2型糖尿病合并代谢综合征患者周围神经损害相关因素的研究

目的：运用神经传导检测,探讨合并代谢综合征（MS）是否加重2型糖尿病患者周围神经损害并分析相关因素。方法选取符合2型糖尿病诊断标准的患者258例,测定血压、体重、腰围、空腹血糖、胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、体重指数、神经传导,记录病史,根据 MS 诊断标准分为合并MS组145例和非合并MS组113例,并与100例健康人对照。结果与非合并MS组比较,合并 MS 组收缩压、体重、体重指数、腰围、感觉传导速度减慢、运动传导潜伏期延长及感觉运动传导波幅下降差异有统计学意义（P均＜0.05）;与对照组比较,合并MS组及非合并MS组均有感觉传导速度减慢、运动传导潜伏期延长及感觉运动传导波幅下降差异有统计学意义（P均＜0.05）。结论合并MS的2型糖尿病患者周围神经损害更重,可能与收缩压、体重、体重指数、腰围有关。     

Nerve conduction studies and vibration perception thresholds in diabetic and uremic neuropathy.

Two parameters of nerve conduction studies (nerve conduction velocities and amplitudes of the evoked sensory and motor responses) were compared with quantitative vibration perception thresholds (VPT) in patients with peripheral neuropathy (diabetes mellitus and/or end-stage renal disease). VPT measurements were made using a "two-alternative, forced-choice" method in which the patient is required to identify which of the two rods is vibrating at progressively decreasing vibration intensities. VPTs correlated significantly with nerve conduction velocities in all upper and lower extremity sensory and motor nerves tested, and with the amplitudes of the evoked motor responses in three motor nerves: median and ulnar (motor components) and tibial. For the median and ulnar nerves (motor components) the amplitudes of the evoked motor responses were more sensitive than nerve conduction velocities in correlation with VPTs. Comparison of VPT values, based upon whether or not evoked sensory and motor responses were obtained, indicated that mean VPTs were consistently higher among subjects in whom these evoked responses were not elicited. VPT measurements is thus shown to be a valid and valuable method for evaluation of severity in peripheral neuropathy. It has the advantages of being simple, quick and painless. Patient cooperation and compliance with this form of testing are excellent.     

Temperature effect on antidromic and orthodromic sensory nerve action potential latency and amplitude

The measurement of sensory nerve action potential (SNAP) latency and amplitude is often necessary to accurately diagnose disorders of peripheral nerves. The sensory evoked response can be obtained using either the antidromic (AD) or orthodromic (OD) technique. In a previous study we demonstrated that in healthy subjects the AD SNAP distal latency of median and ulnar nerves at 14 cm distance is approximately 0.2 msec slower than the OD SNAP distal latency at 32C. The AD SNAP amplitude was also two times greater than the OD SNAP amplitude. In this study we observed that these differences between the AD and OD SNAP latency and amplitude varied significantly as temperature changed. The AD median nerve SNAP distal latency was delayed by .06 msec/degree with cooling. The OD median nerve SNAP distal latency was delayed by .03 msec/degree with cooling. These values represent less of a slowing per degree centigrade cooling than has been previously noted in the literature. The median nerve SNAP amplitude was found to increase with upper extremity cooling with the AD and OD technique by 3.5 microV and 0.5 microV per degree, respectively. For accurate interpretation of SNAP latency and amplitude, the electromyographer must be familiar with the technique used and the differing effect of the temperature with each technique.     

Relationship between electroneurographic changes and serum ubiquitin levels in patients with type 2 diabetes

OBJECTIVE: The aim of the present study was to investigate any relationship between serum ubiquitin levels and electroneurographic changes in peripheral nerves for patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The study involved 34 patients (19 men, 15 women; mean age 46 +/- 13 years) with type 2 diabetes. Serum ubiquitin values were measured by sandwich enzyme-linked immunosorbent assay Measurement of nerve conduction velocity (NCV) was performed on three motor (median, tibial, and peroneal) and three sensory (median, ulnar, and sural) nerves. The value of motor compound muscle action potential (CMAP) was obtained from the sum of median, tibial, and peroneal motor nerve amplitudes, and sensory compound nerve action potential (CNAP) was computed as the sum of median and ulnar sensory nerve amplitudes. RESULTS: Patients with diabetes were divided into three groups: group 1 (n = 8) had normal electroneurography results, group 2 (n = 8) had slowed NCV, and group 3 (n = 18) had low values of motor CMAP and/or sensory CNAP as well as slowed NCV. Mean ubiquitin level in group 3 (20.4 +/- 2.9 ng/dl) was significantly higher than that in group 1 (11.2 +/- 1.1 ng/dl, t = 11.5, P < 0.0001) and group 2 (13.2 +/- 2.7 ng/dl, t = 5.9, P < 0.0001). Serum ubiquitin levels were inversely correlated with motor CMAP (r = -0.68) and sensory CNAP (r = -0.61) values. CONCLUSIONS: The results of this study indicate that there could be a relationship between the diminished amplitudes of axons of the peripheral nerve and the increase in serum ubiquitin levels in patients with type 2 diabetes. Further studies are required to confirm this relationship.     

