2型糖尿病154例患者神经电生理检查

目的探讨神经电生理检查在2型糖尿病患者周围神经、自主神经及脑神经损害中的意义。方法对154例2型糖尿病患者进行神经传导速度(NCS)、交感皮肤反应(SSR)、心率变异趋势图(RRIV)及瞬目反射(BR)检测,分析检测异常率及其与年龄、病程及糖化血红蛋白的相关性。结果 154例患者中NCS、SSR、RRIV及BR异常率分别为72%、58%、73%和7%。NCS、SSR及RRIV异常率与年龄无关,而与病程及糖化血红蛋白有关。正中神经感觉神经传导速度(SCV)值与病程呈负相关,而与糖化血红蛋白值无关,SSR与病程及糖化血红蛋白值均呈正相关。结论神经电生理检测可早期发现糖尿病患者周围神经、自主神经受损证据,为早期合理治疗提供依据。     

脊髓小脑性共济失调3型无症状基因携带者与患者周围神经传导特征北大核心CSCD

目的探讨脊髓小脑性共济失调3型(spinocerebellar ataxia type 3,SCA3)无症状基因携带者与患者周围神经传导异常特征,寻找与SCA3疾病严重程度及病程相关的电生理指标。方法对确诊的20例无症状基因携带者(preclinical carriers of spinocerebellar ataxias type 3,PreSCA3)、39例SCA3患者及32名健康对照者进行周围神经传导(nerve conductive study,NCS)检测,比较各组间的神经传导异常,分析各电生理参数与共济失调等级量表(scale for the assessment and rating of ataxia,SARA)总分及病程的相关性。结果PreSCA3感觉神经传导异常发生率为20%,并且PreSCA3组尺神经、胫神经、腓肠神经SNAP波幅及尺神经MCV显著低于健康对照组(P<0.05)。SCA3患者NCS异常发生率为69.2%,以感觉神经传导异常为主(53.8%),主要表现为混合性损害(48.1%)。与健康对照组相比,SCA3患者所有检测神经SNAP波幅、SCV及腓总神经CMAP波幅、尺神经MCV显著降低(P<0.05)。此外,正中、尺、胫、腓总及腓肠神经SNAP波幅、SCV与SARA总分及病程呈负相关(P<0.05)。结论部分PreSCA3已存在周围神经损害,主要累及感觉神经。SCA3患者NCS检查异常率高,主要表现为混合性损害为主的感觉性周围神经病。SNAP波幅、SCV可能作为监测疾病发生发展的潜在生物学标记物。     

200例2型糖尿病患者神经传导速度检测分析

目的:探讨2型糖尿病(DM)患者周围神经病变的客观神经电生理特点。方法:分别对200例DM患者,其中有周围神经损害临床表现组(DM-I)100例和无周围神经损害临床表现组(DM-Ⅱ)100例,与50例正常成人进行运动神经传导速度(MCV)、感觉神经传导速度(SCV)、复合肌肉动作电位(CMAP)、感觉神经动作电位(SNAP)进行测定。结果:两组患者所测的MCV、SCV、CMAP、SNAP与正常对照组比较有显著差异,而DM-I组与DM-II所测的MCV、SCW、CMAP、SNAP比较亦有显著差异,下肢神经的4个参数总异常率高于上肢。结论:(1)神经传导速度的检测有助于糖尿病周围神经病的早期诊断。(2)DM并发周围神经损害在临床症状出现之前已有神经传导速度的改变。(3)下肢神经的总异常率高于上肢。     

