甲钴胺治疗糖尿病神经病变的效果观察

目的:探讨甲钴胺治疗糖尿病神经病变的效果.方法:选取102例糖尿病神经病变患者,随机纳入参照组(51例)和观察组(51例).参照组采用常规救治,观察组在参照组的基础上采用甲钴胺救治,对比患者总有效率、神经传导速度.结果:观察组总有效率高于参照组(P<0.05).观察组神经传导速度高于参照组(P<0.05).结论:于糖尿病神经病变患者中,甲钴胺药物治疗方式既可提高总有效率,还可增强神经传导速度,应引起重视.     

Residue dynamics of tebuconazole and quinalphos in immature onion bulb with leaves, mature onion bulb and soil

Residue persistence of tebuconazole and quinalphos in immature onion bulb with leaves (spring onion), mature onion bulb and soil was studied following their spray applications 3 times. The applications were untreated control; tebuconazole @ 187.5 and 375 g a.i. ha⁻¹; quinalphos @ 300 and 600 g a.i. ha⁻¹. Initial residue deposits of tebuconazole in immature onion bulb with leaves from the two treatments were 0.628 and 1.228 mg kg⁻¹. The residues of tebuconazole dissipated with the half-life of 5 and 7.7 days. The safe pre-harvest intervals (PHI) for consumption of immature onion bulb with leaves were 16 and 35 days, respectively. Initial residue deposits of quinalphos in immature onion bulb with leaves from the two treatments were 0.864 and 2.283 mg kg⁻¹. Loss of quinalphos residues from immature onion bulb with leaves was very fast. The residues dissipated with the half-life of 1.7 and 2.6 days and the required PHI was 5 and 11 days, respectively. At harvest mature onion bulbs were free from residues of both tebuconazole and quinalphos.     

Vibration perception thresholds in 279 diabetic patients

Generalised peripheral neuropathy is a well recognised complication of diabetes mellitus and early detection is important in order that morbidity can be reduced by interventional therapy at an early stage. Since nerve conduction studies are not a feasible option in a busy diabetic clinic, an alternative technique of detection, superior to clinical examination, is beneficial. In this study vibration perception thresholds were measured in 279 diabetic outpatients. Seventy-eight patients (28%) had abnormal results but only 35 (13%) had clinical evidence of neuropathy. While nerve conduction studies remain the most sensitive technique to detect nerve dysfunction, vibration perception threshold determination is a useful screening test to detect subclinical peripheral nerve dysfunction in a routine diabetic outpatient clinic.     

足底内侧神经检测在2型糖尿病周围神经病诊断中的价值分析

目的 探讨足底内侧神经检测对糖尿病周围神经病的诊断价值.方法 选取2020年1—7月就诊于大连市中心医院内分泌科,明确诊断2型糖尿病的109例患者为研究对象,应用肌电诱发电位仪对患者胫神经、足底内侧神经、腓肠神经、腓浅神经进行检测.结果 足底内侧神经检出异常率均高于腓肠神经、腓浅神经和胫神经H反射及F波异常率,差异均有...     

糖尿病早期周围神经病变患者神经传导速度及定量感觉检查检测分析

目的 探讨糖尿病早期周围神经病变的神经电生理特点.方法 分别对175例无周围神经损害的糖尿病患者及50例健康人进行神经传导速度(NCV)及末梢感觉定量检查(OST)检测,并将结果进行对比分析.结果 175例糖尿病患者中,NCV异常率为7%(13/175),QST异常率为45%(79/175),两者比较差异有统计学意义(P<0.01).糖尿病患者与健康人比较运动传导速度、感觉传导速度差异无统计学意义(P>0.05);QST阈值中的冷觉、温觉、热痛觉差异有统计学意义(P<0.01).结论 对于糖尿病性周围神经病变QST较NCV的诊断敏感性高,提示其早期以小神经纤维受损更常见.     