Ulnar nerve involvement in carpal tunnel syndrome

This is a retrospective study of the involvement of the ulnar nerve in patients with electrodiagnostic evidence of carpal tunnel syndrome as defined by median sensory nerve action potential (SNAP) greater than 3.6msec at the wrist and/or motor distal latency in excess of 4.3msec. The study included 248 patients, 63 (25%) with unilateral and 185 (75%) with bilateral carpal tunnel syndrome. The electrodiagnostic criteria for ulnar nerve involvement was a SNAP peak latency greater than 3.7msec and/or motor distal latency in excess of 4.2msec. One hundred fourteen patients (46%) had delayed ulnar SNAP peak at the wrist; of these, 100 cases had bilateral ulnar nerve involvement and 14 had unilateral abnormalities. Slowing of the motor nerve conduction velocity for the elbow-wrist segment was noted in 24% and 15% of the study group for the median and ulnar nerves, respectively. An incidental finding was the presence of "double crush syndrome" in 35 patients (14%). The results of this study suggest the frequent association of ulnar nerve involvement at the wrist for sensory fibers and carpal tunnel syndrome.     

正常人周围神经传导速度40例分析

目的:研究健康成人周围神经运动传导速度(motor-nerveconductionve-locity,MCV)和感觉传导速度(sensory-nerveconductionvelocity,SCV)的正常值,为诊断周围神经疾病提供依据。方法:健康志愿者40例,年龄22～53岁,男女各20例。分别检测双侧正中神经、尺神经、胫神经及腓神经MCV和双侧正中神经、尺神经及胫神经SCV。分析指标包括潜伏期、波幅及神经传导速度(nerveconductionvelocity,NCV)。结果:NCV在正常人男女之间、左右侧肢体之间的差异在统计学上无显著性意义(P>0.05),并且随着年龄的增加而逐渐减慢。结论:NCV检测是周围神经病的重要诊断技术之一,而正常值的确定是临床诊断的前提。不同年龄组应采用各自的正常值。     

糖尿病患者下肢周围神经传导速度分析

目的　探讨下肢周围神经传导速度检测对糖尿病周围神经病变 (DPN )的早期诊断价值及评价DPN程度的意义。方法　对 5 3例糖尿病患者下肢F波、运动神经、感觉神经的传导速度检测 ,分析糖尿病患者中有、无神经系统自觉症状组 ,1型、2型糖尿病组的周围神经传导速度变化。结果　各观察组神经传导速度较正常值减慢 (P <0 .0 1) ;有症状组与无症状组比较 ,F波、运动神经传导速度减慢加重 (P <0 .0 1) ,感觉神经传导比较尚无统计学意义 (P >0 .0 5 ) ;1型糖尿病神经传导速度减慢较 2型为重 (P <0 .0 1)。结论　下肢周围神经传导速度减慢是DPN早期诊断及评价DPN程度的敏感指标。     

腕管综合征的电生理分析及与身体质量指数的相关性

目的:探讨88例腕管综合征(CTS)的电生理特点,明确电生理检查的诊断价值。方法:对88例门诊腕管综合征患者行一侧或双侧正中神经、尺神经的分段运动神经传导速度(MCV)和,Ⅰ、Ⅴ、Ⅳ指刺激感觉神经传导速度(SCV)测定,以及拇短展肌针极肌电图检查;计算每一位患者身体质量指数(BMI)及正中神经与尺神经Ⅳ指刺激感觉神经动作电位(SNAP)波幅比值。结果:Ⅰ、Ⅳ指刺激正中神经SNAP潜伏期延长者的百分比分别为59.1%与65.9%;复合肌肉动作电位(CMAP)波幅降低者中拇短展肌肌电图异常者占87.2%;SNAP各参数正常者中有8例(72.7%)出现Ⅳ指刺激正中神经与尺神经波幅比值的异常,各异常参数患者BMI值无显著性差异。结论:神经电生理检查是诊断CTS的理想检测手段。     

