糖耐量减低患者神经传导速度及交感皮肤反应的研究

目的:观察糖耐量减低(IGT)患者神经传导速度(NCV)和交感皮肤反应(SSR)的变化。方法:对25例IGT患者(IGT组)、32例2型糖尿病(DM)患者(DM组)及18名对照者(对照组)进行一侧肢体NCV检测和四肢SSR检测。结果:与对照组相比,IGT组(除腓神经外)各根神经NCV均有不同程度减慢,但差异均无统计学意义;DM组(除胫神经外)各根神经NCV与对照组相比差异均减慢(P<0.05)。IGT组双下肢SSR起始潜伏期与对照组相比延长(P<0.05);与对照组相比,DM组四肢SSR起始潜伏期显著延长、波幅显著降低(P<0.01)。对照组、IGT组和DM组NCV异常率分别为5.56%、28.00%、65.63%,SSR异常率分别为33.33%、72.00%、93.75%,3组间NCV和SSR异常率均有显著差异(P<0.01)。在IGT和DM组中,SSR异常率均高于NCV异常率,且无症状者亦有一定的NCV和SSR异常率。结论:IGT患者存在临床或亚临床周围神经损害,以小纤维受累为主,大纤维受累较少且局限于感觉纤维;SSR对糖代谢紊乱相关的周围神经损害的早期诊断敏感性优于NCV,但其特异性较差。

Changes of Nerve Conduction Velocity and Sympathetic Skin Reflex in Patients with Impaired Glucose Tolerance

Objective:To observe the changes of nerve conduction velocity(NCV) and sympathetic skin reflex(SSR) in patients with impaired glucose tolerance(IGT).Methods:NCV of bilateral side of the body and SSR of 4 limbs test were performed in 25 IGT patients(IGT group),32 diabetes mellitus(DM) patients(DM group) and 18 controls(control group).Results:Compared with the control group,the NCV in the IGT group(except the peroneal nerve) was slow but without statistical significance,while the NCV in the DM group of every nerves(except the tibial nerves) was significantly slow(P<0.05).Compared with the control group,the onset latencies of the lower limbs were prolonged significantly in the IGT group(P<0.01).In the DM group,the onset latencies of the 4 limbs were also prolonged significantly and the amplitudes were also decreased significantly(P<0.01).The abnormality rates of NCV in the control group,IGT group,DM group were 5.56%,28.00%,65.63% respectively.And the abnormality rate of SSR in the three groups was 33.33%,72.00%,and 93.75% respectively.The abnormality rates of both NCV and SSR was significantly different among the three groups(P<0.01).In both IGT and DM group,the SSR abnormality rate was higher than that of NCV.And patients without peripheral nerve impairment symptoms in the two groups showed a certain percentage of abnormality in SSR and NCV.Conclusion:Clinical or subclinical peripheral nerve impairment could be found in the IGT patients,with the predominant damgae of small fibers.The large fibers were affected less and confined to sensory nerves.Compared with NCV,SSR has better sensitivity for the early diagnosis of peripheral nerves damage associated with disturbed glucose metabolism with poor specificity.