神经电生理检查对糖尿病神经病变的诊断价值

目的探讨神经电生理检查对糖尿病神经病变的诊断价值。方法抽取2015年3月—2017年3月110例糖尿病患者,依据其并发症情况将其分为存在神经病变,即DPN组(n=58)与不存在神经病变,即无DPN组(n=52),分别检查两组患者的正中神经、尺神经运动传导速度(MCV)与感觉传导速度(SCV)、腓总神经MCV及胫神经MCV,观察两组患者的MCV差异、DPN组的MCV与SCV异常率及上下肢NCV异常率。结果经检测得知,在DPN组中,有症状DPN患者共37例;无DPN组的正中神经、尺神经运动传导速度与感觉传导速度、腓总神经MCV及胫神经MCV明显快于DPN组;有症状DPN组与无症状DPN组的SCV异常率高于MCV,并且下肢NCV异常率明显高于上肢,差异有统计学意义(P0.05)。结论神经电生理检查能够有效的确诊糖尿病患者的神经病变情况,具有较高的临床推广价值。     

53例2型糖尿病患者神经电生理检测结果分析

近年来,我们检测了53例无神经系统病变症状的2型糖尿病（DM）患者的感觉神经传导速度（SCV）、脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）,旨在探讨三者对中枢神经系统及周围神经系统损害的诊断意义。     

前列地尔联合甲钴胺治疗糖尿病神经病变临床研究

目的研究前列地尔联合甲钴胺治疗糖尿病神经病变的临床效果。方法随机抽取该院2013年6月—2014年6月采用前列地尔联合甲钴胺治疗糖尿病神经病变的患者31例作为研究组;选取同期单纯采用前列地尔的31例糖尿病神经病变的患者作为对照组,对比研究两组的临床效果。结果治疗后,研究组血糖、Hb Alc正中神经和腓神经的MCV、SCV及临床总有效率等,与对照组比较,差异有统计学意义(P0.05)。结论前列地尔联合甲钴胺治疗糖尿病神经病变的临床效果较好,具有推广应用的价值。     

肌电图在糖尿病周围神经病变诊断中的运用及应用优势探析

目的观察肌电图在糖尿病周围神经病变诊断中的运用及应用优势。方法选取该院收治的60例疑似糖尿病周围神经病变患者(2014年10月—2016年10月期间),所有患者均经肌电图检查。对疑似糖尿病周围神经病变患者的四肢运动神经传导速度(MCV),感觉神经传导速度(SCV)及F波的检测情况进行观察,并将其糖尿病周围神经病变的确诊率与临床诊断结果进行对比。结果经肌电图检查后,患者的糖尿病周围神经病变确诊率为70.00%,而临床诊断结果为45.00%,两组差异有统计学意义(P0.05);其中正中神经的MCV、SCV异常率分别为20.00%、26.67%,尺神经的MCV、SCV异常率分别为20.00%、21.67%,胫神经MCV、SCV的异常率为23.33%、31.67%,腓神经MCV、SCV的异常率分别为30.00%、36.67%,正中神经F波、胫神经F波异常率为35.00%、43.33%。结论在疑似糖尿病周围神经病变患者的诊断中,经肌电图检查的确诊较高,且可反映患者各个神经的MCV、SCV异常情况,具有较高的临床诊断价值。     

老年糖尿病患者神经传导速度的改变

目的　探讨 2型糖尿病患者神经传导速度的改变。方法　通过肌电图的测定和分析 ,对 6 0例 2型糖尿病患者的神经传导速度进行研究。结果　显示神经传导速度 (NCV)较正常对照组减慢 ,异常率为 42 %～ 85 % ,下肢异常率高于上肢 ,感觉神经传导速度 (SCV)异常率高于运动神经传导速度 (MCV) ,尤以腓浅神经SCV最敏感。结论　NCV检查对早期诊断糖尿病性神经病变具有实用价值。     

神经传导速度在糖尿病无症状性周围神经病中的应用价值

目的：探讨神经传导速度（NCV）在糖尿病（DM）无症状性周围神经病变患者中的应用价值。方法：选择DM伴周围神经病变患者（有症状组）25例及无周围神经病变症状患者（无症状组）30例,分别测定双侧正中神经、尺神经、胫神经及腓总神经运动传导速度（MCV）和双侧正中神经、尺神经、胫神经及腓浅神经感觉传导速度（SCV）,并对30例无神经系统症状的患者用空腹血测糖化血红蛋白（HbAlc）,3个月后复查神经传导速度和HbAlc。结果：NCV能及早发现有周围神经损害亚临床糖尿病周围神经病变（DPN）患者,NCV的异常率与血糖升高关系密切,动态观察NCV对了解疾病预后很重要。     