糖调节受损患者神经电生理分析

目的 探讨糖调节受损（IGR）患者神经损害的临床和电生理特点。方法 对40例IGR患者（IGR组）、2型糖尿病患者（T2DM组）40例及30例健康对照者（对照组）进行四肢神经传导检测,对空腹血糖（FBG）、餐后2小时血糖（2 hPBG）、糖化血红蛋白（HbA1c）、血脂、运动及感觉神经传导速度等指标进行分析。结果 与对照组比较,IGR组胫神经感觉神经传导速度（NCV）减慢（P<0.05）;T2DM组各神经NCV均减慢（P<0.05）,以胫神经、腓总神经减慢显著（P<0.01）。IGR组和T2DM 组感觉神经传导异常程度重于运动神经,下肢重于上肢（P<0.05）。FBG、2 hPBG、HbA1c水平是IGR患者发生神经传导异常的独立危险因素（P<0.05）。结论 IGR患者早期神经损害在血糖轻微出现异常时已出现,电生理检查有助于早期发现临床病变,可用于IGR患者糖尿病性周围神经病变的早期筛查。     

Electrophysiologic responses of human sural nerve to temperature

The purpose of this study was to assess the conduction, specifically the latency and amplitude of the sensory nerve action potential (SNAP), of the sural nerve as a function of intraneural temperature of the leg. The electrophysiologic responses of the sural nerve were determined at different temperatures in 22 healthy adults. Distal sensory latency and amplitude of the sural SNAP was determined at 1 degree C intervals over a limb temperature range of 23 degrees to 40 degrees C. Limb temperature was monitored with a thermistor probe placed subcutaneously near the sural nerve. Ice bath soaks were used for cooling and infrared radiation for warming the limbs. An analysis of covariance was performed for the SNAP latencies and amplitudes to determine the effect of gender and leg (right or left) at each temperature level. No effect of gender or leg on neural conduction was detected in individual subjects. A regression analysis was then used on pooled data to determine the effect of temperature on sural SNAP latency and amplitude. An inverse linear change in the latency of sural SNAP was observed over the temperature ranges used. Mean latency increased 0.1 msec per 1 degree C increase in subcutaneous temperature. A direct relationship between amplitude of the SNAP and temperature was determined. Mean amplitude increased 0.3 muV per 1 degree C increase in subcutaneous temperature. The results of this study support previous reports, which state that SNAP latency is indirectly related to the intraneural temperature. Clinical electromyographers must monitor the temperature of the lower leg and foot whenever sensorineural conduction of the lower limbs is performed.     

Role of height and glycosylated hemoglobin in abnormal nerve conduction in pediatric patients with type I diabetes mellitus after 4-9 yr of disease

OBJECTIVE: To determine the role of height and glycosylated hemoglobin in abnormal nerve conduction in pediatric patients with insulin-dependent (type I) diabetes mellitus. RESEARCH DESIGN AND METHODS: Sixty-six pediatric patients (aged 6.3-18.2 yr) with a duration of diabetes from 4 to 8.5 yr but free of clinical neuropathy were evaluated for abnormal nerve conduction. RESULTS: Mean HbA1 values for 1 and 2 yr before study were available. Electroneurographic findings were significantly different from control subjects in upper and lower extremities and included all five measured velocities, three sensory latencies, and one amplitude. Stepwise regression analysis identified an adverse effect of height on latency (5 of 6) and of mean HbA1 concentration on decreasing velocity (4 of 5). The data analysis from 52 patients who were restudied and who had a duration of diabetes from 5.3 to 9.6 yr confirmed that all velocity values slowed; one of five values did so significantly. The coefficients associated with mean HbA1 concentration usually increased in both upper- and lower-extremity velocity analyses at the follow-up examination. The change in peroneal motor velocity between the first and last examinations was significantly related to the increasing time interval between examinations. CONCLUSIONS: Prospective evaluation of nerve conduction parameters in pediatric patients with diabetes should include both height (the most significant independent variable in latency analysis) and mean glycemic control (the most consistent variable in velocity analyses) as variables in the assessment of the natural history of evolving peripheral neuropathy.     