Prospective study of cardiac autonomic neuropathy in diabetes mellitus

For assessment of clinical and prognostic values of cardiac autonomic neuropathy, 53 patients with diabetes mellitus were followed-up for five years. Parasympathetic innervation was assessed by recording heart rate variability during deep breathing, Valsalva manoeuvre and lying-to-standing while sympathetic function was evaluated by measuring postural change in systolic blood pressure. During the follow-up period 1 of 23 diabetic patients died in group without signs of cardiac autonomic neuropathy whereas 2 of 13 diabetics and 10 of 17 diabetics deceased in groups with mild and definitive signs of cardiac autonomic neuropathy, respectively. At reinvestigation, the values of tests for parasympathetic impairment worsened or did not change significantly while improvement in these tests was only exceptionally observed in 40 diabetic patients. No significant change in values of test for sympathetic function was documented during the follow-up period suggesting that parasympathetic (vagal) impairment might precede the sympathetic dysfunction during development of autonomic neuropathy in diabetic patients. No correlation was observed between changes in cardiac autonomic neuropathy and alterations in distal somatic neuropathy (assessed by measurement of motor nerve conduction velocity in peroneal nerves) during the prospective study. Definitive cardiac autonomic neuropathy--as one of the late complications of diabetes mellitus--suggests poor prognosis in diabetic patients.     

糖尿病周围神经病变危险因素分析

[目的]探讨糖尿病周围神经病变(DPN)的危险因素。[方法]对714例糖尿病患者作肌电电生理检查,分为糖尿病周围神经病变组与非周围神经病变组,测定了体重指数、血压、血糖、HbAlc、果糖胺、胰岛素、C肽、血脂、尿白蛋白排泄率(UAER)等。对多个危险因素作单因素及Logistic回归模型多因素分析。[结果]单因素分析显示DPN组之年龄、病程、收缩压、空腹及餐后2h血糖、HbAlc、TCho、LDL-C、Lp(a)、UAER水平显著高于非DPN组,餐后2h血C肽水平显著低于非DPN组。多因素分析结果表明年龄、病程、空腹血糖、UAER、TG与DPN呈显著正相关,餐后2h血C肽与DPN呈显著负相关。[结论]年龄、病程、空腹血糖、餐后2h血C肽、UAER、甘油三酯是DPN的危险因素。     

Diabetic peripheral neuropathy: international guidelines for prevention, diagnosis, and treatment

Recently, international guidelines for the diagnosis and management of diabetic polyneuropathy were issued. The aim of this initiative was to develop simple and practical guidelines for general practitioners and hospital physicians in day-to-day practice. Regular assessment of peripheral nerve function can be performed in diabetic patients using simple diagnostic tools. In such a way, patients will become more aware of the risks associated with diabetic neuropathy. Early detection of neuropathy and other risk factors for the development of foot ulcers may lead to avoidance of amputations. The guidelines emphasize foot care education of diabetic patients with or without neuropathy and early referral of patients with ulcerations to specialised outpatient foot clinic.     

空气压力治疗仪辅助治疗糖尿病周围神经病变的研究

目的：观察空气压力治疗仪对糖尿病周围神经病变的疗效。方法：将80例糖尿病周围神经病变患者随机分为实验组和对照组2组,每组40例。2组患者均采用甲钴铵、前列地尔注射液治疗,对实验组加用空气压力治疗仪治疗。观察2组患者治疗后的临床症状、血液流变学及神经传导速度的情况。结果：实验组治疗后临床症状、血液流变学指标及神经传导速度（SCV、MCV）较对照组有明显改善（P〈0.05）。结论：联合空气压力治疗仪对糖尿病周围神经病变的疗效有明显提高。     

