糖尿病痛性周围神经病的临床及电生理特点分析

目的探讨糖尿病痛性周围神经病（PDPN）的临床和电生理特点。方法严格入选32例PDPN患者,病程〉1年,疼痛视觉模拟评分〉4,未伴有其他内科系统合并症,进行视觉模拟评分（VAS）并记录疼痛性质。电生理检测包括：常规神经传导速度（NCV）、定量感觉检测（温度觉）（QST-t）。结果PDPN往往有客观的感觉异常,但神经系统体征不典型,NCV检测可正常,而QST—t可有异常表现,本组NCV检测13例正常,其中11例QST-t异常;本组NCV异常率为59．4％,QST异常率为87．5％,QST＋NCV异常率为93．7％。VAS与QST的上下肢热痛觉（HP）呈正相关（t=0．595、P=0．009;t=0．784、P=0．004）,与胫神经的感觉神经传导速度（SCV）呈负相关（t=-0．554;P=0．032）;与其它电生理各项参数不相关,与空腹血糖、糖化血红蛋白、病程及疼痛病程不相关。结论PDPN以小纤维受累为主,QST可为早期PDPN提供客观的临床依据;疼痛程度与C类纤维及下肢胫神经感觉纤维病变有一定的相关性。

Clinical and electroneurophysiological features of painful diabetic peripheral neuropathy

Objective To analyze the clinical and electrophysiological features of the painful diabetic peripheral neuropathy (PDPN).Methods Thirty-two patients with PDPN,whose history was more than 1 year and visual analog scale (VAS) was more than 4,were recruited and investigated.Twenty well-matched healthy volunteers as controls.Conventional motor and sensory nerve conduction velocity(NCV) and quantitative sensory testing(QST) were performed.The relations between VAS and clinic,eletrophysiology were analyzed.Results NCV of Thirteen patients showed normal,but 11 of them QST revealed abnormal.The abnormality rates of NCV,QST and NCV+QST were 59.4%,87.5% and 93.7% respectively.The relations between VAS and heat pain threshold(HP) of QST,VAS and tibial sensory nerve conduction velocity (SCV) were found.Conclusion Small nerve fibres(SNF) were involved in early stage of PDPN and QST is the sensitive means for the early diagnosis of PDPN.VAS is associated with damage of C-nerve fibres and tibial sensory nerve.