糖尿病周围神经病变的神经传导速度测定

目的分析NCV在诊断DPN中的临床应用价值。方法选取该院2013年5月—2015年1月接诊的322例糖尿病患者作为研究对象,采用NCV对DM患者中DPN进行筛选,分析各神经传功功能以及MCV、SCV和波幅、波宽、波形、潜伏期等。结果糖尿病病程5年患者的阳性率较高,有刺痛、四肢远端麻木等症状患者DPN的阳性率更高;在四肢神经病变中,胫后神经病变和腓总神经病变较为常见,波形和波宽均出现明显变化,传导速度的波幅特异性较高。结论糖尿病周围神经病变是糖尿病患者最为常见的并发症,神经传导速度变化直接影响到周围神经病变,测定糖尿病患者的神经传导速度,有利于周围神经病变的诊断。     

糖尿病性膀胱残余尿与心脏植物神经功能障碍的关系

本文对49例健康对照组,32例糖尿病无植物神经病变症状者(无植组)及51例有植物神经病变症状者(有植组)分别进行膀胱残余尿测定和心脏植物神经功能检查。结果糖尿病83例中38例(45.78％)有残余尿,有植组中残余尿发生率及残余尿量均明显高于无植组(P<0.01),而对照组均无残余尿。膀胱残余尿与心脏植物神经功能障碍比较,其发生率与后者病变严重程度有较高的一致性。提示糖尿病性植物神经病变是弥漫性的。植物神经功能测定有助于神经病变的早期诊断。     

运动习惯对老年糖尿病周围神经病患者血流灌注及神经传导速度影响的初步探索

目的探索老年糖尿病周围神经病(diabetic Peripheral Neuropathy,DPN)患者运动习惯的有无对血流灌注及神经传导速度的影响。方法选取焦作市人民医院2019年3月-2019年8月收治的老年糖尿病周围神经病患者58例,分为有运动习惯组(n=31)和无运动习惯组(n=27例)。采集患者一般信息并进行四肢运动神经传导速度(MCV)、感觉神经传导速度(SCV)检查,采用双波长激光散斑衬比成像仪(dwLSCI)评估患者手部和足部的血流灌注情况。结果有运动习惯组的下肢血流灌注较无运动习惯组的好(P<0.05);2组双上肢血流灌注,双上肢正中神经和尺神经的MCV与SCV,双下肢腓总神经、胫神经的MCV及腓肠神经、腓浅神经的SCV的差异无统计学意义(P>0.05)。结论维持运动习惯对老年DPN患者的下肢血流灌注有正向影响,增加了单位时间内足部的血流量。     

交感神经皮肤反应与神经传导速度对糖尿病周围神经病变的诊断价值

目的:分析交感神经皮肤反应(SSR)与神经传导速度(NCV)对糖尿病周围神经病变(DPN)的诊断价值。方法:选取43例2型糖尿病患者和43例健康体检者,同时行神经电图检测,包括感觉神经传导速度(SCV)、运动神经传导速度(MCV)和交感神经皮肤反应(SSR),并进行统计学分析。结果:糖尿病组的正中神经、尺神经、腓总神经、胫神经的MCV和正中神经、尺神经、腓肠神经、腓浅神经的SCV均明显低于健康组(均P0.01);健康组上下肢的起始潜伏期均明显短于糖尿病组(均P0.01),但糖尿病组上下肢的波幅与健康组比较,差异有统计学意义(P0.01);糖尿病组患者下肢NCV和SSR的异常率均明显高于上肢(34.8%vs 18.9%,55.7%vs 35.2%,均P0.01);SSR总异常率显著高于NCV(45.5%vs 24.2%,P0.01)。结论:NCV和SSR可为DPN的早期诊断提供重要依据,且SSR敏感性更高。     

Brainstem auditory and visual evoked potentials in Type 1 (insulin-dependent) diabetic patients

Summary Brainstem auditory evoked potentials and pattern shift visual evoked potentials were measured in 34 Type 1 (insulin-dependent) diabetic patients with long-standing disease and in 43 control subjects. Thirty-two percent of diabetic patients had abnormal brainstem auditory evoked potentials and 15% had abnormal visual evoked potentials. These abnormalities were not related to duration of diabetes, diabetic control or individual diabetic complications (retinopathy, nephropathy, peripheral or autonomic neuropathy). The aetiology of the abnormalities must remain a subject for speculation. The findings of this study are consistent with a central diabetic neuropathy involving the brainstem in long-standing diabetic patients.     