探讨SEP、NCS、SSR、F波联合检测对糖尿病周围神经病变早期诊断的价值

目的探讨SEP、NCS、SSR、F波联合检测对糖尿病周围神经病变的早期诊断价值。方法随机选取2013-01—2015-12我院门诊收治的糖尿病患者80例,并选取80例健康人群作对照,根据是否患病分为糖尿病组(n=80)和对照组(n=80)。分别对入选患者进行联合电生理检查,包括运动NCS、腓总神经、胫后神经、尺神经、正中神经感觉检查,及上下肢SEP、SSR检查、胫后神经和正中神经F波检查。结果糖尿病组NCS检查总异常率为74.6%,其中感觉神经异常比例较运动神经明显升高,差异有统计学意义(P0.05)。糖尿病组患者电生理检查F波总异常率为57.2%,其中远端运动神经传导正常者的F波异常率相对降低为50.6%。在糖尿病组中,其SEP近端周围神经电位总异常率为70.1%,而在上肢正中神经感觉传导结果为正常范围的患者中,其锁骨上电位并不存在明显异常;在下肢胫后神经感觉传导结果为正常范围内的患者中,其臀点电位异常率为62.6%。糖尿病组SSR总异常率为80.1%,在四肢NCS正常者中,其SSR异常率高达71.8%。糖尿病组应用SEP、NCS、SSR、F波联合检测的总异常率高达90.8%,均显著高于使用单项电生理检查时的异常率,差异具有统计学意义(P0.05)。结论糖尿病周围神经病变患者,NCS检查是其诊断的一种基本手段,将其与SEP、SSR、F波进行联合检测,能显著提高糖尿病周围神经病变患者的早期检出率,值得临床推广。     

神经型布氏杆菌病周围神经损害的临床与电生理研究

目的研究神经型布氏杆菌病周围神经损害的临床特征,探讨电生理对其的诊断价值。方法对32例神经型布氏杆菌病周围神经损害患者(病例组)和32名性别及年龄与病例组匹配的正常对照组进行神经电生理检查,并对所得检查结果进行统计学分析。结果病例组与对照组在运动末梢潜伏期(distal motor latency,DML)、复合肌肉动作电位(compound motor active potentials,CMAP)波幅、运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经动作电位潜伏期(sensory nerve action potential latency,SL)、感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉神经传导速度(sensory nerve conduction velocity,SCV)方面的比较,差异均有统计学意义(P0.05)。电生理检查提示上下肢周围神经损害,感觉神经及运动神经均受累,其中感觉神经占55.47%,运动神经占16.80%,上肢以正中神经(64条)最多见,下肢以腓肠神经(16条)最多见。四肢运动神经256条中43条传导速度减慢,占16.80%,四肢感觉神经256条中142条传导速度减慢,占55.47%,SCV较MCV改变明显,上肢病变重于下肢。结论神经电生理检查为神经型布氏杆菌病周围神经损害的临床诊断提供了客观依据。     

定量感觉及神经传导检测在糖尿病患者中的应用比较

目的:分析定量感觉检查(QST)及神经传导检测(NCS)在糖尿病患者中的应用价值.方法:用QST对100例2型糖尿病(T2DM)组和50例正常对照组分别进行四肢的冷觉(CS)、温觉(WS)、冷痛觉(CP)、热痛觉(HP)的感觉阈值测定并进行比较分析;并对T2DM患者进行上肢的正中神经、尺神经,下肢的胫神经、腓神经运动和感觉支的NCS、复合肌肉动作电位(CMAP)、感觉神经动作电位(SNAP)以及运动末梢潜伏期(DML)进行测定并分析.T2DM患者分为有症状组和无症状组,分别对QST及NCS的异常率进行分析并比较.结果:T2DM组QST和NCS结果与正常对照组比较差异有显著意义(P＜0.01); QST与NCS异常率比较差异有显著意义(P＜0.01),QST的异常率均显著大于NCS;提示糖尿病周围神经病(DPN)患者中周围神经小纤维受损比大纤维更明显,T2DM患者有症状组和无症状组各值比较差异均有显著意义(P＜0.01).结论:QST对DPN的早期诊断提供可靠依据,QST对DPN的诊断敏感性高,但特异性低,需与NCS结合对糖尿病周围神经状况进行评价更为完善.QST和NCS不能相互替代,全面了解DPN病情需QST和NCS结合,并密切结合临床.     

