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.     

A Meta-analysis of Trials on Aldose Reductase Inhibitors in Diabetic Peripheral Neuropathy

Peripheral neuropathy is one of the most common and disabling long-term seque lae of diabetes mellitus. Aldose reductase inhibitors (ARIs) have been proposed and are increasingly used in many countries for the prevention and treatment of diabetic neuropathy. The aim of this study was to review existing evidence on the effectiveness of ARIs in the treatment of peripheral diabetic neuropathy, with particular reference to the type and clinical relevance of the end point used and to the consistency of results across studies. Thirteen randomized clinical trials (RTCs) comparing ARIs with placebo, published between 1981 and 1993 were included in the meta-analysis. Nerve conduction velocity (NCV) was the only end point reported in all trials. Treatment effect was thus evaluated in terms of NCV mean difference in four different nerves: median motor, median sensory, peroneal motor, and sural sensory. A statistically significant reduction in decline of median motor NCV was present in the treated group as compared to the control group (mean 0.91 ms⁻¹; 95 % CI 0.41–1.42 ms⁻¹). For peroneal motor, median sensory, and sural sensory nerves results did not show any clear benefit for patients treated with ARIs. When the analysis was limited to trials with at least 1-year treatment duration, a significant effect was present for peroneal motor NCV (mean 1.24 ms⁻¹; 95 % CI 0.32–2.15 ms⁻¹) and a benefit of borderline statistical significance was also present for median motor NCV (mean 0.69 ms⁻¹; 95% CI −0.07−1.45 ms⁻¹). A heterogeneous picture emerged when looking at the results of different studies and serious inconsistencies were also present in the direction of treatment effects among nerves in the same studies. Although the results of 1-year treatment on motor NCV seem encouraging, the uncertainty about the reliability of the end-point employed and the short treatment duration do not allow any clear conclusion about the efficacy of ARIs in the treatment of peripheral diabetic neuropathy.     

糖尿病痛性周围神经病的临床及电生理特点分析

目的探讨糖尿病痛性周围神经病（PDPN）的临床和电生理特点。方法严格入选32例PDPN患者,病程〉1年,疼痛视觉模拟评分〉4,未伴有其他内科系统合并症,进行视觉模拟评分（VAS）并记录疼痛性质。电生理检测包括：常规神经传导速度（NCV）、定量感觉检测（温度觉）（QST-t）。结果PDPN往往有客观的感觉异常,但神经系统体征不典型,NCV检测可正常,而QST—t可有异常表现,本组NCV检测13例正常,其中11例QST-t异常;本组NCV异常率为59．4％,QST异常率为87．5％,QST＋NCV异常率为93．7％。VAS与QST的上下肢热痛觉（HP）呈正相关（t=0．595、P=0．009;t=0．784、P=0．004）,与胫神经的感觉神经传导速度（SCV）呈负相关（t=-0．554;P=0．032）;与其它电生理各项参数不相关,与空腹血糖、糖化血红蛋白、病程及疼痛病程不相关。结论PDPN以小纤维受累为主,QST可为早期PDPN提供客观的临床依据;疼痛程度与C类纤维及下肢胫神经感觉纤维病变有一定的相关性。     

肌电电生理诊断糖尿病早期周围神经病变的敏感指标探讨

本文报道了１７１例糖尿病患者通过肌电图电生理检查，测定运动和感觉传导速度及胫神经Ｈ反射的结果，并分析了临床症状，发现糖尿病周围神经病１１６例（６７．８％），其中单纯Ｈ反射异常２７例，神经传导异常兼有或无Ｈ反射异常８９例，提出了诊断糖尿病性周围神经病电生理检查最敏感的指标，并探讨了神经传导与年龄、病程、空腹血糖、果糖胺及ＨｂＡｌｃ之间的相互关系。     

A multicentre trial of the aldose-reductase inhibitor tolrestat, in patients with symptomatic diabetic peripheral neuropathy. North European Tolrestat Study Group.

