糖尿病肾病患者外周神经传导速度的变化

目的 分析影响２型糖尿病外周神经传导速度的因素,比较合并糖尿病肾病（ＤＮ０与未合并ＤＮ患者的外周神经传导速度的差异。方法 检测６３例２型糖尿病患者左正中神经,左腓总神经的运动神经传导速度（分别为ＭＣＶ１,ＭＣＶ２）,左正中神经的感觉神经传导速度（ＳＣＶ）,同时测定ＦＢＧ,ＨｂＡ１Ｃ和晨尿白蛋白（ＭＡＣ）,按ＭＡＣ的水平确定有无ＤＮ并分组,分别统计两组的ＭＣＶ１,ＭＣＶ２,ＳＣＶ。结果 ＭＣＶ１,Ｍ     

2型糖尿病患者H反射的观察

目的 了解2型糖尿病患者H反射与周围神经传导速度（PNCV）的关系。方法 测定2型糖尿病患者H反射和周围神经传导速度。结果 2型糖尿病232例，H反射异常率为83．6％（194／232），高于PNCV异常率70．6％（164／232）（P＜0．01）。病程≤5年组H反射异常率80．8％（118／146），高于PNCV异常率65．7％（96／146）（P＜0．01）。病程＞5年组，H反射异常率88．4％（76／86），略高于PNCV异常率79．0％（68／86）（P＞0．05）。结论 H反射可作为对早期糖尿病神经病变的检测手段之一。同时为早期治疗提供可靠依据。     

HCV RNA链扩增反应（PCR）检测及其基因分型方法的建立

我们用选自ＨＣＶ５’ＮＣＲ和Ｃ区引物建立了检测血清中ＨＣＶＲＮＡ及其基因型的ＲＴ／ＰＣＲ方法，可以敏感而特异地检出血清中ＨＣＶＲＮＡ及其４种基因型。５０例抗ＨＣＶ阳性献血员ＨＣＶＲＮＡ检出率为８４％（４２／５０），４２例ＨＣＶＲＮＡ阳性者中ＨＣＶⅡ型占５９．５％（２５／４２），Ｉ型和混合型（包括Ⅰ／Ⅱ、Ⅱ／Ⅲ、Ⅰ／Ⅲ和Ⅰ／Ⅱ／Ⅲ各２例）分别占１１．９％和１９％，另有４例Ｃ区分型结果阴性，为未定型，占９．５％，没有发现Ⅳ型。上述结果说明我国献血员中存在无症状ＨＣＶ携带者，ＨＣＶ基因型则以Ⅱ型为主，Ⅰ型次之，Ⅲ型较少。     

163例丙型肝炎八年前瞻性研究

为探讨我国丙型肝炎的特点，对１６３例丙型肝炎患者进行了８年随访。急性丙型肝炎急性期后的主要异常表现为血清丙氨酸转氮酶（ＡＬＴ）升高，病后１年内、１、２、５和８年的ＡＬＴ异常率分别为１００％、７３％、５７％、３７％和２８％；ＡＬＴ异常分持续性和波动性两类，后者约占１／３～１／２。用第二代丙型肝炎病毒抗体（抗－ＨＣＶ）ＥＬＩＳＡ试剂检测，病后２个月内、２～６个月、７～１２个月及１、２、５和８年的抗－ＨＣＶ阳性率分别为５６％、９３％、９４％、９６％、９７％、９３％和８３％；病后１年起少数患者抗－ＨＣＶ阴转，仅见于ＡＬＴ复常者，病后１、２、５和８年，ＡＬＴ复常者的抗－ＨＣＶ阴转率分别为１０％、８％、１６％和２２％。病后８年时用套式聚合酶链反应（ＰＣＲ）法检测抗－ＨＣＶ阳性血，丙型肝炎病毒（ＨＣＶ）ＲＮＡ阳性率为８４％，其中ＡＬＴ异常和正常者无明显差异。用型特异引物ＰＣＲ法测定４５份抗－ＨＣＶ阳性血清，４２份为Ⅱ型，３份待定。８年时未检出甲胎蛋白异常者，肝功能（血清胆红素和白蛋白）９６％～９７％为ＨｏｂｂｓⅠ级，表明还没有明显的失代偿性肝硬化和肝细胞癌者。     