高同型半胱氨酸血症对大鼠周围神经结构和功能的影响

目的 观察高同型半胱氨酸血症(hyperhomocysteinemia,Hhcy)对大鼠周围神经组织结构和传导功能的影响.方法 通过高蛋氨酸饮食建立Hhcy大鼠模型.应用电生理技术检测大鼠尾神经传导功能;光镜下计数大鼠腓肠神经单位面积有髓神经纤维密度(fiber density,FD)、平均髓鞘面积(mean myelin area,MMA);免疫组化方法分析腓肠神经髓鞘碱性蛋白(myelin basic protein,MBP)、神经丝蛋白(neurofilament protein,NF)表达;电镜观察腓肠神经超微结构.结果 Hhcy组大鼠尾神经运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经传导速度(sensory nerve conduction velocity,SCV)与复合肌肉动作电位(compound muscle action potential,CMAP)、感觉神经动作电位(sensory nerve action potential,SNAP)波幅均较对照组减慢和下降(均P＜0.05);Hhcy组大鼠腓肠神经FD、MMA与MBP、NF积分光密度均较对照组减小(均P＜0.05);Hhcy组大鼠有髓神经纤维出现了髓鞘脱失、轴突肿胀、间质水肿等超微结构改变.结论 Hhcy可造成大鼠周围神经组织结构与传导功能的损害.     

上肢易卡压部位神经电生理检查对银杏达莫联合甲钴胺治疗糖尿病周围神经病作用的评估价值

目的 通过上肢易卡压部位神经电生理检查探讨银杏达莫联合甲钴胺对2型糖尿病患者周围神经病变的治疗作用. 方法 选择河北联合大学附属医院内分泌科自2008年1月至2011年6月收治的208例2型糖尿病合并糖尿病周围神经病(DPN)患者为研究对象,采用随机数字表法将其分为治疗组(103例)和对照组(105例),2组患者同时采用糖尿病饮食、运动及降糖等基础治疗方案,对照组加用口服甲钴胺1000 μg,每日3次;治疗组在对照组治疗基础上联合应用银杏达莫注射液20 mL静脉滴注,每日1次.2组患者均连续应用4周.治疗前及治疗后4周,观察正中神经、尺神经感觉神经传导速度(SCV)、感觉神经电位(SNAP)、运动神经传导速度(MCV)、肌肉复合动作电位(CMAP)及远端潜伏期(DML)等指标变化. 结果 2组患者治疗后正中神经远端DML缩短、SCV增快、SNAP波幅增加,尺神经肘上下段MCV、SCV均较治疗前增快且SNAP波幅增高;治疗组各项指标均优于对照组,差异有统计学意义(P＜0.05). 结论 易卡压部位神经电生理检查是评价DPN疗效的敏感指标,银杏达莫注射液与甲钴胺联合应用对于DPN具有良好的治疗作用.     

糖尿病周围神经病患者上肢受累神经的分布特点

目的 探讨糖尿病周围神经病(DPN)患者上肢受累神经的分布特点.方法 应用神经电图对98例DPN患者及32名正常对照者的正中神经、尺神经及桡神经的感觉神经传导速度(SCV)及波幅(SNAP)、运动神经传导速度(MCV)及波幅(CAMP)进行检测,分析DPN患者上肢受累神经的分布特点.结果 (1)与正常对照组比较,DPN组正中神经、尺神经及桡神经SCV和MCV明显降低(P<0.05～0.01);(2)DPN组正中神经SCV、SNAP、MCV及CAMP的异常率明显高于尺神经及桡神经(均P<0.05).结论 DPN患者上肢正中神经更易受累.     

糖尿病周围神经病电生理特点及与血糖水平的关系

目的研究糖尿病周围神经病的神经电生理特点以及与血糖水平的关系。方法分析2013年3月~2014年3月于本院神经内科住院的108例糖尿病周围神经病患者,测定其正中、尺、胫、腓总神经的运动传导速度(MCV)和复合肌肉动作电位波幅(CMAP),以及正中、尺、腓肠神经、腓浅神经的感觉传导速度(SCV)和感觉神经动作电位波幅(SNAP),比较上、下肢和运动、感觉神经异常情况,分析糖化血红蛋白(HbA1C)、餐后2 h血糖对神经传导速度(NCV)的影响。结果糖尿病患者下肢运动神经病变重于上肢,且差异明显(P<0.05)。感觉神经损害重于运动神经,且差异明显(P     

A comparison of sural nerve conduction studies in patients with impaired oral glucose tolerance test

