青壮年糖尿病周围神经病186例临床与神经电生理分析

目的：探讨青壮年糖尿病周围神经病（DPN）的临床与电生理变化。方法：分析186例青壮年DPN患者的临床特点，比较青壮年DPN组与对照组的神经传导速度（NCV）、远端潜伏期和远端波幅3个参数。结果：①临床特征以肢体麻木（52％）最多见、其次为自发痛（32％）；②青壮年DPN组NCV和远端波幅值低于对照组，远端潜伏期比对照组延长，两组3个参数比较差异均有统计学意义（P〈0．05）．③周围神经损害程度（轻、中和重度）明显高于对照组（P〈0．05）。结论：①青壮年DPN患者临床特点以肢体麻木与自发疼痛多见；②检测NCV、远端潜伏期和远端波幅，有助发现早期临床病变；⑨为周围神经损害程度（轻、中和重度）的诊断与治疗提供依据。     

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.     

腕管综合征的神经电生理特征

目的:探讨腕管综合征(CTS)患者的神经电生理特征。方法:对临床症状、体征符合CTS的患者22例(31侧)行正中神经,尺神经.桡神经运动和感觉传导速度测定,以及拇短展肌,小指展肌,伸指总肌肌电图检测。结果:在31条患病正中神经中9条感觉传导未引出反应波、22条正中神经感觉潜伏期延长、波幅降低、或(和)感觉传导速度减慢;23条正中神经运动传导远端潜伏期延长、波幅降低;18块正中神经支配肌拇短展肌呈神经源改变。结论:神经电生理检测中以正中神经感觉潜伏期异常阳性率最高(100%);其次是正中神经运动传导远端潜伏期延长(74%)和拇短展肌神经源性改变(58%)。     

视神经脊髓炎谱系疾病周围神经病变的相关神经电生理研究

目的探讨视神经脊髓炎谱系疾病(NMOSD)周围神经病变的神经电生理改变。方法对15例NMOSD患者(NMOSD组)及20名健康对照者(正常对照组)进行EMG检查。结果 NMOSD组中,10例(66.7%)患者的EMG检查有异常改变,主要表现为运动或感觉神经传导速度减慢,波幅减低,F波出现率下降和H反射的潜伏期延长。与正常对照组比较,NMOSD组胫神经及腓总神经运动神经传导速度显著降低(均P0.01),正中神经远/近段潜伏期、胫神经远端潜伏期显著升高(均P0.05),胫神经、腓总神经运动神经远/近端波幅显著降低(均P0.01)。与正常对照组比较,NMOSD组尺神经、正中神经、腓肠神经感觉神经传导速度显著减慢(均P0.01),腓肠神经感觉神经潜伏期显著升高(P0.01),正中神经、腓肠神经感觉神经波幅显著降低(均P0.01)。NMOSD组H反射潜伏期(26.22±10.10)与正常对照组(24.36±0.63)差异无统计学意义(P0.05)。结论 NMOSD患者可以合并周围神经系统受损。EMG检查主要表现为运动或感觉神经传导速度减慢,波幅减低,F波出现率下降和H反射的潜伏期延长。     

远端潜伏期指数在POEMS综合征和慢性炎症性脱髓鞘性多发性神经根神经病鉴别诊断中的价值研究

目的探讨远端潜伏期指数(TLI)在鉴别POEMS综合征和慢性炎症性脱髓鞘性多发性神经根神经病(CIDP)中的应用价值。方法分析18例POEMS综合征(POEMS组)、58例CIDP患者(CIDP组)和30名正常者(对照组)的正中神经和尺神经运动传导参数,包括远端潜伏期、传导速度和TLI。结果 POEMS组与CIDP组正中神经和尺神经传导速度以及TLI存在差异。POEMS组TLI大于正常上限的比例在正中神经和尺神经分别为55.6%(10/18)和52.9%(9/17);CIDP组大于正常上限的比例分别为25.9%(15/58)和24.1%(13/58),小于正常下限的比例分别为22.4%(14/58)和20.7%(12/58),POEMS与CIDP组间差异有统计学意义(P0.05)。CIDP组TLI大于正常上限的患者多伴有传导阻滞或波形离散。结论 POEMS综合征和CIDP的髓鞘脱失各具特征。TLI与传导阻滞和波形离散等参数相结合有利于鉴别POEMS综合征和CIDP。     

