糖尿病周围神经病122例电生理分析

目的探讨分析糖尿病周围神经并的电生理特征与临床价值。方法该研究中将2014年10月—2015年10月区间内,该院住院部确诊并收治的糖尿病周围神经病患者共计122例作为研究对象,对患者临床资料进行回顾分析。应用牛津公司提供Synergy肌电图、诱发电位仪进行检测。对该组122例患者电生理检测的异常情况进行观察并分析。观察指标包括感觉神经异常情况、运动神经异常情况,上肢异常情况、以及下肢异常情况。结果电生理检出异常情况方面:122例患者中,经电生理检查有117例(95.90%)患者出现异常征象,5例(4.10%)患者未见异常征象。有异常征象的例患者中:感觉神经异常率为81.20%(95/117),运动神经异常率为36.75%(43/117);上肢神经异常率为77.78%(91/117),下肢神经异常率为47.86%(56/117)。糖尿病周围神经病患者感觉神经异常率明显高于运动神经异常率,下肢神经异常率明显高于上肢神经异常率,组间数据对比可见差异有统计学意义(P0.05)。结论在电生理检测技术不断发展、完善的背景下,其对糖尿病周围神经病的早期诊断价值得以凸显,可作为判定病变、确定病变范围、病变程度的重要手段,在临床中进一步推广应用。     

神经电生理检测在糖尿病周围神经病变患者的早期诊断意义

糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)是糖尿病(DM)最常见的慢性并发症之一,大多数患者在病变早期并没有主观感觉症状,起病隐匿,且临床表现多样无特异性[1],早期诊断非常棘手.随着近年来临床神经电生理检测技术的不断发展,神经肌电图检测在临床的应用也日益广泛.本文回顾性分析DM患者的临床症状和神经电生理检测诊断结果,旨在探讨神经电生理检测在DPN诊断中的应用价值.     

2型糖尿病住院患者糖化血红蛋白与果糖胺及空腹血糖的相关分析

目的分析住院T2DM患者HbA1c水平与FPG和果糖胺(FRU)之间的相关性。方法选取432例住院T2DM患者,按HbA1c水平分为<6.5%、6.5%～7.5%和>7.5%3组。分析各组HbA1c与FPG、FRU之间的相关性。结果 HbA1c<6.5%组,HbA1c与FPG和FRU之间无相关性(r=0.254,P=0.108;r=-0.032,P=0.884),TG与HbA1c呈正相关(r=0.342,P=0.031);6.5%～7.5%组,HbA1c与FPG和FRU之间无相关性(r=0.153,P=0.151;r=0.167,P=0.132),WHR与HbA1c呈正相关(r=0.230,P=0.035);>7.5%组,HbA1c与FPG和FRU呈正相关(r=0.522,P=0.000;r=0.770,P=0.000)。各年龄段患者(<65岁,65～80岁,>80岁)HbA1c与FPG和FRU之间均呈正相关(r=0.2193～0.2921,P<0.01;r=0.6525～0.7436,P<0.01)。结论住院的HbA1c<7.5%的T2DM患者,FPG、FRU与HbA1c水平无相关性,三指标间的一致性较差。     

糖化血红蛋白检测在糖尿病诊断中的价值

对120例糖尿病患者(糖尿病组)和50例健康人员(对照组)进行空腹血糖(FPG)和HbA1c,比较两组测定值,并比较糖尿病组不同FPG患者的HbA1c检测值,分析二者的相关性。结果糖尿病组FPG、HbA1c均高于对照组,差异有统计学意义(P<0.05);不同FPG水平的糖尿病患者HbA1c差异有统计学意义(F=12.682,P<0.05),糖尿病组患者HbA1c含量随着FPG的升高而升高,二者呈显著正相关(r=0.428,P<0.05)。结论 HbA1c在糖尿病的诊断和病情判断方面具有重要意义。     

HbA1c检测在糖尿病诊断中的价值

测定68例空腹血糖（FPG）〈6．1mmol／L和糖化血红蛋白（HbA1c）6％-7％就诊者口服75g葡萄糖后2h血糖（2hPG），研究HbA1c对糖耐量受损（IGT）的诊断价值。发现IGT患者（2hPG≥7．8mmol／L）与血糖正常者（2hPG〈7．8mmol／L）HbA1c水平无统计学差异（P〉0．05），提示HbA1c对IGT的诊断价值不高。     