OBJECTIVE: Monitoring of the sural nerve is a sensitive method for detection of neuropathies. We examined different methods of studying sural nerve conduction in a group of patients with impaired glucose tolerance (IGT) in the same study. MATERIALS AND METHODS: Several parameters of sural nerve were investigated in 20 patients. First, sensory nerve conduction studies of the sural nerve were performed on the distal-leg and the proximal-leg segments. Second, dorsal sural nerve studies were conducted. Third, the sural/radial sensory nerve action potential (SNAP) amplitude ratios were calculated. The results were compared with those obtained from 21 healthy controls. RESULTS: Abnormal results revealing peripheral neuropathy were found in only one patient and dorsal sural SNAP was absent in another patient (5%). Although the results of nerve conduction studies were within normal ranges except the patient with peripheral neuropathy, the lower extremity nerves and especially sural nerves have been found to be more affected and the parameters revealed large differences between groups (P < 0.05). Only dorsal sural nerve latency related to fasting blood glucose level in patients (<0.05). DISCUSSION AND CONCLUSIONS: Sural nerve studies should be of value to determine neuropathy in IGT patients. This study supported the idea that IGT is a transitional state before diabetes and also the importance of the dorsal sural nerve latencies for early detection of neuropathy.     

86例颈总动脉粥样硬化患者糖代谢分析

目的探讨颈总动脉粥样硬化程度与血糖异常情况。方法 86例行颈总动脉检查根据颈动脉硬化程度分组,并行空腹血糖、糖耐量及血脂检查。结果糖耐量异常患者颈总动脉粥样硬化程度比正常糖耐量硬化程度高(P<0.05)。结论早期干预糖耐量异常患者血糖具有临床意义。     

Idiopathic polyneuropathy and impaired glucose metabolism in a Norwegian patient series

Background and purpose:  North American studies have indicated a high prevalence of impaired glucose tolerance (IGT) in patients with sensory polyneuropathy. We searched for the occurrence of IGT in a Norwegian patient material with polyneuropathy.
Methods:  Seventy patients with symptoms and signs of sensory polyneuropathy were included. Cases with known causes of neuropathy were excluded. All patients underwent a 2 h oral glucose tolerance test (OGTT). Nerve conduction studies (NCS), quantitative sensory testing (QST) and skin biopsy with assessment of intra-epidermal nerve fibre (IENF) density were performed.
Results:  Sixteen patients (23%) had impaired glucose metabolism (IGM): 2 (3%) were found to have diabetes, 9 (13%) had IGT, 3 (4%) had impaired fasting glucose (IFG) and 2 (3%) both IFG and IGT. About 62% of the patients with IGM and polyneuropathy and 50% of those with chronic idiopathic axonal polyneuropathy (CIAP) had abnormalities on NCS. Reduction of IENF occurred in 37% of the patients with IGM and 43% of those with CIAP.
Conclusions:  Patients with polyneuropathy and IGM had essentially the same degree of involvement of small and large nerve fibres as patients with CIAP. IGT seems less frequent in Norwegian patients with polyneuropathy than reported in North American populations.     

Nerve conduction studies,electromyography and sympathetic skin response in Fabry's disease

We prospectively performed neurophysiologic studies in nine Fabry's Disease (FD) patients (8 male and 1 female) in order to describe the results of nerve conduction studies (NCS) and electromyography (EMG) and to verify whether the sympathetic skin response (SSR) is impaired in these patients. The investigation protocol included SSR, sensory and motor NCS and EMG. SSR was performed not only in FD patients, but also in 18 normal controls. All FD patients had normal nerve conduction studies and electromyography. SSR was present in all controls with a mean amplitude of 1453.6+/-682.3 microV. However, the SSR was absent in six and lower than 500 microV in the remaining FD patients. All patients had normal sensory and motor NCS and EMG. SSR, on the other hand, was significantly altered in all patients and this test could, therefore, be useful in the diagnostic evaluation of FD patients.     