HCV和HIV-1合并感染标本中HCV基因分型

目的了解丙型肝炎病毒（ＨＣＶ）和人类免疫缺陷病毒Ｉ型（ＨＩＶ－１）混合感染标本中ＨＣＶ基因型情况。方法采用了根据ＨＣＶ５′端非转译区基因组所设计的反相探针杂交测定方法（ＩＮＮＯＬｉＰＡ，ＨＣＶⅡ），对来自六个地区的１７份抗－ＨＣＶ和抗－ＨＩＶ－１双阳性标本进行ＨＣＶ基因型分型研究。结果在１７份标本中，７份（４１．１８％）为Ｉ（１ｂ）型病毒，５份（２９．４１％）为Ⅱ（２ａ／２ｃ）型病毒，５份（２９．４１％）为Ｉ型（１ｂ）和Ⅱ（２ａ／２ｃ）混合型病毒。结论发现ＨＣＶ与ＨＩＶ－１合并感染标本中存在Ｉ（１ｂ）型、Ⅱ（２ａ／２ｃ）型以及Ｉ（１ｂ）型与Ⅱ（２ａ／２ｃ）型混合型ＨＣＶ。值得注意的是对α－干扰素治疗不敏感并且较易趋于导致严重的慢性肝炎、肝硬化和肝细胞癌的Ⅱ型ＨＣＶ感染的比率占７０．５８％（１２／１７）。     

糖尿病周围神经病变的神经传导检查特点

目的 分析神经传导检查在糖尿病周围神经病变（DPN）中的特点,提高此方法诊断DPN的敏感性. 方法 对符合标准的213例患者的2283条神经行传统的神经传导、F波、H反射检查,并分析各条神经总的神经电生理检查情况. 结果 2283条神经进行常规神经传导检查结果显示,感觉神经传导速度（SCV）中,正中神经的异常率最高;运动神经传导速度（MCV）中,胫神经、正中神经异常率高;最长的胫神经运动神经神经传导异常率为47.45％,容易合并卡压的正中神经感觉神经传导异常率为46.83％,而腓肠神经感觉神经传导异常率最低（22.60％）.对有临床明确症状的21条神经进行神经传导检查,异常率可达76.19％.对感觉神经传导异常的尺神经进行运动神经传导检查,尺神经异常率为57.14％.常规神经传导检查,正中神经感觉神经传导异常率（46.83％）高于正中神经运动神经传导异常率（41.13％）.正中神经感觉神经传导异常者运动神经传导异常率为76.56％,正中神经运动神经传导异常者感觉神经传导异常率为89.63％.尺神经F波、胫神经H反射的异常率分别为25.83％、52.24％.结论 DPN具有长度依赖性、与临床表现一致、感觉重于运动、全长弥漫受累等特点,根据这些特点选择神经进行神经传导检查,可提高神经传导检查诊断DPN的敏感性.     

血管紧张素Ⅰ转化酶基因多态和2型糖尿病肾病相关性研究

血管紧张素Ⅰ转化酶（ＡＣＥ）基因多态和２型糖尿病肾病（ＤＮ）的关系。方法用ＰＣＲ技术检测１０２例中国汉族２型糖尿病患者ＡＣＥ基因Ｉ／Ｄ多态基因型。结果ＤＮ组（ｎ＝３６）和无ＤＮ组（ｎ＝４９）相比,Ｄ型等位基因和ＤＤ基因型糖频率升高（分别为５９．７％ｖｓ３８．８％,Ｘ＾２＝７．３０,３３．３％ｖｓ１２．２％,Ｘ＾２＝５．５３）,有显著性差异（Ｐ〈０．０５）,病程≤５年合并ＤＮ组（ｎ＝１１）与病程〉５     