神经传导速度在肌萎缩侧索硬化中的诊断价值

目的　研究肌萎缩侧索硬化 (ALS)患者中神经传导速度的改变 ,建立量化评定肌萎缩侧索硬化病情轻重的神经生理指数。方法　对 2 1名ALS患者的 3 0条尺神经、3 2条正中神经及 2 4名健康对照组的 3 8条尺神经、40条正中神经进行神经运动传导速度 (MCV)及感觉传导速度 (SCV)和F波的检测。两组间数据进行统计学分析。结果　ALS组正中神经、尺神经运动传导速度的远端潜伏期 (DML)、肌肉动作电位 (CAMP波幅及面积、F波的出现率 )较对照组有显著性差异。而两组MCV、SCV、F波的潜伏期差异无显著性。ALS组中 1 0名小指展肌的肌力与 (CAMP波幅 /DML×F出现率 )的数值有显著的相关性 (r=0 89,P <0 0 1 )。结论　 (CMAP波幅 /DML×F波的出现率 )是一种有效的客观的电生理指数 ,可对ALS病情进行量化评估     

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.     

肯尼迪病患者60例神经电生理研究

目的对肯尼迪病患者进行神经电生理检测, 了解其神经功能状况。方法对2010年11月至2022年11月北京大学第三医院门诊和病房收治的60例肯尼迪病患者(根据是否合并糖尿病分为单纯肯尼迪病组29例、肯尼迪病合并糖尿病组31例)及60例糖尿病周围神经病(DPN)患者, 分别进行肌电图、神经传导、体感诱发电位(SEP)、接触性热痛诱发电位(CHEP)及三重刺激技术(TST)检测。采用t检验分别对组内及组间神经传导速度及动作电位波幅、SEP各波潜伏期和波间期、CHEP起始峰潜伏期等参数进行比较。结果与正常值比较, 肯尼迪病组患者感觉神经动作电位(SNAP)波幅明显降低[正中神经(0.7±0.4)μV, 尺神经(0.8±0.3)μV, 腓肠神经(1.8±0.1)μV, 波幅下降30%～80%], 正中神经和尺神经波幅低于腓肠神经(t=2.43, P=0.010;t=2.40, P=0.010);SEP和CHEP的周围段异常(潜伏期延长115%～130%), SEP中枢段异常(潜伏期延长104%～115%), 17例TST结果异常(TST测试/TST对照波幅比下降40%～60%)。DPN组患者SN...     

糖尿病患者下肢神经传导功能异常的特征分析

目的探讨糖尿病患者下肢神经传导功能异常的特征。方法搜集223例T2DM患者下肢神经传导检测资料,分析腓深、腓肠、胫神经传导功能。结果(1)158例神经传导异常,异常率70.85%,糖尿病病史1年内、1~4年、5~9年、10~30年异常率分别为61.54%、67.5%、71.19%、79.41%。(2)上述三神经传导速度(NCV)异常率分别为20.67%、16.86%、16.28%;腓深、胫神经波幅异常率为19.94%、11.73%,其末梢潜伏时(DL)异常率为8.94%、5.57%。(3)NCV减慢伴波幅降低和(或)DL延长占47.47%,单纯运动神经(MN)波幅降低占29.75%,单纯NCV减慢占16.46%,DL延长和(或)波幅降低占6.35%。结论(1)T2DM患者随病史延长,糖尿病周围神经病(DPN)发病率升高。(2)T2DM患者下肢神经中,腓深神经较易受累,腓肠神经次之,胫神经受累率低于前两者;在判断MN传导功能指标中,敏感性由高至低依次为NCV、波幅、DL。(3)DPN中,NCV减慢伴随波幅降低和(或)DL延长发生率高于单纯NCV减慢。     

60例腕管综合征患者的神经电生理检测与临床分析

目的 探讨腕管综合征(CTS)患者的神经电生理特征.方法 对临床症状、体征符合CTS的60例患者进行正中神经、尺神经的运动和感觉传导速度测定,及拇短展肌、小指展肌的肌电图检测.结果 60例患者中,双侧病变18例,单侧病变42例.60例CTS患者中78条正中神经感觉传导潜伏期均延长和感觉传导速度均减慢,60条正中神经感觉诱发波幅降低,74条正中神经运动远端潜伏期延长,4条正中神经运动远端潜伏期和诱发波幅正常.58块正中神经支配的拇短展肌呈神经源性损害.结论 神经电生理检查在CTS的诊断与鉴别诊断中有重要意义.     

Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy： an analysis of 500 cases

Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013：221 cases showed symptoms of peripheral neuropathy （symptomatic group） and 279 cases had no symptoms of peripheral impairment （asymptomatic group）. One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases （71.6%）, among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.     

