神经根磁刺激H反射对糖尿病神经根病的诊断作用

目的探讨糖尿病神经根病的诊断及其发病频度。方法经磁刺激骶１神经根以及窝胫神经,比目鱼肌记录二种Ｈ反射,并常规检测胫神经远端感觉、运动神经传导。正常组胫神经８０条,糖尿病组胫神经８２条。用多元回归分析。结果正常人骶１Ｈ反射Ｈ－Ｍ波峰间期（ＨＭＩ）与身高、年龄呈显著正相关;８２条糖尿病胫神经中４０．２％、５３．７％有骶１Ｈ反射ＨＭＩ和波幅,５４．９％、４６．３％有窝磁刺激胫神经Ｈ反射潜伏期和波幅,４０．２％、４０．２％远端感觉传导速度和波幅分别大于或小于９５％正常范围。结论与远端神经病变相比较,糖尿病神经根病和近段神经病具有相当高的发病频度,糖尿病神经病多为广泛多发性周围神经病变

Hoffmann reflex elicited by magnetic stimulation of S1 nerve roots in the diagnosis of diabetic radiculopathy

Objective To determine the incidence of radiculopathy in diabetic patients neurophysiologically.Methods The H reflexes were elicited by magnetic stimulation to S1 nerve root at the first sacral foramen (S1 H reflex) in 40 normal subjects and 41 diabetic patients. The action potentials of the H reflex were recorded from the soleus muscle. For comparison, a popliteal H reflex (stimulated at popliteal fossa), and a regular distal sensory and motor conduction of the tibial nerves were simultaneously evaluated.Results A significant correlation of the peak interval of H wave and M wave (HMI) of the S1 H reflex with body height and age was confirmed by multiple regression analysis in the normal subjects. The simultaneous regression of the HMI adjusted on age and body height produced the formula as 0.02 x (age) 0.03 x (height) 0.92. At 95% normal limits of the significant test, 40.2% HMI and 53.7% amplitude of H waves of the S1 H reflex, 54.9% latency and 46.3% amplitude of H waves of the popliteal H reflex, 40.2% SCV and 40.2% amplitude of sensory action potentials were diagnosed as abnormal.Conclusions A high incidence rate of diabetic radiculopathy was confirmed to be comparable to that of proximal neuropathy and distal symmetrical sensory polyneuropathy. This suggests that diabetic neuropathy may be related to metabolic and/or vascular disorders.