交感神经皮肤反应与神经传导测定对糖尿病周围神经病变的诊断价值

[摘要]目的 分析比较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。方法 选取本院2014年1月-2015年12月门诊收治的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、运动神经传导速度和交感神经皮肤反应,并对结果进行记录和统计学分析。结果 糖尿病组的正中神经、尺神经、腓总神经、胫神经的运动神经传导速度和正中神经、尺神经、腓肠神经、腓浅神经的感觉神经传导速度均明显低于健康组（P＜0.01）;健康组上下肢的起始潜伏期均明显少于糖尿病组（P＜0.01）,但糖尿病组上下肢的波幅与健康组相比较,差异均无统计学意义（P＞0.05）;糖尿病组患者的下肢的神经传导速度的异常率（34.84%）明显高于上肢（18.85%）,两者差异存统计学意义（χ2=16.97,P＜0.01）;上肢的交感神经皮肤反应异常率（35.24%）低于下肢（55.74%）,差异存统计学意义（χ2=10.33,P＜0.01）;神经传导速度和交感神经皮肤反应总异常率分别为25.58%、45.49％,交感神经皮肤反应的总异常率显著高于神经传导速度,差异存统计学意义（χ2=39.96,P＜0.01）。 结论 神经传导速度和交感神经皮肤反应作为糖尿病自主神经及周围神经病变诊断的重要指标,可为糖尿病周围神经病的早期诊断提供重要依据,且交感神经皮肤反应对糖尿病周围神经病早期诊断的敏感性更高。     

120例2型糖尿病患者的周围神经传导速度检测分析

检测并分析2型糖尿病患者（NCV组）与正常对照组的四肢周围神经传导速度（NCV）。结果两组比较,运动神经传导速度（MCV）、感觉神经传导速度（SCV）、复合肌肉动作电位（CAMP）波幅及感觉神经动作电位（SNAP）波幅均有显著统计学差异（P均〈0．05）,且SCV异常率高于MCV、下肢NCV异常率高于上肢（P均〈0．01）。糖尿病性周围神经病变（DPN）程度与糖尿病病程有关,与空腹血糖水平元明显相关性。提示NCV检测有助于DPN患者的早期诊断。     

66例慢性非甲非乙型肝炎患者的丙型肝炎病毒感染研究

以ＨＣＶ－Ｔ３序列为引物，结合ＲＴ－ＰＣＲ和寡聚核甘酸探针Ｓｏｕｔｈｅｒｎ杂交，检测６６例慢性非甲非乙型肝炎（ＮＡＮＢＨ）患者的血浆ＨＣＶ－ＲＮＡ，阳性４２例（６３．６％）。同样病例以相当于ＨＣＶＣ区基因编码和ＮＳ３区编码的人工合成肽抗原检测抗ＨＣＶ，阳性４９例（７４．２％）。这６６例慢性ＮＡＮＢＨ病例，抗ＨＣＶ和ＨＣＶ－ＲＮＡ双阳性者３８例（５７．６％）；抗ＨＣＶ阴性而ＨＣＶ－ＲＮＡ阳性者４例（６．１％）；抗ＨＣＶ阳性而ＨＣＶ－ＲＮＡ阴性者１１例（１６．７％）。其中诊断为散发型ＮＡＮＢＨ者３５例，检出ＨＣＶ－ＲＮＡ者１７例（４８．６％），为输血后ＮＡＮＢＨ者３１例，检出ＨＣＶ－ＲＮＡ者２５例（８０．７％）。     