Comparison of electrophysiologic and autonomic tests in sensory diabetic neuropathy

We examined autonomic function in 46 patients with symmetric sensory non-insulin dependent diabetic neuropathy without autonomic symptoms and 31 age-matched control patients using the composite autonomic scoring scale (CASS) and electrophysiologic examination. The patients were divided into three groups by subjective severity of pain or numbness; 17 had slight pain or numbness, 15 had mild pain or numbness, and 14 had moderate pain or numbness. The patients in the moderate group had the following: a mild reduction in systolic and mean blood pressure (BP) within 1 minute of head-up tilt and a partial recovery after 5 minutes; an excessive fall in early phase II (IIe), an absence of late phase II (III) and reduced phase IV beat-to-beat BP responses to Valsalva maneuver (VM); a poor heart rate response to deep breathing; a reduced quantitative sudomotor axon reflex test (QSART) response in distal leg and foot; the highest CASS among the 3 groups; and reduced conduction velocity and amplitude in post-tibial nerve and sural nerve. The mild group had a mild reduction in BP during phase IIe and an absent phase III but normal phase IV overshoot during VM; a reduced QSART in the foot; a CASS between the moderate and slight groups; and reduced conduction velocity and amplitude in post-tibial nerve and reduced amplitude in sural nerve. The slight pain group had no abnormalities except for mild cardiovagal dysfunction. CASS gathered from all cases had a significant correlation with amplitude of sural nerve. These results suggest that the patients with symmetric sensory diabetic neuropathy may also have autonomic dysfunction, although they did not have any obvious autonomic symptoms, and that abnormalities in autonomic function parallel changes in somatic function in peripheral nerve. The CASS may be a sensitive tool, similar to the neurophysiologic test, for assessing diabetic neuropathy.     

Peripheral motor nerve function in diabetic autonomic neuropathy.

Motor conduction velocity was measured in the median, ulnar and common peroneal nerves of 32 diabetics with clinical features of autonomic neuropathy. The responses to the Valsalva manoeuvre and sustained handgrip, and the postural fall in blood pressure were used to assess the integrity of the autonomic nervous system. Abnormalities in the three autonomic function tests were significantly correlated with the forearm conduction velocity of the ulnar nerve, the conduction velocity and motor latency of the common peroneal nerve, and the H reflex. These results show that, in diabetics with autonomic neuropathy, abnormalities in the autonomic nervous system parallel changes in the peripheral nerves. Any diabetic with peripheral neuropathy should be examined for evidence of autonomic nervous system involvement.     

Interrelationship among nerve conduction velocity, amplitudes of compound muscle and compound nerve action potentials in diabetic neuropathy]

In order to clarify the relationship among amplitudes of compound nerve action potential (CNAP), compound muscle action potential (CMAP) and nerve conduction velocity parameters, data of nerve conduction studies were analyzed in 102 patients with diabetes mellitus. In motor conduction studies CMAP amplitudes after stimulations at the distal nerve trunk, and the polyneuropathy index (PNI), a mean percentage of normal for 12 indices from 4 nerves concerning to the velocity or long distance latency, were evaluated. CNAP was recorded in the median and ulnar nerves from an intrafascicularly inserted microelectrode at the elbow after wrist stimulation. CMAP amplitudes were high in the median and ulnar nerves, and were reduced in the tibial and peroneal nerves. A close relationship was found between PNI and CNAP amplitudes. Among CMAP amplitude parameters tibial nerve, not median or ulnar nerves, had a good correlation with PNI and CNAP amplitude. Along with the progression of diabetic neuropathy, neuropathic signs or symptoms become conspicuous, and nerve conduction velocity drops as is expressed by the PNI level, which reflects the change in nerve conduction velocity in the upper and lower limbs. At the same time CNAP amplitude or CMAP amplitude in the tibial nerve decreases, but in nerves of the upper limb CMAP amplitude doesn't always decrease. So, tibial nerve is best among CMAP amplitude parameters in evaluating the degree of diabetic neuropathy. It is necessary to judge the degree of diabetic neuropathy after due consideration of these facts.     

Clinical utility of dorsal sural nerve conduction studies in healthy and diabetic children.

