神经传导检测结合交感皮肤反应及R—R间期变化率对糖尿病周围神经病的诊断价值

目的：探讨神经传导检测（NCS）结合交感皮肤反应（SSR）及心电图R-R间期变化率（RRIV）对糖尿病周围神经病（DPN）的诊断价值。方法：选择82例糖尿病患者（DM组）和22例年龄、性别相匹配的健康志愿者（健康对照组）进行NCS、SSR、RRIV检测。将DM组根椐有无感觉、运动神经损害症状再分为有症状组和无症状组；根据NCS结果再分为正常组和异常组进行比较。结果：①SSR和RRIV各参数与临床自主神经症状量表（ASP）评分均有显著相关性（P〈0．05）；②与健康对照组比较，DM不论有症状组还是无症状组NCS异常率均增高（P〈0．01），SSR潜伏期延长和波幅下降，RRIV参数减低（P〈0.05）。DM有症状组NCS异常率显著高于无症状组（P〈0．01），但两组间SSR及RRIV各参数比较差异无显著意义；③与健康对照组比较，DM组中的NCS异常组SSR潜伏期延长和波幅下降，RRIV参数减低（P〈0.05），DM组中的NCS正常组上肢SSR潜伏期延长和波幅下降（P〈0．05），而下肢SSR及RRIV各参数比较差异无显著意义。结论：NCS和SSR、RRIV分别是检测感觉、运动神经和自主神经受损的客观敏感方法，并能发现亚临床病变；在DPN中，感觉、运动神经受累与自主神经受累并非完全呈平行关系，这三种方法相结合，可更好地对周围神经病变作出全面评价。

Significance of nerve conduction velocity with sympathetic skin response and R-R interval variation in the diagnosis of diabetic peripheral neuropathy

Objective：To investigate the significance of nerve conduction study（NCS） with sympa- thetic skin response（SSR） and R-R interval variation（RRIV） in the diagnosis of diabetic peripheral neuropathy（DPN）. Methods： Eighty-two diabetic patients（DM group） and age-and gender-matched volunteers（controls） underwent NCS,SSR,RRIV. The DM group was divided into subgroups with or without symptoms according to the clinical sensory motor nerves damages, or divided into subgroups with normal or abnormal NCS. Results： （1） The parameters of SSR and RRIV were significantly related to scores of clinical autonomic nerve dysfunction（all P〈0.05） ;（2） As compared with the healthy controls, the abnormality rate of NCS increased（P〈0.01） ,latency of SSR was prolonged and amplitude of SSR decreased, parameters of RRIV decreased in DM group whether with or without symptoms（all P〈0.05） . The abnormality rate of NCS in DM group with symptoms was higher than that in DM group without symptoms （P〈0.01） . Tshere was no significant difference of SSR was and RRIV between the two groups; （3） Compared with the healthy controls,latency of SSR prolonged and amplitude of SSR decreased, parameters of RRIV decreased in DM group with abnormal NCS（P〈0.05） ;latency of SSR in upper limbs prolonged and amplitude of that decreased（P〈0.05） ,while parameters of SSR in lower limbs and RRIV had no significant change in DM group with normal NCS. There was no significant difference of SSR and RRIV hetween the two DM subgroups. Conclusion：NCS and SSR, RRIV are objective and effective meth- ods to detect sensory and motor nerves and autonomic nerves damages respectively,and to discover subclinical lesions. There is no parallel relationship between involvement of sensory motor nerves and that of autonomic nerves in DPNCcombined use of the three methods can give a comprehensive evalution of peripheral neuropathy.