138例糖尿病患者神经电图分析

目的探讨2型糖尿病患者周围神经病变(DPN)的神经电生理特点及其与病程的关系。方法连续记录138例血糖控制良好的糖尿病患者神经电图(包括感觉神经传导速度SCV和运动神经传导速度MCV)的检测结果,并根据糖尿病病程将其分组进行比较。结果共检测周围神经1669条,异常神经313条(18.75%),下肢异常率(132/530,24.9%)明显高于上肢(59/517,11.4%)(P<0.0001),感觉神经(122/622,19.6%)与运动神经(191/1047,18.2%)受累无差异(P=0.5665);糖尿病病程10年以上者运动、感觉神经异常率(24.3%,33%)明显高于病程小于10年组(14.2%,14%)(P<0.001)。病程大于10年组神经传导速度均较病程小于10年组减慢,正中神经、胫后神经运动传导速度和尺神经、腓肠神经感觉传导速度有统计学意义(P<0.05);除尺神经外所查运动神经近远端复合肌肉动作电位波幅(CAMP)病程≥10年组均明显低于病程<10年组。结论尽管受检时血糖控制良好,但依然有周围神经电生理异常变化。2型糖尿病患者下肢神经传导异常率高于上肢,尤以运动神经明显。病程是糖尿病周围神经损害的危险因素,随着病程增加神经传导异常率和损伤严重程度增高。     

高频超声联合肌电图在腕部正中神经受压诊断中的应用价值

目的 探讨高频超声联合肌电图在腕部正中神经受压诊断中的应用价值。方法 选取本院2017年2月-2018年3月110例疑似腕部正中神经受压患者为研究对象,手术确诊腕部正中神经受压患者为WZ组,非腕部正中神经受压患者24例为NZ组,分别应用高频超声与肌电图仪对所有患者进行检查,并观察2组患者正中神经运动传导的远端潜伏期(DML)、复合肌肉动作电位(CMAP)、腕-肘段运动传导速度(MCV)、正中神经感觉传导速度(SCV)、感觉神经的动作电位波幅(SNAP)等肌电图参数,同时观察2组患者高频超声检查的声像图; 以手术确诊为金标准,比较分析不同方案的灵敏度、特异度与准确度。结果 与NZ组比较,WZ组MCV、CMAP、SCV及SNAP均显著降低(P<0.05),而DML显著升高(P<0.05); WZ组患者腕部正中神经横截面面积显著高于NZ组(P<0.05); 肌电图检测显示腕部正中神经受压阳性患者共55例,阴性共55例,诊断灵敏度为56.98%,特异度为75.00%,准确度为60.91%,误诊率为25.00%,漏诊率为43.02%; 高频超声检测显示腕部正中神经受压阳性患者共57例,阴性共53例,诊断灵敏度为58.14%,特异度为70.83%,准确度为60.91%,误诊率为29.17%,漏诊率为41.86%; 联合检测显示腕部正中神经受压阳性患者共84例,阴性共26例,诊断灵敏度为95.35%,特异度为91.67%,准确度为94.55%,误诊率为8.33%,漏诊率为4.65%; 肌电图、高频超声联合检测腕部正中神经受压患者的灵敏度与准确度均显著高于单项检测(P<0.05)。结论 肌电图可有效诊断早期腕部正中神经受压,高频超声可准确判断卡压部位,肌电图与高频超声联合检测可互为补充并提高诊断准确率、降低漏诊率及误诊率。     

Medial plantar and dorsal sural nerve conduction studies increase the sensitivity in the detection of neuropathy in diabetic patients.

OBJECTIVE: Clinical utility of nerve conduction studies (NCS) of the medial plantar and dorsal sural nerves in the early detection of polyneuropathy have already been shown separately. However, at present, there is no data about the combined assessment of these two nerves in distal sensory neuropathy. In the present study, we aimed to evaluate the medial plantar and dorsal sural NCS in a group of diabetic patients with distal sensory neuropathy (DSN) and in healthy controls. METHODS: Thirty healthy and 30 diabetic adult patients were included. In all subjects, peripheral motor and sensory NCS were performed bilaterally with surface electrodes on the lower limbs including medial plantar and dorsal sural nerves. In addition, motor and sensory nerves were studied unilaterally on the upper limb. RESULTS: In all patients, nerve action potential (NAP) amplitudes of sural and superficial peroneal nerves were within normal ranges, but in the patient group mean value was significantly lower than in the controls. Among clinically defined 30 DSN patients, medial plantar NAP amplitude was abnormal in 18 (60%) and dorsal sural nerve amplitude was abnormal in 13 (40%) of the patients bilaterally. Additionally, the onset NCV of the dorsal sural nerve was significantly slower in patients than controls (P=0.038). Evaluation of both of these nerves increased the sensitivity up to 70% in the detection of neuropathy. CONCLUSIONS: Bilateral NCS assessment of both of the medial plantar and dorsal sural nerves together increases the rate of diagnosis of diabetic distal sensory neuropathy compared to assessment of either of these nerves. SIGNIFICANCE: Assessment of medial plantar in addition to dorsal sural NCS together increases the sensitivity in the detection of neuropathy and allows earlier diagnosis, especially when routine NCS are normal.     