神经诱发电位对肝硬化患者亚临床肝性脑病的诊断意义

目的:探讨神经诱发电位对肝硬化亚临床脑病的诊断价值。方法:用神经诱友电位仪检测29例失代偿期肝硬化患者视觉诱发电位(VEP)与脑干听觉诱发电位(BAEP)的变化。结果:29例肝硬化患者中,VEP异常12例(41.4％),BAEP异常14例(48.3％),总异常率为65.5％。结论:诱发电位检查对于肝硬化亚临床肝性脑病是一种客观而又敏感的方法。     

脑白质疏松症患者的脑诱发电位研究

目的 探讨脑白质疏松症(Leukoaraiosis，LA)患者脑诱发电位改变的特点及其对LA的诊断价值。方法对40例脑白质疏松症合并脑梗死(LA CI)患者及40例单纯脑白质疏松症患者进行体感诱发电位(sEP)，脑干诱发电位(BAEP)及视觉诱发电位(VEP)检查，并与40名同年龄组健康人对照。结果LA CI组患者SEP、BAEP及VEP异常率分别为80％、63％及60％。SEP各波潜伏期、BAEP除Ⅰ波外各波潜伏期及波间期、VEP的P100波潜伏期和对照组相比差异均有显著性意义。而单纯LA组患者SEP、BAEP及VEP异常率分别为35％、30％及45％，SEP仅P15及％波潜伏期、VEP的P100波潜伏期和对照组相比差异有显著性意义。而BAEP和对照组相比，差异无显著性意义。结论SEP、BAEP及VEP联合检查，可反映LA患者皮层、皮层下及脑干功能的损害，并对判断LA患者白质疏松范围，LA严重程度有一定的意义。     

Multimodal evoked potentials and heart rate variability in comatose patients. 3. Electrophysiologic findings in inflammatory diseases of the brain

Multimodal evoked potentials and heart-rate variability (HRV) measurements were performed in a total of 15 comatose patients with inflammatory diseases of the brain. The following potentials were recorded: Brainstem auditory evoked potentials (BAEP), early (SSEP) and long latency (SEP) somatosensory evoked potentials and visual evoked potentials (VEP). The results of the initial BAEP recordings indicate that in 83% of the patients the IV-V interpeak latency was prolonged and out of the range of normal values. Additionally an atypical form of the IV-V wave complex was detected. The SSEP after electrical stimulation demonstrated pathological findings in 90% of the patients; long latency components after mechanical vibration could be identified only by 30%. The results of the VEP show an attenuation of vertex VEP (mean value: 43%). Heart-rate variability of the patients was calculated (mean +/- SD) to be 2.5 +/- 1.4% (norm: 7.8 +/- 2.5%) with a mean heart-rate of 95.2 +/- 16.6/min (norm: 67.8 +/- 10.7/min).     

Effects of hyperglycaemia on visual evoked potentials in insulin-dependent diabetic patients

Multimodality evoked potentials frequently reveal subclinical involvement of the central nervous system in patients with insulin-dependent diabetes mellitus. We devised this study to evaluate the possible effects of acute hyperglycaemia on visual evoked potential (VEP) parameters in type 1 diabetic patients. A hyperglycaemic clamp (250 mg/dl for 180 min) was performed in ten patients. Monocular pattern reversal VEPs (check size 15, contrast 50%) were recorded before, and every 30 min after the start of the clamp. Basal VEP latencies and amplitudes were normal bilaterally in nine patients. No significant changes in pattern reversal and flash VEP parameters were observed after the induction or during the clamp period. None of the neurophysiological parameters evaluated during the test was related to the duration of the disease, the basal VEP latency or amplitude or the presence of retinopathy. Our data suggest that the neurophysiological abnormalities detected in insulin-dependent diabetic patients are due to structural involvement of the central nervous pathways and not to functional damage induced by acute short-term hyperglycaemia.     

诱发电位对肝硬化患者轻微肝性脑病的诊断价值

目的 探讨诱发电位(EP)在没有症状性肝性脑病(OHE)的肝硬化患者中检测轻微肝性脑病(MHE)的价值.方法 对114例无OHE的肝硬化患者进行盲法、自身同步对照的数字连接试验A(NCT-A)、数字符号试验(DST)并检测视觉诱发电位(VEP)、脑干听觉诱发电位(BAEP)、体表感觉诱发电位(SSEP)、P300听觉事件相关诱发电位(P300ERP).NCT-A和DST检测中1项异常即诊断为MHE,比较各EP检测的异常率,评估其诊断MHE的价值.结果 114例肝硬化患者中诊断MHE 60例(52.6%),其阳性率与Child-Pugh分级呈等级正相关(r=0.278,P=0.003).VEP、BAEP、SSEP、P300ERP异常率分别为17.5%、29.8%、38.6%、57.0%.仅P300ERP的异常率与NCT-A+DST的阳性率差异无统计学意义(X2=0.432,P=0.511).VEP、BAEP、SSEP、P300ERP的诊断敏感度分别为13.3%、41.7%、46.7%、73.3%,特异度分别为77.8%、83.3%、70.4%、61.1%.P300ERP的受试者工作特征曲线(ROC)下面积最大(0.672,95%CI 0.572～0.773).VEP、BAEP、SSEP、P300ERP与NCT-A+DST的符合率分别为43.9%、61.4%、57.9%、67.5%.各EP检测的Kappa值均<0.39.结论 以P300ERP诊断无OHE的肝硬化患者MHE敏感度和特异度均较高.P300ERP不可替代NCT-A-4+DST,但可作为补充检测手段.     