One hundred and ninety patients with symptomatic diabetic peripheral neuropathy took part in a double blind multicentre trial of either placebo or tolrestat 200 mg once daily for 6 months. Painful and paraesthetic symptoms, vibration sensory threshold, and nerve conduction velocity (NCV) were assessed as efficacy end-points during the trial. There was an equally marked improvement of painful symptoms during the trial in the tolrestat and placebo groups. A difference in the improvement of paraesthetic symptoms was found however in favour of the placebo group at 24 weeks (p less than 0.02). The deterioration in mean vibration threshold of the tolrestat group was less than placebo at 24 weeks at all 3 sites measured, and reached significance at the carpal site (p less than 0.05). Significant improvements in median motor NCV and in the mean NCV of the four motor nerves were also seen in tolrestat treated patients at 24 weeks compared to placebo (p less than 0.05). In addition, significant changes in favour of tolrestat were seen when the number of motor nerves per patient with NCV increased during the trial was analysed (p less than 0.001). Concordance analysis of patients with increased mean motor NCV and improvement in painful symptoms demonstrated a positive effect for tolrestat compared to placebo (p less than 0.02). Mild reversible elevations of hepatic transaminases were seen in a few patients treated with tolrestat, with no other significant adverse effects. Tolrestat may therefore be helpful in diabetic peripheral neuropathy, where there is little opportunity for therapeutic intervention apart from effort to achieve normoglycaemic control.     

糖尿病周围神经病700例临床与神经电生理分析

目的探讨糖尿病周围神经病的临床和电生理特点,明确电生理检查的诊断价值。方法对700患者进行感觉和运动神经传导测定,240例患者进行针极肌电图测定。结果507例(724%)患者电生理检查异常,其中307例(606%)为多发性周围神经病,74例(146%)为腕管综合征;感觉神经传导异常程度重于运动神经,波幅的下降程度较传导速度减慢明显,下肢重于上肢(P<005)。仅有46%的患者针极肌电图异常而神经传导正常。结论糖尿病周围神经病的临床和电生理表现均以感觉神经受损为主;电生理检查有助于发现临床病变,但并非所有患者均能发现电生理异常;建议不将针极肌电图进行糖尿病周围神经病的筛查作为常规使用。     

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332例神经传导速度检测分析

对３３２例糖尿病患者肢体神经传导速度（ＮＣＶ）检测结果及临床情况进行回顾性分析。结果显示：Ⅰ型糖尿病４８例中，ＮＣＶ异常率为７７．１％，略高于Ⅱ型糖尿病２８４例中的６６．２％，总异常率为６７．８％。Ⅱ型糖悄病者病程〉５年组的ＮＣＶ阳性率（７４．５％）高于≤５年组。３３２例共检测神经２５４６条，其中运动神经传导速度（ＭＣＶ）检测异常率（３７．０％）和感觉神经传导速度（ＮＣＶ）经（３５．２％）相似。各     

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.     

2型糖尿病踝肱指数与周围神经病变的关系：427例临床分析

目的探讨2型糖尿病患者踝肱指数与糖尿病周围神经病变（DPN）之间的关系。方法对427例2型糖尿病患者采用多普勒血流探测仪测定踝肱指数（ABI）,并依据ABI分为,周围动脉病变（PAD）组（ABI〈0．9）和非PAD组（ABI≥0．9）,同时检测所有患者胫后感觉神经传导速度（NCV）、潜伏期、振幅,进行组间比较,并对上述指标进行线性相关分析及多元线性回归。结果ABI〈0．9者115例,占26．9％,与非PAD组比较,PAD组周围NCV明显下降【左NCV：（30±8）VS（32±7）m／s,右NCV：（29±6）VS（33±7）m／s,P〈0．01],潜伏期延长[左潜伏期：（8．2±2．0）VS（7．4±1．4）ms,右潜伏期：（8．3±1．7）w（7．4±1．3）ms,P〈0．01],振幅下降[左振幅：（10±12）vs（15±16）mV,右振幅：（9±7）vs（14±13）mV,P〈0．011;相关分析显示,踝肱指数与潜伏期呈负相关、与振幅呈正相关;在调整年龄、病程、体质量指数（BMI）、收缩压、总胆固醇、低密度脂蛋白胆固醇（LDL．C）、血肌酐、NCV和振幅,多元逐步回归提示,ABI与年龄、LDL．C、NCV、BMI相关。结论2型糖尿病患者中,PAD可能是DPN的重要危险因素或影响因素。     