OBJECTIVE: Monitoring of the dorsal sural sensory nerve action potential (SNAP) is a sensitive method for detection of peripheral neuropathies. We tried to determine the normal dorsal sural nerve conduction values of the childhood population and assessed the clinical utility of this method in diabetic children who have no clinical sign of peripheral neuropathy. METHODS: In the study, 36 healthy and 27 diabetic children were included. In all subjects peripheral motor and sensory nerve studies were performed on the upper and lower limbs including dorsal sural nerve conduction studies. RESULTS: The dorsal sural SNAP mean amplitude was 8.24+/-3.08 microV, mean latency was 2.47+/-0.48 ms, mean sensory conduction velocity was 41.63+/-5.43 m/s in healthy children. Dorsal sural SNAPs were absent bilaterally in one diabetic patient. In the other 26 diabetic patients, the mean dorsal sural nerve distal latency was longer (2.93+/-0.63 ms, P = 0.004), mean SCV was slower than in healthy subjects (36.68+/-7.66 m/s, P = 0.005). However, dorsal sural nerve amplitude was not different between the groups. A dorsal sural nerve latency of more than 2.9 ms had a sensitivity of 50% and a specificity of 75%. A dorsal sural nerve velocity of less than 36 m/s had a sensitivity of 54% and a specificity of 92%. CONCLUSIONS: We designated the reference values of the dorsal sural nerve in healthy children. In addition, our findings suggest that dorsal sural nerve conduction studies may have value to determine neuropathy in the early stages in children with diabetes. SIGNIFICANCE: The dorsal sural nerve conduction studies in diabetic children may have value to determine the neuropathy in its early stages.     

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     

Peripheral neuropathy in multiple sclerosis: a clinical and electrophysiologic study

Peripheral nerve abnormalities are uncommon in multiple sclerosis (MS). When present, they are usually attributed to factors associated with advanced disease, such as malnutrition or cytotoxic drugs. We prospectively evaluated 22 mildly disabled MS patients with sensory complaints for evidence of neuropathy using the Neuropathy Symptom Score (NSS), clinical examination, and electrophysiologic studies of peripheral nerves. Distal latency, F-wave response, and nerve conduction velocity (NCV) and amplitude in the ulnar, median, tibial, peroneal and sural nerves were examined. Neuropathy was recorded if electrophysiologic abnormalities were detected in at least two peripheral nerves in the same patient. The most frequent electrophysiologic abnormalities noted were prolonged F-wave response and low motor amplitude in the peroneal nerve, slow sensory conduction velocities of the ulnar and sural nerves, and prolonged distal latencies in the sensory ulnar and sural nerves. Electrophysiologic abnormalities were found in 33 of 244 nerves examined (14.7%) and occurred in 10 patients (45.5%). Neuropathic symptoms were mild and did not correlate with electrophysiologic abnormalities. Age, disease duration, disease course and neurologic disability as evaluated by the Kurtzke Expanded Disability Status Scale, were not associated with the presence of neuropathy. Our findings indicate a high frequency of sensory-motor neuropathy in a selected group of MS patients.     

Increased nerve conduction in diabetics after a year of improved glucoregulation

We studied median, ulnar and peroneal motor nerve conduction velocity (NCV) and median sensory action potential (SAP) latency and amplitude in 18 insulin-dependent diabetic patients who were begun on a continuous subcutaneous insulin infusion (CSII) program. With institution of this therapy, significant decreases in mean blood glucose and glycosylated hemoglobin occurred. After 12 months of CSII treatment, median, peroneal, and ulnar motor NCVs all increased significantly. The average NCV increase was 2.5 m/s. Median SAP amplitude and latency did not significantly change. In a second group of 12 diabetic patients with the same mean age and comparable initial NCV and SAP measures, no significant changes in motor NCVs or SAPs occurred after 12 months of conventional insulin treatment. These results indicated the need for further long-term studies of the role of strict glucose control in the prevention of diabetic neuropathy.     

糖尿病周围神经病病情分级与电生理的相关性

目的探讨糖尿病周围神经病病情分级与电生理的相关性。方法依据糖尿病性周围神经病的诊断标准确定入选对象;依据糖尿病周围神经病病情分级对入选对象进行临床分级;应用丹麦产DANTEC CANTATA型肌电图仪,进行运动神经和感觉神经传导功能检查。结果腓肠神经、正中神经诱发感觉动作电位波幅(SNAP)和腓总神经复合肌肉动作电位波幅(CMAP)随病情分级的升高而明显减低(P<0.05);腓肠神经、正中神经感觉传导速度(SCV)和腓总神经、正中神经运动传导速度(MCV)3级与1、2两级比较显著减慢(P<0.05)。结论神经电生理改变,尤其感觉神经电生理改变,易此作为糖尿病周围神经病情程度评定的指标。