利多卡因及穴位电刺激与曲马多在治疗糖尿病神经痛中的疗效比较

目的评估利多卡因和穴位电刺激对糖尿病性神经性疼痛的疗效,探索其临床应用前景。方法 200例糖尿病患者根据所使用治疗方法随机分为4组:对照组(曲马多200mg/天)、利多卡因组(6mg/kg)、穴位电刺激组和利多卡因与穴位电刺激复合治疗组。观察糖尿病神经病变性疼痛的疗效,包括疼痛评分、神经传导功能及副作用等,综合评价上述治疗方法的疗效。结果利多卡因和穴位电刺激都能明显的缓解糖尿病性神经性疼痛(P<0.05),与曲马多相比无明显差异(P>0.05),并且副作用少。利多卡因可同时改善此类患者神经传导功能。结论利多卡因和穴位电刺激是临床上治疗糖尿病性神经痛的一种安全有效的方法之一。     

醛糖还原酶抑制剂对糖尿病周围神经病变的疗效观察

目的观察醛糖还原酶抑制剂依帕司他治疗糖尿病周围神经病变的有效性及安全性，方法临床确诊糖尿病周围神经病变（DNP）的80名患者随机分为试验组和对照组,分别给予依帕司他（50mg,3次/d）和甲钴胺（50mg,3次/d）治疗16周,治疗期间评价患者症状、体征及左侧正中神经、尺神经、腓神经和胫神经感觉神经传导速度（SNCV），结果两组治疗有同等改善,治疗后较治疗前主观症状（分别由治疗前20，35和18，57降至治疗后9，16和11，18）和客观评估（分别由治疗前5，50和5，00降至治疗后3，63和3，95）均有显著性改善,试验组胫后神经（治疗前41，02 m/s升至治疗后47，44m/s）、腓神经（治疗前33，34 m/s升至治疗后41，27m/s）及对照组正中神经（治疗前40，07 m/s升至治疗后46，75 m/s）、胫后神经（治疗前32，34 m/s升至治疗后45，30 m/s）SNCV均有改善（P＜0，05），结论依帕司他治疗糖尿病周围神经病变安全有效。     

α-硫辛酸联合甲钻胺治疗糖尿病外周神经病变的效果观察

目的评价应用α-硫辛酸联合甲钴胺治疗糖尿病外周神经病变的临床效果。方法选取糖尿病外周神经病变患者90例,按随机数字表法分为两组,每组45例,观察组给予α-硫辛酸联合甲钴胺治疗,对照组给予α-硫辛酸治疗,经过3周的药物治疗后观察患者的临床表现与肌电图情况,并进行分析比较。结果观察组的总有效率显著高于对照组[93．3％（42／45）比55．6％（25／45）],差异有统计学意义（P〈0．05）;观察组患者的腓总神经感觉传导速度治疗后显著高于对照组[（49．5±3．2）m／s比（40．2±2．9）m／s],差异有统计学意义（P〈0．05）;正中神经感觉传导速度,正中神经和腓总神经运动传导速度比较差异无统计学意义（P〉0．05）。在药物治疗期间和治疗后,患者均未出现不良反应。结论利用α-硫辛酸联合甲钻胺治疗糖尿病外周神经病变患者,可有效改善患者的临床症状,具有较好的临床效果。     

硫辛酸治疗糖尿病周围神经病变的效果分析

目的分析硫辛酸治疗糖尿病周围神经病变的疗效,探讨其临床适用性。方法选取从2013年1月1日—2014年4月30日于我院接受治疗的43例糖尿病周围神经病变患者作为病例资料,随机分为研究组和对照组两组,对照组采用甲钴胺进行治疗,研究组硫辛酸进行治疗。观察并记录两组患者治疗前后正中神经、胫神经、尺神经的传导速度以及两组患者治疗后的总有效率,并且进行比较。结果治疗后研究组患者正中神经传速为（47.57±4.26）m/s、尺神经为（44.56±2.83）m/s、胫神经为（45.37±3.43）m/s,而对照组正中神经为（43.45±3.18）m/s、尺神经为（40.21±2.16）m/s、胫神经为（41.23±3.19）m/s,两组对比,研究组患者的正中神经、尺神经、胫神经传导速度均明显优于对照组,差异有统计学意义（P〈0.05）;治疗后研究组患者总有效率为83.9%,对照组患者总有效率为41.7%,两组对比,差异具有统计学意义（χ^2=7.6592,P=0.0056）。结论硫辛酸治疗糖尿病周围神经病变的效果良好,适合临床长期推广应用。     