α硫辛酸治疗糖尿病周围神经病变84例临床观察

目的观察α硫辛酸治疗糖尿病周围神经病变的疗效。方法选择126例糖尿病周围神经病变患者,随机分成三组,每组42例。A组给予单用甲钴胺治疗,B组给予单用α硫辛酸治疗,C组给予α硫辛酸和甲钴胺联合治疗,疗程均为2周。观察三组治疗后的临床疗效及神经传导速度（NCV）。结果治疗后三组临床疗效比较,差异有统计学意义（H=12．175,P=0．02）。B组和C组疗效优于A组（P〈0．05）;三组治疗后神经传导速度均显著提高,C组有效率最高,但C组和B组无统计学差异。结论α硫辛酸能有效改善糖尿病周围神经病变的症状和神经传导速度。     

Protective effects of mineralocorticoid receptor blockade against neuropathy in experimental diabetic rats

Aims: Mineralocorticoid receptor (MR) blockade is an effective treatment for hypertension and diabetic nephropathy. There are no data on the effects of MR blockade on diabetic peripheral neuropathy (DPN). The aim of this study was to determine whether MRs are present in the peripheral nerves and to investigate the effectiveness of MR blockade on DPN in streptozotocin (STZ)‐induced diabetic rats. Methods: Expression of MR protein and messenger RNA (mRNA) was examined in the peripheral nerves using Western blot analysis and RT‐PCR. We next studied the effects of the selective MR antagonist eplerenone and the angiotensin II receptor blocker candesartan on motor and sensory nerve conduction velocity (NCV), morphometric changes and cyclooxygenase‐2 (COX‐2) gene and NF‐κB protein expression in the peripheral nerves of STZ‐induced diabetic rats. Results: Expression of MR protein and mRNA in peripheral nerves was equal to that in the kidney. Motor NCV was significantly improved by 8 weeks of treatment with either eplerenone (39.1 ± 1.2 m/s) or candesartan (46.4 ± 6.8 m/s) compared with control diabetic rats (33.7 ± 2.0 m/s) (p < 0.05). Sensory NCV was also improved by treatment with candesartan or eplerenone in diabetic rats. Eplerenone and candesartan caused significant improvement in mean myelin fibre area and mean myelin area compared with control diabetic rats (p < 0.05). COX‐2 mRNA and NF‐κB protein were significantly elevated in the peripheral nerves of diabetic rats compared with control rats, and treatment with eplerenone or candesartan reduced these changes in gene expression (p < 0.05). Conclusion: MR blockade may have neuroprotective effects on DPN.     

Presence of carpal tunnel syndrome in diabetics: Effect of age,sex, diabetes duration and polyneuropathy

Summary Common thought is that diabetic neuropathy is a predisposing factor to entrapment syndromes. Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy; females and old people are most frequently affected (Comi et al., 1978). Prevalence of CTS in diabetics and associated risk factors were studied in 401 patients (208 males and 193 females) with insulin-dependent and non-insulin-dependent diabetes using electrophysiological techniques. Median nerve sensory and motor conduction velocity, ulnar and peroneal nerve motor conduction velocity and sural nerve sensory conduction velocity were investigated in all patients. Diagnostic criteria for CTS were the presence of delayed median nerve sensory conduction velocity in the palm-wrist tract and of increased distal motor latency. Polyneuropathy was defined by slowing-down of conduction velocity in two or more nerves. Forty-five patients (11.2%), 36 females and 9 males, showed CTS. One-hundred-sixty-eight patients (41.8%), 74 females and 94 males, were suffering from peripheral neuropathy. The strongest risk factors for CTS, in order of importance, were: female sex, older age and presence of neuropathy. Polyneuropathy but not CTS was related to duration of diabetes.     