2型糖尿病患者听觉阈值与周围神经病变的关系分析

目的 通过比较无糖尿病的人群和2型糖尿病患者的纯音听阈值、振动觉阈值(VPT),了解2型糖尿病患者周围神经病变(DPN)与耳聋的关系.方法 测定173例研究对象的VPT及纯音听阈值,2型糖尿病患者同时测定感觉神经传导速度(SCV)和运动神经传导速度(MCV),将其分为对照组35例,无糖尿病神经病变组74例,糖尿病伴神经病变组64例.比较3组的基本情况、感音神经性耳聋(SNHL)发生率、纯音听阈值和VPT值,分析听阈值和神经传导速度的关系.结果 伴神经病变的糖尿病组SNHL发生率为29.69%,明显高于无糖尿病神经病变组(17.57%)和对照组(17.14%),且3组的年龄、糖尿病病程、HbA1c、糖化血清蛋白(GA)、空腹血糖、餐后2 h血糖、VPT和听阈值之间有显著性差异(均P＜0.05).不同VPT亚组的听阈值之间也存在明显差异(均P＜0.05).正中神经传导速度与1.00、2.00、4.00、8.00kHz听阈值呈明显负相关,logistic回归分析显示,年龄(回归系数=0.088,P＜0.01)是SNHL的独立危险因素,正中神经MCV(回归系数=-0.135,P=0.046)是影响SNHL的重要因素.结论 糖尿病患者易影响中高频听力,DPN患者常同时合并听力受损,年龄、正中神经MCV是影响SNHL的主要危险因素.

Abstract：

Objective In order to investigate the relationship between hearing loss and diabetic peripheral neuropathy( DPN ) via comparing the pure tone thresholds and vibration perception threshold(VPT) in type 2 diabetic patients and control person without diabetes. Methods 173 subjects including 138 type 2 diabetic patients(DM)and 35 non-diabetes controls were examined for VPT and hearing threshold. Nerve conducting velocity ( NCV )including sensory nerve conducting velocity( SCV )and motorial nerve conducting velocity( MCV )of diabetic patients were determined. The participants were divided into three groups: control group (n = 35 ), DM group without peripheral neuropathy( non-PN group, n = 74 ), and DM group complicated with peripheral neuropathy (PN group,n = 64 ). The clinical characteristics, biochemical parameters , the incidence of sensorineural hearing loss ( SNHL),pure tone threshold, and VPT were compared among three groups. At last, the relationship between hearing thresholds and NCV were analyzed. Results The incidence of hearing impairment of sensorineural type was 29.69% in PN group, which was significantly higher than that of non-PN group( 17.57% )and control group( 17. 14% ). There was significant differences in age, duration of diabetes, glycolated hemoglobin (HbA1c), glycolated serum albumin ( GA), Fasting blood glucose( FPG), 2h postprandial blood glucose( PPG), VPT, and hearing threshold among the three groups( all P＜0. 05 ). The value of hearing threshold increased significantly( all P＜0. 05 ) in 3 VPT subgroups with VPT≤ 15 V, VPT 16-25 V, and VPT ＞25 V. The Spearman correlation analysis showed median NCV was negatively correlated with hearing threshold on 1.00, 2.00, 4. 00, and 8. 00 kHz ( All P ＜ 0. 05 ). The logistic regression analysis indicated that the age( regression coefficient =0. 088, P＜0. 01 ) was the independent risk factor of SNHL, median nerve MCV ( regression coefficient = -0. 135, P = 0. 046 ) was the important influencing factor of SNHL. Conclusion Diabetic patients are more likely to suffer from impaired middle-frequency and high-frequency hearing, DPN in patients is often complicated with hearing impairment. Age and median nerve MCV were major risk factors of SNHL in diabetic patients.     

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。     

糖尿病周围神经病变神经传导速度、F波及皮肤交感反应的变化及临床意义

目的 探讨糖尿病周围神经病变（DPN）患者神经传导速度（NCV）、F波及交感神经皮肤反应（SSR）的变化特点及临床应用价值.方法 97例DPN患者进行神经电生理检查,包括运动神经传导速度（MCV）、感觉神经传导速度（SCV）、F波及SSR检测.结果 异常率分别为SSR 75.2％,NCV 48.8％,F波34.5％,下肢神经病变重于上肢（P＜0.05）.结论 NCV、F波及SSR联合应用可全面地评估糖尿病周围神经的损害,三者相辅相成,缺一不可.     