鼠神经生长因子治疗糖尿病周围神经病变50例临床观察

目的观察鼠神经生艮因子治疗糖尿病周围神经病变的疗效及安全性。方法将98例糖尿病周围神经病变患者随机分为两组,对照组48例给予糖尿病教育,控制饮食,用胰岛素或口服降糖药控制血糖,甲钴胺（弥可保）治疗神经病变;治疗组50例在对照组治疗基础上加用鼠神经生长因子注射液20μg,用2ml注射用水溶解,肌肉注射,每天1次。两组疗程均为30d。两组均在治疗前后分别记录症状及体征,并用肌电图测治疗前后正中神经、胫神经的MNCV及SNCV。结果治疗组总有效率显著高于对照组（P〈0．05）,治疗组各项神经传导速度显著高于对照组（P〈0．05）。结论鼠神经生长因子治疗糖尿病周围神经病变安全有效。     

甲钴胺治疗糖尿病神经病变临床观察

目的探讨甲钴胺对糖尿病神经病变的疗效。方法回顾性分析2004年2月至2006年8月笔者所在医院122例甲钴胺治疗的糖尿病神经病变患者的临床资料。结果注射4周后症状及体征即改善,121服8周后改善更明显;改善率分别为90．8％（下肢自发痛）、87．0％（上肢自发痛）、94．4％（感觉减退）和89．9％（麻木）;在治疗4周后,运动和感觉神经传导速度即已明显提高,并维持至12周;振动觉阈值在治疗4周后虽无明显变化,但在12周时明显下降;心脏自主神经功能测试在治疗4周和12周时无明显改善,仅有7例出现轻微副作用,但无1例因副作用退出治疗。结论甲钴胺是一种治疗糖尿病神经病变安全、有效的药物。     

定量感觉检查在糖尿病周围神经病变早期筛查中的灵敏度和特异度研究

目的 探讨定量感觉检查(QST)在糖尿病周围神经病变早期筛查中的临床意义.方法 分别对100例2型糖尿病患者进行神经传导速度检查和QST,以神经传导速度检查结果阳性为诊断糖尿病周围神经病变的金标准,探讨QST用于早期筛查糖尿病周围神经病变的灵敏度和特异度.结果 100例2型糖尿病患者中.神经传导速度检查结果阳性者41例,阴性者59例;同时QST阳性者74例,阴性者26例.QST用于早期筛查糖尿病周围神经病变的灵敏度为97.56%(40/41),特异度为42.37%(25/59).结论 QST在糖尿病周围神经病变的早期筛查中灵敏度较高,但特异度较低,可作为常规肌电图的补充检查.

Abstract：

Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography.     

血浆C肽水平变化早期预测2型糖尿病并发周围感觉神经病变的价值

目的 探讨血浆C肽水平变化早期预测2型糖尿病并发周围感觉神经病变的价值.方法 500例2型糖尿病予以震动觉、痛觉、温度觉、触压觉、踝反射检测,根据周围感觉神经检测结果分为四组：正常组（159例）、轻度异常组（120例）、中度异常组（121例）、重度异常组（100例）.同时测定其空腹和餐后2h血浆C肽,并与周围感觉神经变化进行分析.制作受试者工作特征（ROC）曲线,找出诊断糖尿病周围感觉神经病变的最佳临界点.结果 四组空腹血浆C肽比较差异无统计学意义（F=1.632,P＞ 0.05）.餐后2h血浆C肽从正常组到轻度异常组再到中度异常组逐渐增高[（1.110±0.526）、（1.324±0.490）、（1.573±0.716） μg/L],而到重度异常组[（0.910±0.465）μg/L]明显下降且低于正常组,差异均有统计学意义（P＜0.05）.当餐后2h血浆C肽为1.173 μg/L时,得到最大约登指数0.366.结论 糖尿病并发周围感觉神经病变的早期可能与空腹C肽水平变化关系不大,而与餐后2h血浆C肽水平变化有关.动态观察餐后2h血浆C肽水平变化可能有助于早期发现糖尿病周围感觉神经病变.     