Visual evoked potentials in NIDDM: a longitudinal study

Summary In order to assess the possible progression of neurological abnormalities over time and the value of visual evoked potential alterations in predicting stability and severity of diabetes-related optic pathway disease, a longitudinal study in non-insulin-dependent diabetic patients was performed. Neurological examination, visual evoked potentials with pattern reversal, motor and sensory nerve conduction velocities and metabolic control were studied in 18 non-insulin-dependent diabetic patients and in 35 normal control subjects at baseline and again after 4.6±0.8 years (range 4–6). At the first recording the peak P100 wave latencies were significantly delayed in the diabetic patients compared with the control subjects; signs of peripheral neuropathy were detected in five patients, clinical in three and in two there was only neurophysiological alteration without clinical signs. The second recording revealed no significant alterations of P100 latencies in patients compared with baseline, but the number with clinical signs and/or neurophysiological alterations with no clinical signs of peripheral neurological disease was increased to seven. In conclusion, we observed that visual evoked potential alterations were stable over time whereas peripheral neurological disease progressed and correlated positively with metabolic control.Abbreviations VEP-PR Visual evoked potentials with pattern reversal - NCV nerve conduction velocities - LP100 peak latencies of P100 wave - ILD interocular latencies difference - NIDDM non-insulin-dependent diabetes mellitus - ARI aldose reductase inhibitor     

Neurophysiological study of the effect of combined kidney and pancreas transplantation on diabetic neuropathy: a 2-year follow-up evaluation

Previous study have reported a significant improvement of peripheral neuropathy following combined pancreas and kidney transplantation attributed to improvement of blood glucose control by some authors and to elimination of uraemia by others. To asses the specific role of uraemia and hyperglycaemia in neuropathy, 16 diabetic uraemic patients with combined pancreas and kidney transplantation were compared to 9 diabetic patients with a renal graft only. Neurophysiological studies of peripheral neuropathy included ulnar and deep peroneal nerve motor conduction velocity, median and sural nerve sensory conduction velocity were performed at baseline and 1 and 2 years after transplantation. One year after transplantation mean nerve conduction velocity significantly improved in both groups. However, changes were statistically significant in the kidney-pancreas group only. At the 2 year follow-up nerve conduction velocity had increased further in the pancreas-kidney group only. These data suggest that improvement of nerve conduction velocity following pancreas and kidney transplantation is predominantly due to the long-term euglycaemic state.     

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     

硫辛酸联合甲钴胺用于糖尿病周围神经病变的治疗效果研究

目的分析α-硫辛酸联合甲钴胺用于糖尿病周围神经病变的治疗效果。方法选取该院2017年1月—2019年4月糖尿病周围神经病变患者共102例,数字表随机分两组,每组51例,对照组的患者给予甲钴胺治疗,观察组给予甲钴胺联合硫辛酸治疗。比较两组治疗前后患者神经传导速度中腓总神经运动神经传导测定值、感觉神经传导测定值以及胫神经速度运动神经传导测定值、感觉神经传导测定值、总有效率。结果治疗前两组患者神经传导速度中腓总神经运动神经传导测定值、感觉神经传导测定值以及胫神经速度运动神经传导测定值、感觉神经传导测定值比较,差异无统计学意义(P>0.05)。治疗后两组测定值均加速,差异有统计学意义(t=4.480、3.914、4.194、6.233,P<0.05)。观察组总有效率100.00%高于对照组,差异有统计学意义(χ²=7.799,P<0.05)。结论甲钴胺联合α-硫辛酸对于糖尿病周围神经病变的治疗效果确切,可显著改善患者症状及周围神经功能,是一种有效的治疗方案。     

Cross sectional study to evaluate the effect of duration of type 2 diabetes mellitus on the nerve conduction velocity in diabetic peripheral neuropathy

ObjectiveTo study the nerve conduction velocity in clinically undetectable and detectable peripheral neuropathy in type 2 diabetes mellitus with variable duration.Material and methodsThis cross sectional study was conducted in diagnosed type 2 diabetes mellitus patients. They were divided in groups: Group I (n = 37) with clinically detectable diabetic peripheral neuropathy of shorter duration and Group II (n = 27) with clinically detectable diabetic peripheral neuropathy of longer duration. They were compared with T2DM patients (n = 22) without clinical neuropathy. Clinical diagnosis was based on neuropathy symptom score (NSS) and neuropathy disability score (NDS) for signs. Nerve conduction velocity was measured in both upper and lower limbs. Median, ulnar, common peroneal and posterior tibial nerves were selected for motor nerve conduction study and median and sural nerves were selected for sensory nerve conduction study.ResultsThe comparisons were done between nerve conduction velocities of motor and sensory nerves in patients of clinically detectable neuropathy and patients without neuropathy in type 2 diabetes mellitus population. This study showed significant electrophysiological changes with duration of disease. Nerve conduction velocities in lower limbs were significantly reduced even in patients of shorter duration with normal upper limb nerve conduction velocities.ConclusionDiabetic neuropathy symptom score (NSS) and neuropathy disability score (NDS) can help in evaluation of diabetic sensorimotor polyneuropathy though nerve conduction study is more powerful test and can help in diagnosing cases of neuropathy.     

