Vibratory and cooling detection thresholds in diabetes mellitus

Vibratory and cooling detection thresholds (VDT and CDT) were determined at both the palmar aspect of the distal phalanx of the right index finger (upper limb) and the plantar aspect of the distal phalanx of the right great toe (lower limb) in 53 consecutive patients with diabetes mellitus (NIDDM), in order to analyze the frequency of the abnormality of each threshold and the relationship between each threshold and the clinical or laboratory findings. VDT in the lower limb was statistically correlated with age, duration of diabetes mellitus, and blood urea nitrogen value of each patient, but not with fasting blood glucose and hemoglobin A1C levels. VDT in the lower limb was significantly greater in the groups of patients with each of the subjective sensory disturbances, peripheral neuropathy (based on our criteria), retinopathy, and proteinuria. Forty-seven per cent of the patients showed clinically peripheral neuropathy, and the frequencies of the abnormality of VDT, CDT and VDT or CDT were 34, 26 and 45%, respectively. VDT and CDT reflect the abnormality of different populations of the peripheral nerve fibers and seem to be affected separately. The determination of both VDT and CDT is useful for the evaluation of the neuropathic state of diabetic patients.     

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...     

Tocotrienol-Rich Vitamin E (Tocovid) Improved Nerve Conduction Velocity in Type 2 Diabetes Mellitus Patients in a Phase II Double-Blind,Randomized Controlled Clinical Trial

Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes that affects approximately half of the diabetic population. Up to 53% of DPN patients experience neuropathic pain, which leads to a reduction in the quality of life and work productivity. Tocotrienols have been shown to possess antioxidant, anti-inflammatory, and neuroprotective properties in preclinical and clinical studies. This study aimed to investigate the effects of tocotrienol-rich vitamin E (Tocovid Suprabio^TM) on nerve conduction parameters and serum biomarkers among patients with type 2 diabetes mellitus (T2DM). A total of 88 patients were randomized to receive 200 mg of Tocovid twice daily, or a matching placebo for 12 months. Fasting blood samples were collected for measurements of HbA1c, renal profile, lipid profile, and biomarkers. A nerve conduction study (NCS) was performed on all patients at baseline and subsequently at 2, 6, 12 months. Patients were reassessed after 6 months of washout. After 12 months of supplementation, patients in the Tocovid group exhibited highly significant improvements in conduction velocity (CV) of both median and sural sensory nerves as compared to those in the placebo group. The between-intervention-group differences (treatment effects) in CV were 1.60 m/s (95% CI: 0.70, 2.40) for the median nerve and 2.10 m/s (95% CI: 1.50, 2.90) for the sural nerve. A significant difference in peak velocity (PV) was also observed in the sural nerve (2.10 m/s; 95% CI: 1.00, 3.20) after 12 months. Significant improvements in CV were only observed up to 6 months in the tibial motor nerve, 1.30 m/s (95% CI: 0.60, 2.20). There were no significant changes in serum biomarkers, transforming growth factor beta-1 (TGFβ-1), or vascular endothelial growth factor A (VEGF-A). After 6 months of washout, there were no significant differences from baseline between groups in nerve conduction parameters of all three nerves. Tocovid at 400 mg/day significantly improve tibial motor nerve CV up to 6 months, but median and sural sensory nerve CV in up to 12 months of supplementation. All improvements diminished after 6 months of washout.     

皮肤交感反应和标准电生理方法评价早期糖尿病性周围神经病的敏感性研究

目的比较皮肤交感反应(SSRs)和标准电生理方法对诊断糖尿病性周围神经病的敏感性。方法选择76例2型糖尿病患者和23例健康对照者,进行SSRs和标准电生理方法(神经传导速度、F波、H反射)检测。结果(1)SSRs的异常率为76.3%,标准电生理方法总的异常率为84.2%。(2)SSRs异常的患者中,有7例标准电生理方法各指标在正常范围内。(3)SSRs结合标准电生理方法对糖尿病性周围神经病发现率为93.4%(。4)血糖控制差的患者周围神经病变的范围更广、程度更重。结论SSRs和标准电生理方法是检测糖尿病性周围神经病非常敏感的手段,SSRs可以早期检测出标准电生理方法尚不能发现的病变。两者结合可尽早发现临床或亚临床糖尿病性周围神经病,有效预防伤残发生。     

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.     

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.     