Possible contribution of adipocytokines on diabetic neuropathy

Neuropathy is one of the typical features of chronic complications of diabetes mellitus. Recent analyses indicate that subjects with impaired glucose tolerance (IGT) already have disturbance of peripheral nerve function. To test the role of adipocytokines, that tend to be abnormal in IGT subjects, on diabetic neuropathy, we analyzed the relationship between plasma adipocytokine levels (TNFalpha, adiponectin, and leptin) and nerve conduction velocity in 105 type 2 diabetic subjects (M/F = 66/39, age = 60.8 +/- 11.8 years, BMI = 24.7 +/- 5.0kg/m2). Adipocytokines were measured by ELISA, and motor conduction velocity (MCV) and sensory conduction velocity (SCV) in median, ulnar, and tibial nerve were measured by electrical stimulation. Motor conduction velocity and SCV were corrected by age to be 1.0 as the normal value, and the average of three nerves were used to be the representative value. Relationship between corrected MCV or corrected SCV as a dependent variable and the duration of diabetes, HbA1C, BMI, TNFalpha, adiponectin, and leptin concentrations as independent variables were analyzed by multiple regression. Duration of diabetes and HbA1C were highly related with both corrected MCV (P < 0.02 and P < 0.001) and SCV (P < 0.02 and P < 0.05) by this analysis. Only corrected SCV was related significantly with TNFalpha (P < 0.05), and close to significantly with leptin (P = 0.059) concentrations. These results indicate that increased plasma glucose levels and duration of diabetes are the major factors that modulate diabetic neuropathy. However, nerve function may be affected by plasma cytokine levels like TNFalpha, and this effect was more significant on sensory nerves than motor nerves. The present results suggest that adipocytokines may play a role not only on angiopathy but also on neuropathy in diabetics.     

2型糖尿病肾病亚甲基四氢叶酸还原酶基因多态性研究

目的探讨亚甲基四氢叶酸还原酶(methylenetetrahydrofolate     

核转录因子κB在糖尿病大鼠坐骨神经中的表达及其与传导速度的关系

目的研究核转录因子出（NF-κB）在糖尿病大鼠坐骨神经中的表达动态变化及其意义。方法建立糖尿病大鼠模型后，分别在实验1个月、3个月、6个月时测定坐骨神经的传导速度和NF-κB的表达量。结果（1）坐骨神经传导速度：与正常对照（NC）组相比，糖尿病模型1个月组大鼠坐骨神经传导速度未见明显下降，3个月、6个月组则明显下降（P〈0．05）；（2）EMSA电泳条带灰度分析：与NC相比，NF-κB表达在糖尿病各组均明显增强（P〈0．05）。结论NF-κB在糖尿病大鼠坐骨神经中持续活化，推断NF-κB在糖尿病周围神经病变的发病机制中起重要作用。     

Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome

OBJECTIVE: To prospectively compare high-resolution ultrasonography (US) and nerve conduction velocity (NCV) in clinically diagnosed mild carpal tunnel syndrome (CTS). METHODS: Eighty-five patients (70 women and 15 men, mean age 46.8 years) reported symptoms compatible with classic/probable CTS. The protocol included NCV of the median and ulnar nerves (distal motor latency [DML], sensory conduction velocity [SCV] from the third [M3 SCV] and fourth fingers [M4 SCV] to the wrist for the median nerve); electrophysiologic severity scale; self-administered Levine/Boston questionnaire (BQ); and cross-sectional area (CSA) measurement of the nerve at the tunnel inlet (CSA-I), at the middle (CSA-M), and at the outlet (CSA-O). Relationship between age, body mass index, duration of symptoms, CSAs, NCV, electrophysiologic severity scale, and BQ scores was calculated. Concordance between CSAs and NCV, sensitivity of NCV and US was also evaluated. RESULTS: The mean values of CSA-I, CSA-M, and CSA-O were 10.3, 9.8, and 8.7 mm2, respectively. Relationships were found between CSA-I and M3 SCV (r = -0.45), M4 SCV (r = -0.56), and median nerve DML (r = 0.29). Anomalous CSA-I, CSA-M, and CSA-O were found in 48, 25, and 26 patients, respectively; 55 (64.7%) had > or =1 abnormal CSA. NCV abnormalities were found in 67%. The sensitivity increased to 76.5% if US and NCV were considered together. The highest concordance to detect absence/presence of abnormalities was between CSA-I and NCV (77.6%; kappa = 0.52). CONCLUSION: In mild cases of CTS, US did not detect more anomalies than NCV and vice versa, and no anomalies were detected with either diagnostic instrument in 23.5% of mild cases.     