2型糖尿病患者周围神经传导速度有关因素分析

目的 评价影响2型糖尿病患者周围神经传导速度的因素。方法 对157例2型糖尿病患者进行周围神经传导速度测定,并就其与病程、尿白蛋白排泄和糖化血红蛋白的关系进行分析。结果 ①在病程<5年、5～10年、10-15年和超过15年的患者中,周围感觉神经电生理异常的发生率随病程的延长而显著增高,P<0.05;而运动神经早期多不明显,仅在病程超过10年的患者中,其神经传导速度才明显减慢;②在正常、微量和大量白蛋白尿的患者中,感觉神经电生理异常的发生率随尿白蛋白排泄的增加而增高,大量白蛋白尿患者周围运动神经波幅明显降低,传导速度显著减慢;③与正常对照组比较,糖尿病患者,糖化血红蛋白水平显著升高,P<0.01。结论 糖尿病患者周围神经病变与病程、尿白蛋白排泄和血糖控制有关。     

正中神经返支卡压征的电生理研究

目的 探讨正中神经返支卡压征的临床与电生理特点。方法 总结14例正中神经返支卡压征患者的临床与电生理资料，其中男10例，女4例，平均年龄34．7岁，应用肌电诱发电位仪进行神经电生理检测。结果 14例患者正中神经末梢运动潜伏时延长，11例复合肌肉动作电位波幅降低，14例感觉传导速度、感觉动作电位波幅正常，12例前臂段运动传导速度正常；12例拇短展肌、14例拇指对掌肌见纤颤电位和／或正锐波；14例旋前方肌、小指展肌与指浅屈肌肌电图检测均正常。结论 神经电生理检测是诊断和鉴别诊断正中神经返支卡压征的可靠手段，能为临床提供客观、准确的诊断指标。     

80例腕管综合征患者的神经电生理测定

目的：观察神经电生理检测对腕管综合征(CTS)的诊断敏感性。方法：80例临床提示为CTS或不能除外CTS的患者进行神经电生理测定并进行回顾性分析。结果：80例116侧正中神经复合肌肉动作电位末端运动潜伏期和波幅、肘至腕的运动传导速度、指至腕部的感觉传导速度及感觉神经动作电位波幅等5项指标检测异常率分别为75．0％、19．8％、9．5％、88．8％及37．9％；45例65侧拇指正中／桡浅神经潜伏期差(MRLD)及环指正中／尺神经潜伏期差(MULD)检测异常率95．4％。结论：正中神经拇指至腕段的感觉传导速度测定是诊断CTS的敏感指标，采用MRLD及MULD测定，诊断敏感性更高。     

多发性硬化周围神经损害的临床与神经电生理分析

目的探讨多发性硬化（MS）患者合并周围神经损害的的临床和神经电生理特点。方法分析41例MS患者周围神经损害的临床，同时采用神经传导速度（NCV）技术检测MS患者周围神经的运动传导速度（MCV）、感觉传导速度（SCV）及其潜伏期、波幅；检测正中神经、胫神经F波、H反射的潜伏期和F波的出现率。结果MS合并PNS损害的发生率为41．4％，其临床表现主要为肢体麻木12例（29．2％）、肢体乏力10例（24．3％）、神经根性疼痛2例（4．8％）；体征有末梢／根型感觉障碍9例（21．9%）、腱反射减低5例（12．1％）、肌力减低（〈Ⅳ级）5例（12．1%）、肌萎缩3例（7．3%）。神经电生理改变为F波、H反射潜伏期延长，F波的出现率下降；神经电位波幅降低；不同程度运动感觉神经传导速度减慢及末端潜伏期延长。结论MS是一种以CNS受损为主的脱髓鞘疾病，部分患者可以同时累及PNS，神经电生理检测可对周围神经损害进行定位，同时可定量反映周围神经病变的程度。     

多发性肌炎、皮肌炎患者的肌电图研究

目的探讨肌电图（EMG）、神经传导速度（NCV）的检测对提高多发性肌炎、皮肌炎的诊断价值。方法对30例多发性肌炎、皮肌炎患者肌电图检查中自发电活动,MUP时限、波幅及多相波,最大随意收缩时的募集形式,以及NCV检查进行分析。结果30例中25例EMG示肌原性损害,同时有5例出现NCV的轻度减慢（16．6％）、3例（10．0％）NCV远端潜伏期延长。结论EMG、NCV测定是诊断多发性肌炎和皮肌炎的有价值的电生理检测方法。     

尿毒症患者周围神经的电生理研究

目的研究尿毒症患者周围神经的电生理表现。方法选择尿毒症患者24 例及同期健康对照者19 例,采用常规表面电极对胫后神经、腓总神经、腓肠神经及皮肤交感反应进行检查,观察尿毒症患者周围神经的电生理表现。结果两组运动传导、感觉传导及交感皮肤反应潜伏期均有显著性差异(P<0.05)。电生理表现主要为F 波的潜伏期延长,传导速度减慢,潜伏期延长,感觉纤维受累重于运动纤维。结论尿毒症性周围神经病是尿毒症最常见的并发症之一,神经电生理的异常明显早于临床症状,周围神经的电生理检查对该病的诊断及评价具有重要意义。     