Electrophysiology and nerve biopsy in men exposed to lead

ABSTRACT Twenty lead-exposed men were selected on the basis of a maximum level of lead in the blood of 70-140 μg/100 ml within the past year. There was no clinical evidence of neuropathy attributable to lead and haemoglobin levels were normal. In individuals, maximum motor and sensory conduction and the amplitude of the evoked potentials were normal or borderline in the median, peroneal and sural nerves, except in the distal portion of the deep peroneal nerve. In this nerve, motor conduction was slowed because of compression by metal-lined safety shoes; changes in this segment are not included in the findings. When the average conduction velocity in lead-exposed men was compared with the average in nerves of controls matched for age, distal motor latency was slightly prolonged in the median nerve. The average latency for proximal muscle supplied by the peroneal nerve was prolonged, and the maximum motor conduction velocity was slowed in the median nerve from elbow to wrist (0·01 > p <0·001). In addition, the average maximum sensory conduction was slightly slowed along the distal and intermediate portion of the superficial peroneal and sural nerves (p <0·001). The average minimum sensory conduction velocities were normal, as were the average amplitudes of the evoked muscle action potentials and the average ratio of amplitude of the muscle action potential evoked by stimuli at a proximal and a distal nerve site. The average amplitude of the sensory potentials recorded in the median and the superficial peroneal nerves tended to be increased. Electromyography of the abductor pollicis brevis and anterior tibial muscles showed that the only abnormality was an increased incidence of polyphasic potentials in the anterior tibial muscle of seven men. Neither the slowing in conduction nor the histological findings in the sural nerves of eight men were related to the level of lead in the blood. The slight slowing in conduction suggests a minor defect in the excitable membrane of the nerve fibre: it was not attributable to histological abnormalities in the sural nerve, in which the number of myelinated and unmyelinated nerve fibres was normal and demyelination was absent. In teased fibres, those with paranodal remyelination were slightly increased, and few fibres had segments with diminished diameter. The mechanism of the defect causing the slight slowing in conduction in lead-exposed men seems to differ from the lesion in patients with clinical evidence of lead neuropathy, which is axonal in type. It is, therefore, doubtful whether the slight slowing in the nerves of the group of lead-exposed men should be classified as a subclinical neuropathy.     

Association between chronic exposure to arsenic and slow nerve conduction velocity among adolescents in Taiwan

The association between chronic exposure to arsenic and peripheral neuropathy has been controversial in previous studies, which may be due to the influence of factors, such as age, gender, chronic diseases, occupational injuries, and arsenic exposure. To clarify the question of this association, a cross-sectional study was designed. In total, 130 junior high school students aged 12-14 years were included and examined for the motor and sensory nerve conduction velocity of peripheral nerves in their right-upper and lower limbs. Concentrations of arsenic in well-water and history of drinking well-water were retrieved from a baseline database created in 1991. After adjustment for gender and height, a significant odds ratio of 2.9 (95% confidence interval [CI] 1.1-7.5) was observed for the development of slow nerve conduction velocity of the sural sensory action potential (SAP) among the study subjects with a cumulative arsenic dosage of>100.0 mg. In addition, a borderline statistical significance with odds ratio of 7.8 (95% CI 1.001-69.5) for the development of slow nerve conduction velocity of sural SAP was also observed among the study subjects who drank well-water containing arsenic concentrations of >50.0 microg/L and with a cumulative arsenic dosage of >100.0 mg. The study found that chronic exposure to arsenic might induce peripheral neuropathy. It also found that the slowing of the nerve conduction velocity of sural SAP might be an early marker of chronic arsenic neuropathy.     

Hypertrophic neuropathy with diabetes mellitus

A 52-year-old male with diabetes mellitus showed sensorimotor disturbance of symmetrical glove and stocking distribution. Electromyography demonstrated signs of denervation, and motor nerve conduction velocities could not be obtained because the muscle action potential was not evoked by the electrical stimulation of the nerves. Quantitative histologic and ultrastructual studies were performed in the sural nerve biopsy. Determination of fiber densities revealed a striking decrease of both myelinated and unmyelinated fibers and remarkable increase of the onion bulb formations. Hypertrophic changes with onion bulb formations have been observed in various clinical conditions, particularly in hereditary disorders, but uncommon in diabetic neuropathy. Our case was non-familial and may form one atypical type of diabetic neuropathy.     

TOCP对作业工人周围神经损害的神经电生理研究

对50名磷酸三邻甲苯酯(TOCP)作业工人及5名TOCP迟发性神经病患者进行系统的神经电生理检查。结果表明,TOCP主要影响周围神经远端,导致肌电图异常和远端感觉、运动神经传导速度减慢,而H反射和重复电刺激无显著变化。研究结果提示,神经肌电图检查对于早期发现和诊断TOCP作业工人的周围神经损害有重要意义。     

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.     

Correlations between cardiorespiratory reflex impairment and distal neuropathy in diabetics free of clinical symptoms of autonomic neuropathy