糖尿病性神经病变的运动诱发电位研究

目的 探讨糖尿病运动神经中枢及神经根,周围神经功能。方法 应用经皮层,脊髓电刺激运动诱发电位对５０例ＤＭ进行观察。结果 异常率８２％,表现皮层,脊髓刺激ＭＥＰ潜伏期延迟,波形分化欠佳。部分伴有ＣＭＥＴ异常,ＭＥＰ异常率与病程长短呈正相关;空腹血糖水平对ＭＥＰ结果无明显影响。     

Subclinical nerve dysfunction in children and adolescents with IDDM

Summary The purpose of this study was to investigate whether young insulin-dependent diabetic patients still develop peripheral nerve dysfunction when using modern multiple insulin injection therapy and to elucidate if this correlated with various disease parameters. Seventy-five patients, 7 to 20 years old with a duration of diabetes of more than 3 years, and 128 age-matched healthy control subjects underwent bilateral studies of median, peroneal, and sural nerves. Presence of diabetes lowered motor conduction velocity (p<0.0001), sensory conduction velocity (p<0.0001) and sensory nerve action potential (p<0.05) in all examined nerves. The mean change in conduction velocity induced by diabetes was –4.8 m/s in the peroneal nerve, –3.3 m/s in the median motor nerve, –2.6 m/s in the sural nerve and –2.4 m/s in the median sensory nerve. Fifty-seven percent of the patients had abnormal conduction (values outside 95% predictive interval) which was seen most often in the motor nerves, especially in the peroneal nerve (41%) followed by the median nerve (24%). In multiple regression analysis, long-term poor metabolic control and increased body length correlated with nerve dysfunction identified in most examined parameters. Three patients had signs or symptoms suggestive of neuropathy. It is concluded that despite modern multiple insulin injection therapy, with reasonably good metabolic control, nerve dysfunction is still common in children and adolescents with insulin-dependent diabetes mellitus. Risk factors are increased height and long-term poor metabolic control.Abbreviations IDDM Insulin-dependent diabetes mellitus - MIT multiple insulin injection therapy - MCV motor nerve conduction velocity - CMAP compound muscle action potential - DML distal motor latency - SCV sensory nerve conduction velocity - SNAP sensory nerve action potential     

Structure-function relationships within peripheral nerves in diabetic neuropathy: the hydration hypothesis

Summary To define the quantitative relationship between peripheral nerve structure and function imposed by endoneurial oedema in the diabetic state, we determined values for sural nerve hydration structure as measured by magnetic resonance spectroscopy, and for neurological function with scores for nerve conduction properties (NCV-score), neuropathic symptoms (NS-score), and examination signs (NE-score). The coefficient of sural nerve hydration was elevated to 30±6% (p<0.05) in 79 symptomatic neuropathic diabetic subjects with an average of 15 years of diabetes mellitus, compared to a value of 25±3% in 72 non-diabetic control subjects. In contrast, in 75 asymptomatic diabetic subjects with an average of 6 additional years of diabetes, the mean hydration coefficient was only 28±5% (p<0.05). A nerve hyperhydration state was identified with a prevalence of 25% within the asymptomatic group characterized by nerve hydration greater than the 95th percentile, early changes in nerve electrophysiology and neurological examination, but with no symptomatology of neuropathy. Stratification of the symptomatic neuropathic group by worsening nerve electrophysiology, demonstrates a coincident deterioration in neurological examination (RR=5.39 at maximum NCV-score), and neuropathy symptomatology (RR=4.80 at maximum NE-score). The present data are consistent with the hypothesis that endoneurial oedema initiates deterioration sequentially in nerve electrophysiology, followed by abnormal findings on neurological examination, preceding the patient's final perception of symptomatic stocking-glove peripheral diabetic neuropathy.Abbreviations MRS Magnetic resonance spectroscopy - NCV nerve conduction velocity - NE neurological examination - NS neurological symptoms - IDDM insulin-dependent diabetes mellitus - NIDDM non-insulin-dependent diabetes mellitus