脑梗塞、糖尿病患者感觉障碍的临床研究
摘要
目的应用定量感觉检查研究脑梗塞、糖尿病患者的感觉障碍(主要为痛、温觉)损害程度。方法我们选择90例患者分为3组,其中30例脑梗塞患者、30例糖尿病患者、30例脑梗塞合并糖尿病患者,另外选取30例非脑梗塞非糖尿病患者作为对照组。均使用以色列产TSA-Ⅱ型神经感觉定量分析仪,分别检测冷觉、热觉、冷痛觉、热痛觉定量阈值,从而进行评价。结果脑梗塞组与非脑梗塞非糖尿病组(对照组)相比,双手及双足冷觉、热觉、冷痛觉,左足热痛觉均有显著性差异(P<0.01)。糖尿病组与非脑梗塞非糖尿病组(对照组)相比,右足冷觉,双足热觉有差异(P<0.05);双手及双足冷痛觉均有显著性差异(P<0.01)。脑梗塞合并糖尿病组与非脑梗塞非糖尿病组(对照组)相比,双手及双足冷觉、热觉、冷痛觉,双足热痛觉均有显著性差异(P<0.01)。脑梗塞合并糖尿病组与脑梗塞组相比,左足热觉,右足热痛觉均有差异(P<0.05)。脑梗塞合并糖尿病组与糖尿病组相比,双手及双足冷觉有差异(P<0.05),双手及双足热觉、双足热痛觉均有显著性差异(P<0.01)。结论脑梗塞合并糖尿病的患者感觉功能损害程度明显高于单一脑梗塞或糖尿病患者,且应用定量感觉检查可更早期、更准确的评价脑梗塞、糖尿病患者感觉功能损害程度。
Object To research the sensory obstacles (for pain, temperature feel) with the patients of cerebral infarction and diabetes, using the quantitative sensory testing. Method Meeting the criteria, we delided 90 patients into three teams, cerebral infarction patients (30 cases), diabetic patients (30 cases) and cerebral infarction patients with diabetes(30 cases), other 30 cases were non-diabetic with non-cerebral infarction(the control group ) .We used the Israeli-TSA-Ⅱtype of feeling for quantitative analysis, respectively examination cold sensation,hot sensation, quantitative cold pain sensation and thus to evaluate. Results Group cerebral infarction and non-cerebral infarction? non-diabetic group (the control group) compared to, the cold? heat? cold pain in hands and feet, the fever pain in left foot were significant differences (P<0.01);Group diabetic and non-cerebral infarction? non-diabetic group (the control group) compared to, the cold in right foot and the heat in feet were differences (P<0.05), the cold pain in hands and feet were significant differences (P<0.01); Group cerebral infarction with diabetic and non-cerebral infarction? non-diabetic group (the control group) compared to, the cold、heat? cold pain in hands and feet, the fever pain in feet were significant differences (P<0.01); Cerebral infarction and cerebral infarction group with diabetes compared to, the heat in left foot , the fever pain in right foot were differences (P<0.05); Group cerebral infarction with diabetes and diabetic compared to, the cold in hands and feet were differences (P<0.05),the heat in hands and feet, the fever pain in feet were significant differences (P<0.01). Conclusion Cerebral infarction patients with diabetes sensory nerve damage significantly higher than single cerebral infarction patients or diabetes ,and application of quantitative sensory testing can be more earlier, more accurate assessment of cerebral infarction, diabetes patients with the degree of sensory dysfunction.
Object To research the sensory obstacles (for pain, temperature feel) with the patients of cerebral infarction and diabetes, using the quantitative sensory testing. Method Meeting the criteria, we delided 90 patients into three teams, cerebral infarction patients (30 cases), diabetic patients (30 cases) and cerebral infarction patients with diabetes(30 cases), other 30 cases were non-diabetic with non-cerebral infarction(the control group ) .We used the Israeli-TSA-Ⅱtype of feeling for quantitative analysis, respectively examination cold sensation,hot sensation, quantitative cold pain sensation and thus to evaluate. Results Group cerebral infarction and non-cerebral infarction? non-diabetic group (the control group) compared to, the cold? heat? cold pain in hands and feet, the fever pain in left foot were significant differences (P<0.01);Group diabetic and non-cerebral infarction? non-diabetic group (the control group) compared to, the cold in right foot and the heat in feet were differences (P<0.05), the cold pain in hands and feet were significant differences (P<0.01); Group cerebral infarction with diabetic and non-cerebral infarction? non-diabetic group (the control group) compared to, the cold、heat? cold pain in hands and feet, the fever pain in feet were significant differences (P<0.01); Cerebral infarction and cerebral infarction group with diabetes compared to, the heat in left foot , the fever pain in right foot were differences (P<0.05); Group cerebral infarction with diabetes and diabetic compared to, the cold in hands and feet were differences (P<0.05),the heat in hands and feet, the fever pain in feet were significant differences (P<0.01). Conclusion Cerebral infarction patients with diabetes sensory nerve damage significantly higher than single cerebral infarction patients or diabetes ,and application of quantitative sensory testing can be more earlier, more accurate assessment of cerebral infarction, diabetes patients with the degree of sensory dysfunction.