Signs of autonomic cardiac neuropathy and its association with distal symmetrical polyneuropathy were investigated in adult diabetic patients free from clinical symptoms of autonomic neuropathy. Cardiorespiratory reflexes were assessed by non-invasive tests (deep-breathing, Valsalva manoeuvre and lying-to-standing) evaluating parasympathetic function of cardiac innervation. Measurement of motor nerve conduction velocity in both peroneal nerves and neurological physical examination were carried out for assessment of distal somatic neuropathy. Among 64 diabetics, definitive signs of cardiac autonomic neuropathy were found in 28 patients (44%), early signs of cardiac autonomic neuropathy were observed in 19 patients (30%) while no alterations were documented in 17 patients (26%). The values of motor nerve conduction velocity in peroneal nerves (41.8 +/- 0.7 m/s) were significantly (p less than 0.01) lower in patients with definitive cardiac autonomic neuropathy (n = 28) than those (45.8 +/- 1.1 m/s) of patients without any signs of cardiac autonomic neuropathy (n = 17). These latter values were, however, significantly (p less than 0.001) lower than those (53.7 +/- 0.7 m/s) of control subjects (n = 50). Abnormal results of non-invasive tests for autonomic neuropathy, i.e. alterations of cardiorespiratory reflexes indicating parasympathetic impairment in cardiac innervation could be often found in diabetics without clinical signs of autonomic neuropathy. These alterations could be frequently observed in diabetics with distal symmetrical neuropathy as well as in diabetic patients with one or more late specific complications.     

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。     

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。     

Occupational exposure to pesticides and nerve conduction studies among Korean farmers

This study aimed to determine whether occupational exposure to pesticides was associated with decreased nerve conduction studies among farmers. On 2 separate occasions, the authors performed a cross-sectional study of a group of 31 male farmers who periodically applied pesticides. The study included questionnaire interviews and nerve conduction studies on the median, ulnar, posterior tibial, peroneal, and sural nerves. Although all mean values remained within laboratory normal limits, significant differences between the first and second tests were found in sensory conduction velocities on the median and sural nerves, and motor conduction velocities on the posterior tibial nerve. Lifetime days of pesticide application was negatively associated with nerve conduction velocities at most nerves after adjusting for potential confounders. These findings may reflect a link between occupational pesticide exposure and peripheral neurophysiologic abnormality that deserves further evaluation.     

Combined electroneurographic and electromyographic studies in lead workers.

OBJECTIVES--To evaluate the effects of chronic exposure to lead on the peripheral nervous system in lead workers. METHODS--Nerve conduction velocity and electromyographic studies were performed on 31 lead workers of a battery recycling factory and 31 sex and age matched controls. 25 cases with mild distal extensor weakness of the upper limbs were classified as the lead neuropathy subgroup and the rest of the lead workers as the lead exposure subgroup. Blood lead concentrations and haematological and biochemical data were recorded. An index of cumulative exposure to lead was calculated by the summation of multiplying the average blood concentration of lead with the duration of exposure at various jobs. RESULTS--Compared with the control group, the distal motor latency of the median nerve was significantly prolonged in the lead neuropathy subgroup, but not in the exposure subgroup. Only six of 31 workers had nerve conduction abnormalities, whereas electromyographic evidence of denervation was found in 93.5% of the lead neuropathy subgroup and 83.5% in the lead exposure subgroup. The electromyographic abnormalities found were neurogenic polyphasic waves in all 29 workers with abnormal electromyographic findings (grade in seven cases and grade ++ in the rest). Spontaneous activity was only recorded in seven workers, with grade + in four and grade ++ in three. There was a positive linear correlation between the index of cumulative exposure to lead and the distal motor latencies of the tibial nerve as well as a negative correlation with conduction velocities of the sural nerve after multivariate analysis and control of potential confounding by age and sex. No correlation could be found between the electrophysiological values and a simple duration of exposure or concentration of blood lead. A non-parametric analysis showed that there was a trend of higher index of cumulative exposure to lead with more severe electromyographic changes. Electromyographic abnormality also occurred in workers with blood lead concentrations between 17.4 and 58 micrograms/dl. CONCLUSION--Electromyographic study in the distal extensors of the upper limbs may be used as a tool for biological monitoring of effect in lead workers.     

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。     

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。     

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.     

波动性高血糖对2型糖尿病患者周围神经病变的影响

目的探讨血糖波动对2型糖尿病周围神经病变的影响。方法对202例2型糖尿病患者进行Michigan糖尿病神经病变症状评分、体征评分和神经电生理检测,根据血糖变异系数分为持续性高血糖组和波动性高血糖组,分析不同糖化血红蛋白(HbA1C)水平时两组周围神经病变发生情况和严重程度。结果 HbA1C≥9%时,波动性高血糖组神经病变发生率(44.9%)、Michigan糖尿病神经病变症状评分(2.42±2.38)和体征评分(1.76±1.45)均高于持续性高血糖组(分别为30.4%,0.60±0.83,0.80±1.39),差别有统计学意义(P0.05);腓总感觉神经传导速度[左侧(50.91±5.14)m/s,右侧(51.38±5.98)m/s]和腓总运动神经传导速度[左侧(45.72±4.53)m/s,右侧(44.90±3.56)m/s]低于持续性高血糖组[分别为左侧(54.13±5.82)m/s,右侧(54.43±5.27)m/s和左侧(47.17±3.66)m/s,右侧(47.40±3.57)m/s],差别有统计学意义(P0.05)。结论波动性高血糖增加2型糖尿病患者周围神经病变的发生率和严重性。