Insulin resistance occurs in parallel with sensory neuropathy in streptozotocin-induced diabetes in rats: differential response to early vs late insulin supplementation

We investigated whether progressive sensory neuropathy was accompanied by changes in whole-body insulin sensitivity (WBIS) in rats made diabetic by streptozotocin (STZ). The effects of early and late insulin supplementation were also studied. The STZ-treated rats failed to gain weight and exhibited stable hyperglycemia and low plasma insulin levels with a decrease in nerve conduction velocity (NCV) measured in A and C fibers of the saphenous nerve. A decreased sensory neuropeptide (SNP) release such as that of substance P, somatostatin, and calcitonin gene-related peptide determined from organ fluid of tracheal preparations subjected to electrical field stimulation also occurred in diabetic animals. These features were accompanied by a decrease in WBIS measured by hyperinsulinemic-euglycemic glucose clamping and a decrease in insulin-stimulated glucose uptake in cardiac and gastrocnemius muscle. When insulin supplementation with slow-release implants (2 IU/d) was started 4 weeks after STZ injection, blood glucose level normalized. Both insulin sensitivity and sensory nerve function reflected in either NCV or SNP release completely recovered by the 12th post-STZ week. When the insulin implants were applied from the eighth post-STZ week, both WBIS and glucose uptake remained significantly decreased, with a seriously impaired NCV and SNP release with strong hyperglycemia. Late insulin supplementation, however, even by using double implantation from the 10th post-STZ week, was unable to restore blood glucose, WBIS, NCV, and SNP release by the 12th week. Insulin resistance occurs in parallel with sensory neuropathy in STZ-diabetic rats. Both can be improved by early but not late insulin supplementation.     

Exercise training can modify the natural history of diabetic peripheral neuropathy

BACKGROUND: Diabetes is the most important cause of peripheral neuropathy (DPN). No definitive treatment for DPN has been established, and very few data on the role of exercise training on DPN have been reported. AIM OF THE STUDY: We sought to examine the effects of long-term exercise training on the development of DPN in both Types 1 and 2 diabetic patients. PARTICIPANTS AND METHODS: Seventy-eight diabetic patients without signs and symptoms of peripheral DPN were enrolled, randomized, and subdivided in two groups: 31 diabetic participants [15 f, 16 m; 49+/-15.5 years old; body mass index (BMI)=27.9+/-4.7], who performed a prescribed and supervised 4 h/week brisk walking on a treadmill at 50% to 85% of the heart rate reserve (exercise group: EXE), and a control group of 47 diabetic participants (CON; 24 f, 23 m; 52.9+/-13.4 years old; BMI=30.9+/-8.4). Vibration perception threshold (VPT), nerve distal latency (DL), nerve conduction velocity (NCV), and nerve action potential amplitude (NAPA) in the lower limbs were measured. RESULTS: We found significant differences on Delta (delta) in NCV for both peroneal and sural motor nerve between the EXE and CON groups during the study period (P<.001, for both). The percentage of diabetic patients that developed motor neuropathy and sensory neuropathy during the 4 years of the study was significantly higher in the CON than the EXE group (17% vs. 0.0%, P<.05, and 29.8% vs. 6.45%, P<.05, respectively). In addition, the percentage of diabetic patients who developed increased VPT (25 V) during the study was significantly higher in the CON than the EXE group (21.3% vs. 12.9%, P<.05). Change on Hallux VPT from baseline to the end of the study was significantly different between the EXE and CON groups (P<.05); no significant change in Malleolus VPT between the two groups occurred. CONCLUSIONS: This study suggests, for the first time, that long-term aerobic exercise training can prevent the onset or modify the natural history of DPN.