引文
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[18]冯波,李栩,李惠芝. 2型糖尿病患者高血压与糖尿病性神经病变的关系[J].临床神经内科杂志, 2001, 18(5):178-180
[19] Aaron I, Kevin B, Marie T et al. Muscle Nerve, 1995;18:574-584
[2] Christensen H,Boysen G.Blood glucose increases early after stroke onset:a study on serial measure ments of blood glucose in acute stroke[J].Eur J Neurol,2002,9:297 -301.
[3] Capes SE,Hunt D,Malmberg K,et al.Stress hyperglycemia and Prognosis of stroke in nondiabetic and diabetic patients:a systematic overview[J].Stroke,2001,32:2426 -2432.
[4] Dy ckPJ, Kratz KM, Karnes JL, et al. The prevalence by staged Severity Of various types of diabetic neuropathy, retinopathy, and nephropathy in a population based cohort:the Rochester Diabetic Neuropathy Study. Neurology, 1993, 43:817 -824.
[5] Bertora P, Valla P, Dezuanni E, et al. Prevalence of subclinica Neuropathy in diabetic patients:assessment by study of conduction Velocity distribu tion with motor and sensory nervefibres. J Neurol, 1998, 245:81- 86.
[6] Adler AI, Boyko EJ, Ahroni JH, et al. Risk factors for diabeti Peripheral sensory neuropathy. Diabetes Care, 1997, 20:1162-1167.
[7] Dauid Burke. Sensory conduction of the sural nerve in polyneuropathy. J Neurol Neurosur Psychiatry, 1974;37:647
[8] Weis J, Dimpfel W, Schroder JM. Nerve Conduction changes and fine structural alter ation Ofextra and in trafusal muscle and nerve fibers in strep to ztoncin diabeti crats. MuscleNerve, 1995, 18:175-184
[9] Dyck PJ, Davies JL, Wilson DM, et al. Risk factors for severity o Diabetic polyneuropathy:intensive longitudinal assessment of th Rochester Diabetic Neuropathy Study cohort. Diabetes Care, 1999, 22:1479- 1486.
[10]汤晓芙,杨亭,杨秉贤,等.301名正常人肌电图所见.中华医学杂志,1984,64:91 94.
[11] Sumner C J, She th S, Griffin JW, et al. The spectrum of neu ropathy in diabetes and impaired glucose tolerance. Neurology, 2003,60:108 111.
[12] Oishi M, Mochizuki Y, Suzuki Y, et al. Curren tperception threshold and sympathetic skin response in diabetic and alcoholic polyneuropathies.Intern Med, 2002, 41:819 822.
[13]陈阳美,林丽萍.神经传导速度对糖尿病周围神经病的诊断价值.临床神经电生理学杂志,2004,13(2):167.
[14]秦利,殷峻,邢惠莉.糖尿病周围神经病变相关因素分析.上海第二医科大学学报,2002,22(6):531.
[15] Yarnitsky D Mnscle Nerve, 1997;29(2):198-204.
[16] Sakura S. Quantitative and selective assessment of sensory blockding lumbar epidur alanesthesia with 1%or2% lidocaine.Branaesth,1998,81(5):718.
[17]黄献,资晓宏.神经定量感觉检查及临床应用[J].临床神经电生理学杂志, 2001, 8(3):184-186.
[18]全国第四界脑血管病学术会议.各类脑血管病诊断要点[J].中华神经科杂志. 1996, 29(6):379-382
[19] Yarnitsby D, Fowler CJ. Quantitative sensory testing. Clinical Neurophysiology, 1995, 253-270.
[20] Chéliout-Héraut F, Zrek N, Khem liche H, et al. Exploration of small fibers fortes ting diabetic neuropathies [J]. Joint Bon Spine, 2005, 72(5):412-415.
[21] Claus D, Hilz MJ, Neundorfer. Thermal discrimina tionthresholds:acomparison of different methods. Acta Neurol. Scand, 1990, 81:533~540.
[22]毛思中,董为伟.温度觉、振动觉阈值的正常参考值[J].重庆医科大学学报,2003,28(6):724-728.
[23] Attal N, Gaude V, Brasseur L, et al. Intravenous lidocaine in central pain-Adouble-blind,placebo-controlled, psychophysical study. Neurology, 2000, 54:564.
[24] Nygaard OP, Kloster R, Mellgren SI. Recovery of sensory nerve fibres surgical decompression in lumbar radiculopathy-use of quantitative sensory testing in the exploration of different populations of nervefi bres. J Neurol Neurosurg Psychiarty,1998,64:120.
[25] Bowsher D, Leijon G, Thuomas KA. Central poststroke pain-corre tion of MRI with chinical painchara cteristics and sensory abnormaties. Neurology, 1998 Nov, 51:51352.
[26] Daviesm M,Brophy S,Williams R, et al. The prevslence,severity,and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care, 2006,29(7):1518.
[27]李桂荣,张月进.糖尿病周围神经病变514例临床分析.现代医药卫生,2005,22(8):977.
[28]冯波,李栩?李惠芝. 2型糖尿病患者高血压与糖尿病性神经病变的关系[J].临床神经内科杂志, 2001, 18(5):178-180.
[29]孟家眉.对脑卒中临床研究工作的建议.中华神经精神杂志,1998,21:57
[30]李文贤.172例老年糖尿病并发脑血管病临床分析.中国实用内科杂志,1995; 15(7):444.
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