交感神经皮肤反应在糖尿病患儿周围神经病早期诊断中的应用

目的探讨交感神经皮肤反应(SSR)在儿童糖尿病周围神经病交感神经纤维病变早期诊断的应用价值。方法对35例1型糖尿病(T1DM)儿童和30例健康儿童四肢分别进行电刺激SSR检测,测量每个肢体的平均起始潜伏期和峰-峰波幅,并比较2组各肢体的SSR起始潜伏期及峰-峰波幅差异。同时对T1DM组儿童进行神经传导速度(NCV)的检测,并对NCV检测异常率与SSR检测异常率进行比较。另外,还对有酮症酸中毒(DKA)史和无DKA史的2组患儿SSR检测异常结果进行比较。结果 T1DM组患儿各肢体SSR起始潜伏期均较健康对照组明显延长(Pa<0.05)。健康对照组30例四肢均可引出SSR波形,T1DM组31例患儿四肢均可引出SSR波形;4例患儿至少有一肢不能引出SSR波形(11.4%),其中2例患儿四肢均未引出SSR波形(5.7%);21例(60%)患儿至少有一肢SSR缺失或起始潜伏期异常,其中15例(71.4%)有DKA史,高于无DKA患儿异常检出率(6例,42.9%),但2组比较无统计学差异。T1DM组患儿NCV检测异常10例(28.6%),较SSR起始潜伏期的检出异常率低,两者比较差异无统计学意义(P>0.05)。结论 SSR检测可早期发现糖尿病周围神经病交感神经小纤维病变,较NCV敏感。

Evaluation of Sympathetic Skin Response for Early Diagnosis in Children with Diabetic Neuropathy

Objective To investigate the value of sympathetic skin response(SSR) for early diagnosis of childhood diabetic neuropathy. Methods Electrical SSR was performed in 35 patients with type 1 diabetes(T1DM) and 30 healthy controls.The onset latency and peak-to-peak amplitude(the baseline peak measurement of the first and second deflections) were measured and compared between 2 groups.Nerve conductive velocity(NCV) were detected in 35 patients with T1DM at the same time.And SSR was also assessed in the patients with or without diabetic ketoacidosis(DKA) history. Results The onset latencies were prolonged significantly in T1DM children compared with the controls(Pa<0.05).All controls and 31 of the diabetic children demonstrated SSR in both feet and hands,but 4 patients(11.4%) had no responses in SSR in one of both feet and hands at least.Twenty-one patients(60%) demonstrated abnormal SSR in one lamb at least.Two patients(5.7%) had no responses in both feet and hands.Fifteen patients with abnormal SSR had DKA history,but there was no significant difference between the patients with or without DKA history(P>0.05).Ten patients(28.6%) demonstrated NCV abnormal.There was no significant difference between the frequency of abnormality by SSR and NCV(P>0.05). Conclusion The SSR can detect the early subcli-nical dysfunction of small sympathetic fibers in diabetes mellitus and is more sensitive than NCV.