定量感觉检查在糖尿病周围神经病变诊断中的应用。中华内分泌代谢杂志，2001，17(4)：235-238。
[40] 黄献，资晓宏。神经定量感觉检布及临床应用。临床神经电生理学杂志，2001，10(3)：184-186。
[41] 张玉梅，阔永红，傅丰林。基于DSP和DDS的高精度频率信号源实现。电子工程师，30(1)：43-45。
[42] 万其力，吴文彪。基于DDS及单片机的函数产生器设计。西安邮电学院学报，2003，8(3)：35-38。
[43] 张卫宁。TMS320C2000系列DSPs原理及应用。北京：国防工业出版社，2002。
[44] 张雄伟，曹铁勇。DSP芯片的原理与开发应用。北京：电子工业出版社，2000。
[45] Texas Instruments. Reference Guide: TMS320LF/LC240xDSP Controllers Systems and Peripherals.2000.
[46] Texas Instruments. Reference Guide: TMS320LF/LC240xDSP Controllers: CPU and Instruction Set.2000.
[47] 胡上序，陈德钊。观测数据的分析与处理。杭州：浙江大学出版社，1996。
[2] 杨树源等。最新神经内外科诊疗手册。天津：天津科学技术出版社，1997。
[3] (美)梅欧医院神经科。李海峰等译。梅欧医院神经科检查法。北京：科学出版社，2002。
[4] 叶山东。糖尿病诊断治疗学。安徽：安徽科学技术出版社，2000。
[5] 衡先培。糖尿病性神经性变诊断与治疗。北京：人民卫生出版社，2002。
[6] R．F．施密特，J．杜德尔等。神经生理学基础。科学山版社，1983。
[7] 王伯扬。神经电生理学。北京：高等教学出版社．1982。
[8] 北京师范大学等。人体解剖生理学。北京：人民教育出版社，1982。
[9] 上海第一医学院。人体解剖生理学。北京：人民卫生出版社，1979。
[10] 杨治良。实验心理学。杭州：浙江教育出版社，1998。
[11] 孟庆茂等。实验心理学。北京：北京师范大学出版社，1999。
[12] 孟常庆，常建华。实验心理学。北京：北京师范大学出版社，1999。
[13] B．H．坎特威茨，H．L．罗迪格(Ⅲ)，D．G．埃尔姆斯。实验心理学——掌握心理学的研究。上海：华东师范大学出版社，2001。
[14] 朱滢。实验心理学。北京：北京大学出版社，2000。
[15] 刘世龙，姚海锋，李光等。人体神经定量电流感觉检测系统的研制。中国医学物理学杂志，2003，20(3)：173-175。
[16] AAEM.Technology Review:The Neurometer Current Perception Threshold (CPT).Muscle And Nerve. 1999, 22:523-531.
[17] American Electroencephalographic Society.Technology and equipment review: Quantitative Sensory Testing systems.Journal of Clinical Neurophysiology. 1995,12:192-202.
[18] A consensus report from the Peripheral Neuropathy Association.Quantitative Sensory Testing.Neurology. 1993,43:1050-1052.
[19] American Diabetes Association, American Academy of Neurology. Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy. Diabetes Care. 1988, 11 (7):592-597.
[20] Dotson R M. Clinical neurophysiology laboratory tests to assess the noeiceptive system in humans. Journal of Clinical Neurophysiology. 1997, 14:32-45.
[21] Dyck P J.Comparison of algorithms of testing for use in automated evaluation of sensation.Neurology. 1990,40:1607-1613.
[22] Dyck P J. Quantitative Sensory Testing: methodology, application and future directions.J Journal of Clinical Neurophysiology. 1994, 11:568-581.
[23] Dyck P J, Zimmerman I R, et al. Introduction of automated systems to evaluate touch-pressure, vibration, and thermal cutaneous sensation in man. Ann Neurol.1978,4: 502-510.
[24] Dyck P J, O'Brien P C, Kosanke J L, et al. A 4, 2, and 1 stepping algorithm for quick and accurate estimation of cutaneous sensation threshold. Neurology. 1993, 43:1508-1512.
[25] Dyck P J, Kratz K M, Lehman K A ,et al. The Rochester Diabetic Neuropathy Study: design, criteria for types of neuropathy, selection bias, and reproducibility of neuropathic tests. Neurology .1991, 41: 799-807.
[26] Dyck P J, Larson T S, Dyck P J B, et al. Patterns of quantitative sensation testing of hypoesthesia and hyperalgesia are predictive of diabetic polyneuropathy. Diabetes Care. 2000, 23:510-517.
[27] Dyck P J, Bushek W, Spring E M, et al. Vibratory and cooling detection thresholds compared with other tests in diagnosing and staging diabetic neuropathy. Diabetes Care.1987, 10 (4):432-440.
[28] Dyck P J, Dyck P J B, Kennedy W R, et al. Limitations of quantitative sensory testing when patients are biased toward a bad outcome. Neurology .1998, 50: 893-895.
[29] Dyck P J, Zimmerman I, Gillen D A.Cool, warm, and heat-pain detection thresholds:Testing methods and inferences about anatomic distribution of receptors. Neurology.1993, 1500-1507.
[30] Jamal G A, Hansen S.An improved automated method for the measurement of thermal thresholds. 2. patients with peripheral neuropathy. Journal of Neurology, Neurosurgery, and Psychiatry. 1985, 48:361-366.
[31] Jamal G A, Weir A I, Ballantyne J P. The neurophysiologic investigation of small fiber neuropathies. Muscle & Nerve. 1987, 10:537-545.
[32] Katims J J.Limitation of Quantitative Sensory Testing when patients are biased towards a bad outcome.(Letter;Com ment).N eurology. 1998,50:1214.
[33] O'Brien P C, Dyck P J. Procedures for setting normal values. Neurology. 1995, 45:17-23.
[34] Richard K.Quantitative Sensory Testing.Muscle And Nerve. 1992,1155-1157.
[35] Shy M E, Frohman E M, So Y T. Quantitative sensory testing. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2003, 60:898-904.
[36] Yarnitsky D.Quantitative Sensory Testing.Muscle And Nerve. 1997,20:198-204.
[37] Zaslansky R.Clinical application of Quantitative Sensory Testing.Journal of Neurological Science. 1998, 153:215-238.
[38] Zwislocki J J, Relkin E M. On a psychophysical transformed-ruled up and down method converging on a 75% level of correct responses. PNAS. 2001, 98(8): 4811-4814.
[39] 毛思中，董为伟。定量感觉检查在糖尿病周围神经病变诊断中的应用。中华内分泌代谢杂志，2001，17(4)：235-238。
[40] 黄献，资晓宏。神经定量感觉检布及临床应用。临床神经电生理学杂志，2001，10(3)：184-186。
[41] 张玉梅，阔永红，傅丰林。基于DSP和DDS的高精度频率信号源实现。电子工程师，30(1)：43-45。
[42] 万其力，吴文彪。基于DDS及单片机的函数产生器设计。西安邮电学院学报，2003，8(3)：35-38。
[43] 张卫宁。TMS320C2000系列DSPs原理及应用。北京：国防工业出版社，2002。
[44] 张雄伟，曹铁勇。DSP芯片的原理与开发应用。北京：电子工业出版社，2000。
[45] Texas Instruments. Reference Guide: TMS320LF/LC240xDSP Controllers Systems and Peripherals.2000.
[46] Texas Instruments. Reference Guide: TMS320LF/LC240xDSP Controllers: CPU and Instruction Set.2000.
[47] 胡上序，陈德钊。观测数据的分析与处理。杭州：浙江大学出版社，1996。