糖尿病神经并发症的电生理研究

糖尿病（DM）合并中枢神经系统损害的报道不多。我们对105例DM患者的体感诱发电位（SEP）、感觉神经传导速度（SCV）、运动神经传导速度（MCV）和脑电图（EEG）进行测定,并与正常健康人作一比较。 一、对象:按WHO标准确诊的DM患者105例（男62例,女43例）,平均年龄52岁（18～68岁）。其中Ⅰ型25例,Ⅱ型80例。空腹血糖9.6～25.8mmol/L。神经系统检查:24例末梢型浅感觉障碍,16例深感觉减退。全部病例均无中枢受累的体征。另选健康人40例（男23例,女17例）,平均年龄51岁（28～65岁）,作为对照组。 二、测定方法:SEP,SCV和MCV检查使用DISA-1500型肌电仪。SEP记录极分别置于Erb点及头顶C_3、C_4后2cm处,电刺激为直流方波脉冲,经腕分别刺激双侧正中神经,强度以拇指轻度抖动为准。最后分别测出Erb点波N_9,头顶波P_1、N_1、P_2、N_2、P_3和N_3。SCV     

空腹血糖、果糖胺和糖化血红蛋白联合检测在2型糖尿病患者中的应用

目的探讨空腹血糖（FBG）、果糖胺（GSP）、糖化血红蛋白（HbAlc）三者联合检测在糖尿病患者的诊断中的应用价值。方法收集自2013年6月—2014年1月之间,该院糖尿病专科200例糖尿病患者作为实验组,另选择健康体检者100例作为对照组。分别检测两组的FBG、GSP、HbAlc浓度并进行比较。结果糖尿病组的FBG、GSP、HbAlc浓度均高于对照组,两组差异明显有统计学意义（P〈0.05）。FBG、GSP、HbAlc三者联合检测糖尿病的阳性率明显高于其任意一项单独检测。结论FBG、GSP、HbAlc三者密切相关,分别为糖尿病患者提供即时、近期和长期的血糖信息,三者联合检测在糖尿病患者的早期筛查有着重要的意义。尤其是脆性糖尿病,意义更大。     

慢性酒精中毒性周围神经病患者神经电生理变化的研究

目的 探讨慢性酒精中毒性周围神经病患者神经电生理变化特点.方法 35例酒精中毒性周围神经病患者与35例正常人行肌电图检测后进行统计学分析.结果 观察组的正中神经、尺神经、腓总神经和腓浅神经的神经传导速度(NCV)明显低于对照组.结论 神经电生理检测是本病早期诊断与周围神经受损评价的敏感指标.     

糖尿病周围神经病分型及神经电生理检查研究进展

糖尿病是累及全身多系统和器官的最常见的慢性疾病之一，近年来有年轻化和多发的趋势。糖尿病神经病（DPN）通常指伴有糖尿病的各种周围神经病，其中远端对称性感觉运动性多发性周围神经病最常见。胰岛索依赖型糖尿病（IDM）DPN的主要临床特征为自主神经障碍和疼痛；而非胰岛索依赖型糖尿病（NIDM）DPN为远端感觉障碍和无力。病理改变主要表现为周围神经脱髓鞘和（或）轴索变性，IDM以小纤维为主，而NIDM以大纤维型损害多见。神经电生理检查有助于糖尿病周围神经病的早期诊断和鉴别诊断，现将近年来相关研究进展综述如下。     

维生素D缺乏与糖尿病周围神经病变

糖尿病周围神经病变（DPN）患者中普遍存在维生素D缺乏的现象.1,25（OH）2D3作为维生素D的活性形式,通过与细胞内的维生素D受体（VDR）结合发挥生物学作用.已有研究证明DPN与维生素D缺乏之间具有相关性.维生素D缺乏导致DPN的机制尚不完全清楚,但有资料证实维生素D缺乏可导致神经系统发育障碍、神经损伤及神经变性性疾病,减弱抗炎作用,促进动脉粥样硬化发展,损害胰岛β细胞功能及上调基质金属蛋白酶水平,进一步导致DPN的发生和发展.     