前列地尔联合硫辛酸治疗糖尿病周围神经病变疗效观察

目的：分析糖尿病周围神经病变患者采用硫辛酸与前列地尔联合进行治疗的临床效果。方法：按照随机数字表法抽取本院2010—2012年收治的100例糖尿病周围神经病变患者,分成观察组与对照组,每组50例。对照组在常规治疗基础上采用前列地尔治疗,观察组在常规治疗上采用硫辛酸联合前列地尔进行治疗。比较两组的治疗结果。结果：观察组患者总有效为86％,对照组患者总有效率为60％,两组比较差异有统计学意义（P〈0．05）;治疗后观察组患者感觉神经传导速度（SNCV）、运动神经传导速度（MNCV）等改善情况较为明显,与对照组比较差异均有统计学意义（P〈0．05）。结论：糖尿病周围神经病变患者采用硫辛酸与前列地尔联合进行临床治疗,临床效果确切,值得推广。     

丹参川芎嗪注射液联合甲钴胺治疗2型糖尿病周围神经病变的临床分析

目的 观察丹参川芎嗪注射液联合甲钴胺治疗2型糖尿病周围神经病变的临床疗效.方法 112例2型糖尿病周围神经病变患者按随机数字表法分为两组,对照组56例采用甲钴胺治疗,观察组56例在对照组基础上加用丹参川芎嗪注射液治疗,比较两组的临床疗效及腓总神经、胫神经运动神经传导速度(MNCV)和感觉神经传导速度(SNCV)的变化.结果 观察组总有效率为87.5％(49/56),明显高于对照组的57.1％(32/56),差异有统计学意义(P＜0.05).观察组治疗后腓总神经、胫神经MNCV和SNCV分别为(47.89±6.93)、(49.12±5.54) m/s和(43.69±4.97)、(42.35±5.14) m/s,与治疗前比较明显升高(P＜0.05),而对照组分别为(41.15±4.36)、( 39.89±3.67) m/s和(37.57±3.08)、(36.56±2.81) m/s,与治疗前比较差异无统计学意义(P＞0.05).并且,观察组治疗后腓总神经、胫神经MNCV和SNCV均明显高于对照组,差异有统计学意义(P＜0.05).结论 丹参川芎嗪注射液联合甲钴胺治疗2型糖尿病周围神经病变,能够明显提高临床疗效,改善患者的神经功能状态,值得临床推广应用.     

Correlation between vibratory detection threshold and conduction study of sural nerve in diabetic patients

Vibratory detection threshold (VDT) was determined on the plantar side of the distal phalanx of the right great toe of 22 diabetic (NIDDM) patients. In addition, a neurological examination and a sural nerve conduction study were performed. Peripheral neuropathy, based on our criteria, was found in 41% of the patients. VDT was abnormally high in 23% of the patients. The combined frequency of the abnormality of the amplitude of the action potential of the sural nerve or the conduction velocity or both was 73%. The nerve conduction study showed the highest sensitivity in detecting the abnormality of the peripheral nerve in this study; this is in agreement with the result shown in the literature. Seven patients showed no response to electrical stimulation of the sural nerve, although VDT was obtained in these patients. Among the 6 patients that underwent the normal sural nerve conduction study, no one showed abnormally high VDT. The determination of VDT seems to be a useful examination for the follow-up study of diabetic neuropathy, although it is less sensitive than the sural nerve conduction study.