正中神经压迫试验对腕管综合征神经传导速度的影响

目的比较正中神经压迫试验对腕管综合征（carpal tunnel syndrome,CTS）患者正中神经传导速度的影响。方法设置CTS组和对照组两个组别,共29例受试者纳入研究。CTS组为14例CTS患者,对照组为15例健康受试者。神经传导速度测定包括正中神经和尺神经的感觉传导末端潜伏期（distal sensory latency,DSL）、感觉神经动作电位（sensory nerve action potential,SNAP）、跨腕关节感觉传导速度（sensory conduction velocity,SCV）、运动传导末端潜伏期（distal motor latency,DML）及复合肌肉动作电位（compound muscle action potential,CMAP）。先测感觉传导,再测运动传导。正中神经压迫试验5min后再次测量上述指标。结果正中神经压迫试验前后电生理检查考虑诊断CTS分别为22侧和24侧。压迫正中神经后,CTS组正中神经DSL较压迫前显著延长（P〈0.05）。CTS组尺神经和对照组正中神经及尺神经的各参数在压迫前后均无显著改变（P〉0.05）。与对照组相比,在压迫试验前后CTS组的正中神经DSL和DML均明显延长（P〈0.05）,尺神经DSL和DML均无显著改变（P〉0.05）。结论正中神经压迫试验5min能使CTS患者正中神经的感觉传导末端潜伏时明显延长,有助于提高神经传导测定对早期CTS的诊断率。     

持续性腹膜透析和血液透析对慢性肾功能衰竭多发性神经病转归的影响

目的通过电生理测试结果评估持续腹膜透析（PD）或血液透析（HD）的慢性肾功能衰竭患者周围神经病的发生率,并根据残余肾功能判断透析方式对周围神经功能的影响。方法将131例慢性肾功能衰竭患者按透析方式分为HD组（n=73）和PD组（n=58）。根据透析治疗期间肌电图的结果分别将HD组、PD组各分为MN亚组和非MN亚组。采用德国Medelec Shaphire 2MED仪对每例患者的正中神经、尺神经、腓总神经和胫神经的神经传导速度（NCV）进行电生理测定,感觉神经检测包括波幅、潜伏期和传导速度;运动神经检测则包括复合肌肉动作电位的波幅、潜伏期和传导速度。电生理检测发现至少2条神经异常结果可诊断为多发性神经病。在透析开始后的第1、6、12、18、24月检测每位患者的残余肾功能。结果 131例患者中在观察末期有78例存在感觉障碍。78例患者经肌电图检查诊断为MN者77例,其中HD组中MN患者44例（60.3%）,PD组中MN患者33例（56.9%）,2组比较差异无统计学意义（P〉0.05）。透析治疗初期HD组中的MN亚组、非MN亚组,PD组中的MN亚组、非MN亚组对残余肾功能（RRF）变化进行多重比较,差异均无统计学意义（均P〉0.05）。随着透析的进行,第12、24个月2种透析组的MN亚组RRF显著下降（P〈0.05）,非MN亚组RRF比较差异无统计学意义（P〉0.05）。结论 MN在慢性肾衰患者中是常见的并发症,发生率与治疗方法无明显关系;PD或HD治疗不能阻止慢性肾功能衰竭患者周围神经病变的发生。残留肾功能在保护慢性肾功能衰竭患者周围神经功能方面起了重要的作用。     

Electrophysiologic studies of the median nerve and its palmar cutaneous branches after nerve grafting

Electromyography (EMG) and nerve conduction studies were performed on a patient with an incomplete lesion of the median nerve involving the motor fibers to the thenar muscles, the palmar cutaneous branches, and the sensory fibers to the index finger. The studies were done before, and 13 weeks, 16 weeks, and one year after grafting. The preoperative electrodiagnostic evaluation showed abnormalities involving the median motor fibers and the palmar cutaneous branch. Electromyography of the opponens pollicis and abductor pollicis brevis before surgery showed severe active denervation. Thirteen weeks after nerve grafting, the median motor distal latency was prolonged and the amplitude of the evoked potential of the median motor and index finger digital sensory nerves were decreased. At 16 weeks, both the latency and amplitude showed improvement, as did EMG of the affected muscles. One year later, the electrophysiologic findings were normal except for a slightly prolonged median motor distal latency. Clinical and functional improvement after grafting correlated well with the electrophysiologic findings. We conclude that EMG and nerve conduction studies are useful tools for following the progression of recovery after nerve grafting.