Blood flow patterns in painful diabetic neuropathy

Summary Peripheral blood flow is known to be qualitatively increased in diabetic patients with neuropathy. We have measured the actual blood flow in the feet of diabetic patients with neuropathy using non-invasive mercury strain gauge plethysmography and Doppler sonogram techniques and shown that it is increased on average five times above normal at an ambient temperature of 20 °–22 °C. Moreover, reduction of this high flow by sympathetic arousal stimuli proved possible in those with severe painful neuropathy contrasting strongly with failure to reverse it in those with severe non-painful sensory neuropathy. Reduction of blood flow was associated with reduction in neuropathic pain. We studied 22 diabetic patients with severe sensory neuropathy and eight with painful neuropathy. High resting foot blood flows were demonstrated in both groups with neuropathy. The big toe flow in those with severe sensory neuropathy was 29.3±9.2 ml · min^–1 · 100 ml^–1 (mean±SD) and in the painful neuropathy group, 25.9±7.5, compared with 5.2±2.4ml · min^–1 · 100ml^–1 in the non-diabetic control subjects (p<0.001). High foot skin temperatures were also recorded in the groups with neuropathy, reflecting the high blood flow. The subjects with painful neuropathy retained the ability to constrict peripheral blood vessels in response to arousal stimuli, and reduce peripheral flow on average by 32% compared with the patients with sensory neuropathy who responded on average by only 10%. The demonstration of a peripheral sympathetic defect, responsible for the high blood flow and the potential reversal of such flow in painful neuropathy may be important in our further understanding of the aetiology of such pain and its treatment.     

Electrophysiological measurements of diabetic peripheral neuropathy: A systematic review

Introduction

Peripheral neuropathy is one of the main complications of diabetes mellitus. One of the features of diabetic nerve damage is abnormality of sensory and motor nerve conduction study. An electrophysiological examination can be reproduced and is also a non-invasive approach in the assessment of peripheral nerve function. Population-based and clinical studies have been conducted to validate the sensitivity of these methods. When the diagnosis was based on clinical electrophysiological examination, abnormalities were observed in all patients.

黄芩甙治疗糖尿病周围神经病变的初步观察

目的观察黄芩甙对醛糖还原酶（AR）活性的抑制作用及其对糖尿病神经病变的疗效。方法74例糖尿病患者随机分为黄芩甙治疗组和对照组,治疗组每天服黄芩甙3g。结果黄芩甙治疗后患者红细胞AR活性显著降低（1．29±0．64U／gHbvs2．42±0．85U／gHb,P＜0．01）;黄芩甙缓解神经病变症状总有效率为583％,明显高于对照组（3．3％,P＜0．01）;治疗后黄芩甙组神经传导速度趋于稳定,部分项目略有改善,而对照组则呈进行性恶化趋势,两组腓总神经、胫神经传导速度有显著性差异,分别为31．4±6．1m／svs269±5．3m／s（P＜0．05）和31．8±5．2m／svs26．5±4．8m／s（P＜0．05）,黄芩甙组的腓总神经、医神经末端潜伏期明显绍短,分别为5．00±0．64m／svs5．60±0．56m／s（P＜0．05）和5．10±0．58m／svs5．60±0．57m／s（P＜0．05）,正中神经和尺神经的感觉神经动作电位波幅也显著提高（P＜0．05）。未见明显不良反应及肝肾毒性。结论黄芩甙在体内具有明显的AR活性抑制作用,可有效的缓解糖尿病周围神经病变的临床症状,改善其神经传导速度,从而有助于防止糖尿病神经病变的发生与发展。     

Endoneurial localisation of microvascular damage in human diabetic neuropathy

Summary Twenty diabetic patients with neuropathy underwent clinical and neurophysiological evaluation together with a detailed morphometric assessment of capillary pathology in endoneurial and epineurial microvascular beds of the sural nerve. Morphological data were compared with ten non-diabetic control subjects. There were no significant differences in control subjects between basement membrane area, endothelial cell area, endothelial cell profile number or luminal area of endoneurial when compared with epineurial capillaries. In contrast, when compared with epineurial capillaries, endoneurial capillaries from diabetic patients demonstrated a significant increase in basement membrane (p<0.001) and endothelial cell (p<0.001) area and a significant reduction in luminal area (p<0.001). There was no significant difference in endothelial cell profile number between endoneurial and epineurial capillaries amongst diabetic patients. Previous studies have demonstrated a good correlation between the degree of microangiopathy and measures of neuropathic severity. In the present study increased endoneurial capillary basement membrane area was significantly related to reduced peroneal nerve conduction velocity (p<0.001), myelinated fibre density (p<0.001) and elevated vibration (p<0.05) and thermal (p<0.001) perception. Increased endothelial cell area and reduced luminal size were related to a reduced peroneal nerve conduction (p<0.05, p<0.01, respectively), reduced myelinated fibre density (p<0.05, p<0.01) and elevated thermal perception (p<0.05, p<0.001). Epineurial capillary basement membrane, endothelial cell and luminal area failed to relate to measures of neuropathic severity. This study has demonstrated more advanced microangiopathy and a more significant relationship to neuropathic severity in endoneurial compared with epineurial capillaries, thus providing further support for the role of microangiopathy in the pathogenesis of human diabetic neuropathy.     