损伤神经周围注射自体PRP对周围神经损伤的修复效果观察

目的 探讨损伤神经周围注射自体富血小板血浆(platelet-rich plasma,PRP)对周围神经损伤的修复效果。方法 选取2017年1月-2018年7月于本院接受治疗的周围神经损伤患者130例,随机分为手术组、PRP联合组各65例,手术组患者进行显微外科手术,PRP联合组患者在手术基础上注射自体PRP进行治疗; 用酶联免疫吸附实验法检测血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平,用Western blot法检测胰岛素样生长因子1(IGF-1)、血管内皮生长因子(VEGF)表达水平,并对2组患者神经传导速度、下肢运动功能、基本功能优良率以及肌电图疗效进行检测。结果 治疗1、3、6、12个月后PRP联合组患者CRP、TNF-α水平均低于手术组,IGF-1、VEGF表达水平均高于手术组(P<0.05); 治疗1、3、6、12个月后PRP联合组患者感觉、运动神经传导速度、下肢运动功能评分、基本功能恢复优良率、肌电图愈显率均高于手术组(P<0.05)。结论 在手术治疗的基础上注射自体PRP对周围神经损伤患者进行治疗,能够减轻患者炎性损伤程度,上调IGF-1、VEGF的表达水平,加快神经传导速度,促进患者下肢运动功能恢复     

肌电图在椎管内麻醉并发脊神经损害中的早期诊断价值

目的 探讨肌电图在椎管内麻醉并发脊神经损害中的早期诊断价值。方法 回顾性分析2016年9月-2021年2月临床诊断为椎管内麻醉并发脊神经损害的患者,行双下肢神经传导速度测定及针极肌电图检查,并对部分患者进行随访,采用0～5级肌力记录法对受损的神经所支配的肌肉进行临床肌力的恢复评估,对受损神经的复合肌肉动作电位(Compound muscle action potential,CMAP)/正常值比例与复查肌肉的肌力进一步做相关性分析。结果 41例椎管内麻醉患者行神经传导测定共检测运动及感觉神经329条,运动神经的CMAP降低60条,异常率为30.9%; 感觉神经的感觉神经动作电位(Sensory nerve action potential,SNAP)降低12条,异常率为8.9%,且腓总神经、胫神经异常率(分别为41.7、29.7%)高于股神经异常率16.7%。41例患者共检测肌肉491块,异常肌肉331块,异常率67.4%,且低腰段及骶段脊神经支配的肌肉异常率(胫骨前肌、腓肠肌内侧头、低腰段及骶段脊旁肌异常率分别为79.7、82.9、81.5%)高于中腰段脊神经支配的肌肉(股四头肌内侧头、股薄肌、中腰段脊旁肌异常率分别为44.4、36.0、45.8%)。受损神经CAMP/正常值比例与复查肌肉的肌力显著相关(R²=0.9051,P<0.001)。结论 肌电图可以辅助临床早期筛查椎管内麻醉并发脊神经损害,并详细地提供神经损害的范围及严重程度,为早期开展康复治疗提供依据。     

Epidermal nerve innervation in impaired glucose tolerance and diabetes-associated neuropathy.

The authors describe skin biopsy findings in patients with peripheral neuropathy associated with diabetes and impaired glucose tolerance (IGT). Six patients with IGT, eight with early diabetes-associated neuropathy, and five controls were recruited. Most subjects underwent nerve conduction studies (NCS) and quantitative sensory tests (QST). Skin biopsy was abnormal in all neuropathy subjects and correlated poorly with NCS. Neuropathy associated with IGT primarily affects small fibers and is similar to early diabetes-associated neuropathy.