Central motor conduction time in multiple sclerosis: an comparison of visual and somatosensory evoked potentials in relation to the type of disease course

The central motor conduction time (CMCT) was measured by electrical transcranial and spinal stimulation in 70 consecutively admitted patients with definite multiple sclerosis and 26 normal volunteers. The results of the patientgroup were compared with visual and somatosensory (median and tibial nerve) evoked potentials. The mean CMCT of the volunteers was 5.4 ms versus 11.1 ms in the patient group. In 55 of the 70 patients (79%) the CMCT was delayed (p less than 0.0001). VEP showed pathologic results in 67%, SEP of tibial nerve in 51%, SEP of median nerve in 41% of the patients. In 10 of the 70 cases (15%) only CMCT was pathologic. Especially in the first attack of the disease the CMCT (79% pathologic results) was superior in comparison to the evoked potentials (VEP and SEP together 43% pathologic findings). In our cases without clinical evidence of a pyramidal tract lesion a subclinical affection of this pathway could be determined in 69% by a pathologic CMCT. We regard this method therefore as a valuable tool in the early diagnosis of multiple sclerosis.     

Impaired visual evoked potential and primary axonopathy of the optic nerve in the diabetic BB/W-rat

Summary The spontaneously diabetic BB/W-rat has emerged as an important model system for somatic and autonomic diabetic polyneuropathy. In this study we examined visual evoked potentials and the presence of morphometric and structural changes in the optic nerve and the retinal ganglion cells and their afferent axons contained in the retinal nerve fibre layer. A six-month duration of diabetes mellitus was associated with significant increases in the latencies of the visual evoked potentials. The latency of the first positive potential showed a 44% increase, and that of the first negative potential was prolonged by 41%. No significant changes were demonstrated at any of the amplitudes. In the optic nerve mean myelinated fibre size was significantly reduced to 82% of control values, which was accounted for by a significant reduction in axonal size. Axo-glial dysjunction, a prominent structural defect of diabetic somato-sensory neuropathy in both man and diabetic rodents, was non-significantly increased in the optic nerve. In diabetic animals retinal ganglion cells displayed dystrophic changes. No such changes were observed in age- and sex-matched control animals. Proximal axons of the retinal nerve fibre layer showed an increase in dystrophic axons in diabetic BB/W-rats. Morphometric analysis of optic nerve capillaries revealed no abnormalities except for basement membrane thickening. The present data suggest that the diabetic BB/W-rat develops a central sensory neuropathy, characterized functionally by prolonged latencies of the visual evoked potentials and structurally by an axonopathy of optic nerve fibres.This study was presented in part at the 3rd International Workshop on Lessons from Animal Diabetes, Tokyo, Japan, September, 1990     

瞬目反射及脑干听觉诱发电位检测在后循环短暂性脑缺血发作中的应用

目的探讨瞬目反射(BR)和脑干听觉诱发电位(BAEP)检测对后循环短暂性脑缺血发作(TIA)患者脑功能受损的诊断价值。方法回顾分析126例后循环TIA患者的BR、BAEP检测结果,观察BR各反射波波幅及平均潜伏期,BAEP波形及各波潜伏期、峰间期。结果 97例BR检查结果异常74例,异常率76.29%;109例BAEP检测结果异常79例,异常率72.48%;其中80例同时进行BR和BAEP检查结果异常71例,异常率88.75%;两种方法联合检测异常发现率明显高于单纯BR或BAEP检测,差异有统计学意义(P<0.05)。结论 BR与BAEP检查方便易行,均能敏感地反映脑干病变,两者联合检测有助于提高后循环TIA引起脑干功能损伤的早期发现和定位诊断。     

肝硬化患者亚临床肝性脑病的诱发电位检测

目的 了解不同严重程度肝硬化患者亚临床肝性脑病的发生率及其临床意义。方法 对３０例无临床肝性脑病的肝炎后肝硬化患者同时进行脑干听觉、视觉和短潜伏期体感诱发电位（ＢＡＥＰ、ＶＥＰ、ＳＳＥＰ）检测。结果 三种脑诱发电位检测以ＢＡＥＰ异常率（４６．７％）高于ＶＥＰ和ＳＳＥＰ（均为３６．７％）;随着肝病程度加重,ＢＡＥＰ和ＳＳＥＰ异常率逐渐增高,分别为Ｃｈｉｌｄ－Ｐｕｇｈ Ａ级４１．７％和８．３％,Ｂ级４