欧米诺汗印法对糖尿病周围神经病变的早期诊断意义初探

目的评估泌汗神经功能检测在诊断2型糖尿病(T2DM)患者早期周围神经病变中的价值。方法分别采用DNS评分法和欧米诺汗印法(新型诊断膏贴,Neuropad)对218例T2DM患者进行外周神经病变评估及泌汗神经功能检测,计算欧米诺汗印法、10g单纤丝、振动觉、温度觉及针刺痛觉的单项检查相对于DNS评分法对周围神经病变诊断的灵敏度和特异度。结果糖尿病周围神经病变组欧米诺汗印法变色时间为19·1±8·1min,显著高于糖尿病无神经病变组的8·3±1·8min和对照组的3·9±0·8min(P<0·01);欧米诺汗印法测得的周围神经病变发病率为61·9%略高于DNS测得的57·8%。相对于DNS评分法,欧米诺汗印法诊断周围神经病变的敏感度为92·8%,特异度为82·2%阳性预告值82·6%;单项的10g单纤丝、振动觉、足背部温度觉及痛觉测试的灵敏度分别为69·0%、33·3%、67·4%和57·1%,特异度分别为81·5%、90·2%、80·4%和84·8%。欧米诺汗印法变色时间与DNS评分呈显著正相关(r=0·46,P<0·01),优于其他4种单项检查。结论欧米诺汗印法是一种简易、有重要参考价值的检测方法,其对糖尿病患者足部泌汗功能的检测有助于糖尿病周围神经病变的早期筛查。     

Abnormalities of foot pressure in early diabetic neuropathy

Dynamic foot pressure has been studied in 44 diabetic subjects of mean age 52 years with no clinical evidence of neuropathy and in an age and sex matched non-diabetic control group. Vibration perception threshold (VPT), sensory (SCV), and motor conduction velocities (MCV) were also measured in the diabetic subjects. Sixteen diabetic subjects (Group A) had abnormally high pressures under the metatarsal heads (greater than 10 kg/cm2), whereas the remaining 28 diabetic subjects had normal results (Group B). The ratio of toe to metatarsal head loading (normal 0.112) was significantly reduced in Group A (0.077) compared to Group B (0.127: p less than 0.05). VPT and sural nerve SCV were also significantly abnormal in Group A subjects compared with Group B (p less than 0.005 and p less than 0.02, respectively), though there were no differences in MCV. A significant inverse correlation was obtained between toe loading and VPT. It is concluded that abnormalities of foot pressure occur in early sensory neuropathy and may precede clinical abnormalities. Assessment of the toe-loading ratio may provide a sensitive measure of motor dysfunction in early diabetic neuropathy.     

氧化应激与糖尿病神经病变

氧化应激与糖尿病神经病变的发生、发展密切相关,晚期糖基化终末产物、多元醇通路和蛋白激酶C激活等途径均可增加体内氧化应激反应导致糖尿病神经病变的发生、发展。应用α-硫辛酸,维生素C、E和褪黑素等抗氧化治疗将为糖尿病神经病变的防治提供新的思路。     

糖尿病周围神经病变的诊断方法

糖尿病周围神经病变( DPN)难以治愈,不仅影响患者生活质量,还易造成其足部疼痛、溃疡、截肢等不良后果.现有的DPN诊断方法或对早期病变灵敏度低,如临床评分方法、单丝检测;或为侵入性检查,如皮肤活检、神经活检,亟需灵敏、简单、有效且安全的方法.一些新的诊断技术如泌汗功能检测、足底压力测定、角膜共聚焦显微镜等也已在临床上开始应用.